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Savithri Nandeesha S, Kasagga A, Hawrami C, Ricci E, Hailu KT, Salib K, Butt S. Treatment Efficacy of Plasmapheresis Versus Intravenous Immunoglobulin in Guillain-Barré Syndrome Management: A Systematic Review. Cureus 2024; 16:e57066. [PMID: 38681292 PMCID: PMC11052558 DOI: 10.7759/cureus.57066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare and debilitating autoimmune disorder that affects the peripheral nervous system. Although the exact etiology of GBS is still unknown, it is thought to be triggered by a preceding gastrointestinal infection in most of the cases. Clinical manifestations include limb weakness, areflexia, and sensory loss that can further progress to neuromuscular paralysis affecting the respiratory, facial, and bulbar functions. Both plasmapheresis (PE) and intravenous immunoglobulin (IVIG) have shown effectiveness in the treatment of GBS, but it is still unclear which treatment approach is superior in terms of therapeutic efficacy. This systematic review acts per Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. For appropriate studies and research, we searched PubMed, PubMed Central (PMC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Science Direct, and Google Scholar. Screening of articles was performed based on relevance and inclusion and exclusion criteria. To check for bias, we used relevant quality appraisal tools. Initially, we found 2454 articles. After removing duplicates and irrelevant papers, we finalized 31 studies based on titles, abstracts, and reading entire articles. We excluded 14 studies because of poor quality; the remaining 17 papers were included in this review. IVIG is equally efficacious as PE in improving primary outcomes and secondary outcomes. IVIG showed a slight advantage over PE in reducing the need for mechanical ventilation (MV) and hospital stay duration. However, in children, PE demonstrated a slight edge in improving secondary outcomes. PE was associated with a slightly higher risk of adverse events and post-treatment worsening symptoms compared to IVIG. IVIG is considered more user-friendly with a significantly lower patient discontinuation rate than PE. IVIG treatment was found to be significantly more expensive than PE.
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Affiliation(s)
| | - Alousious Kasagga
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chnoor Hawrami
- Pediatric Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Erica Ricci
- Anesthesiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kirubel T Hailu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Afet Speciality Clinic, Addis Ababa, ETH
| | - Korlos Salib
- Internal Medicine, St. Mary El Zaytoun, Cairo, EGY
| | - Samia Butt
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Zaki HA, Iftikhar H, Najam M, Masood M, Al-Marri NDR, Elgassim MAM, Fayed M, Shaban EE. Plasma exchange (PE) versus intravenous immunoglobulin (IVIG) for the treatment of Guillain-Barré syndrome (GBS) in patients with severe symptoms: A systematic review and meta-analysis. eNeurologicalSci 2023; 31:100468. [PMID: 37288440 PMCID: PMC10242495 DOI: 10.1016/j.ensci.2023.100468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023] Open
Abstract
Background and purpose Guillain- Barré syndrome (GBS) is a neuropathic condition that leads to the rapid development of impairments and is characterized by weakness and numbness or tingling sensation in the legs and arms and sometimes loss of movement and feeling in the legs, arms, upper body, and face. Currently, the cure for the disease is yet to be developed. However, treatment options such as intravenous immunoglobulin (IVIG) and plasma exchange (PE) have been used to minimize the symptoms and duration of the disease. Therefore, this systematic review and meta-analysis compared the efficacy of IVIG and PE in treating GBS patients with severe symptoms. Methodology Six electronic databases, including PubMed, Embase, Scopus, ScienceDirect, Medline, and Google scholar, were scoured for articles related and relevant to our research. Additionally, more studies were obtained through the reference lists of the studies retrieved from these electronic databases. Quality assessment and statistical data analysis were conducted using Review Manager software (RevMan 5.4.1). Results The search for relevant articles resulted in 3253 articles, of which only 20 were included for review in the current study. A sub-group analysis indicated no significant difference in the curative effect (Hughes score reduces by at least one score 4 weeks after GBS treatment; OR: 1.00; 95% CI: 0.66-1.52; p = 1.00 and Achieving grade 0 or 1 on Hughes scale; OR: 1.03; 95% CI: 0.27-3.94; p = 0.97). Similarly, the statistical showed that the difference in length of hospitalization and duration of mechanical ventilation was insignificant between the IVIG and PE group (Standard Mean Difference (SMD): -0.45; 95% CI: -0.92, 0.02; I2 = 91%; p = 0.06 and SMD: -0.54; 95% CI: -1.67, 0.59; I2 = 93%; p = 0.35, respectively). Moreover, the meta-analysis did not find any significant difference in the risk of GBS relapse (RR: 0.47; 95% CI: 0.20-1.14; p = 0.10) and risk of complications related to the treatment regimens (RR: 1.03; 95% CI: 0.71-1.48; p = 0.89). However, the statistical analysis of outcomes from 3 studies showed that the risk of discontinuation was significantly lower in the IVIG group than in the PE group (RR: 0.22; 95% CI: 0.06-0.88; p = 0.03). Conclusion Our study suggests that IVIG and PE have similar curative effects. Similarly, IVIG seems easier to use and thus can be preferred for treating GBS.
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Affiliation(s)
- Hany A. Zaki
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Haris Iftikhar
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Mavia Najam
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Maarij Masood
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | | | | | - Mohamed Fayed
- Emergency Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Eman E. Shaban
- Cardiology, Al Jufairi Diagnosis and Treatment, Doha, Qatar
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Pinto AA, De Seze J, Jacob A, Reddel S, Yudina A, Tan K. Comparison of IVIg and TPE efficacy in the treatment of neurological disorders: a systematic literature review. Ther Adv Neurol Disord 2023; 16:17562864231154306. [PMID: 37006460 PMCID: PMC10064470 DOI: 10.1177/17562864231154306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/15/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Intravenous immunoglobulin (IVIg) and therapeutic plasma exchange (TPE) are among the main immunotherapies for neurological disorders. Their benefit is greatest in immune-mediated conditions, but their distinct efficacy cannot be simply explained. Objectives: This review aimed to systematically identify studies comparing the efficacy of TPE and IVIg treatments for selected autoimmune neurological disorders and identify optimal therapies for each condition. Data Sources and Methods: PubMed, MEDLINE and Embase databases were searched for original publications from 1990 to 2021. Additional publications were identified via expert recommendations. Conference abstracts older than 2017, review articles and articles without information on TPE and IVIg comparison in title and abstract were excluded. Risks of bias were descriptively addressed, without a meta-analysis. Results: Forty-four studies were included on Guillain–Barré syndrome (20 studies – 12 adult, 5 paediatric, 3 all ages), myasthenia gravis (11 studies –8 adult, 3 paediatric), chronic immune–mediated polyradiculoneuropathy (3 studies –1 adult, 2 paediatric), encephalitis (1 study in adults), neuromyelitis optica spectrum disorders (5 studies –2 adult, 3 all ages) and other conditions (4 studies – all ages). TPE and IVIg were mostly similarly efficacious, measured by clinical outcomes and disease severity scores. Some studies recommended IVIg as easy to administer. TPE procedures, however, have been simplified and the safety has been improved. TPE is currently recommended for management of neuromyelitis optica spectrum disorder relapses and some myasthenia gravis subtypes, in which rapid removal of autoantibodies is crucial. Conclusion: Despite some limitations (e.g. the low evidence levels), this review provides an extensive 30-year-long overview of treatments for various conditions. Both IVIg and TPE are usually comparably efficacious options for autoimmune neurological disorders, with few exceptions. Treatment choices should be patient-tailored and based on available clinical resources. Better designed studies are needed to provide higher-level quality of evidence regarding clinical efficacy of TPE and IVIg treatments.
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Affiliation(s)
| | - Jerome De Seze
- Department of Neurology, CHU Strasbourg, Strasbourg, France
| | - Anu Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Stephen Reddel
- Department of Neurology, University of Sydney, Sydney, NSW, Australia
| | - Anna Yudina
- Terumo Blood and Cell Technologies, Zaventem, Belgium
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
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Gavrilova N, Kamaeva E, Ignatova M, Ryabkova V, Lukashenko M, Churilov L, Shoenfeld Y. Intravenouse immunoglobuline in dysautonomia. Clin Immunol 2022; 240:109039. [DOI: 10.1016/j.clim.2022.109039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/01/2022] [Accepted: 05/07/2022] [Indexed: 11/03/2022]
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Morales-Ruiz V, Juárez-Vaquera VH, Rosetti-Sciutto M, Sánchez-Muñoz F, Adalid-Peralta L. Efficacy of intravenous immunoglobulin in autoimmune neurological diseases. Literature systematic review and meta-analysis. Autoimmun Rev 2021; 21:103019. [PMID: 34920107 DOI: 10.1016/j.autrev.2021.103019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Corticosteroids are the first-line treatment for several common autoimmune neurological diseases. Other therapeutic approaches, including intravenous immunoglobulin (IVIg) and plasmapheresis, have shown mixed results in patient improvement. OBJECTIVE To compare the efficacy of IVIg administration with that of corticosteroids, plasmapheresis, and placebo in autoimmune neurological diseases like Guillain-Barré syndrome, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, optic neuritis, and multiple sclerosis. METHODS A systematic review was performed on the databases PubMed, MEDLINE, Embase, and Cochrane. Controlled, randomized studies comparing the efficacy of IVIg with placebo, plasmapheresis, and/or glucocorticoid administration were selected. Only studies reporting the number of patients who improved after treatment were included, irrespective of language or publication year. In total, 23 reports were included in the meta-analysis study. RESULTS Our meta-analysis showed a beneficial effect of IVIg administration on patient improvement over placebo (OR = 2.79, CI [95%] = 1.40-5.55, P = 0.01). Meanwhile, IVIg administration showed virtually identical effects to plasmapheresis (OR = 0.83, CI [95%] = 0.45-1.55, P < 0.01). Finally, no significant differences were found in the efficacy of IVIg and glucocorticoid administration (OR = 0.98, Cl [95%] = 0.58-1.68, P = 0.13). CONCLUSION IVIg can be regarded as a viable therapeutic approach, either as a first- or second-line therapy, and as an adjuvant therapy for autoimmune neurological diseases.
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Affiliation(s)
- Valeria Morales-Ruiz
- Unidad Periférica para el Estudio de la Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, Ciudad de México 14269, Mexico; Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Av. Ciudad Universitaria 3000, Coyoacán, Ciudad de México 04510, Mexico
| | - Víctor Hugo Juárez-Vaquera
- Unidad Periférica para el Estudio de la Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, Ciudad de México 14269, Mexico
| | - Marcos Rosetti-Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México-Xochimilco 101, Col. Huipulco, Ciudad de México 14370, Mexico
| | - Fausto Sánchez-Muñoz
- Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Col. Belisario Domínguez Secc. 16, Ciudad de México 14080, Mexico
| | - Laura Adalid-Peralta
- Unidad Periférica para el Estudio de la Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, Ciudad de México 14269, Mexico; Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, Ciudad de México 14269, Mexico.
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Lin J, Gao Q, Xiao K, Tian D, Hu W, Han Z. Efficacy of therapies in the treatment of Guillain-Barre syndrome: A network meta-analysis. Medicine (Baltimore) 2021; 100:e27351. [PMID: 34731107 PMCID: PMC8519256 DOI: 10.1097/md.0000000000027351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is a disease with the features of acuteness, paralysis, inflammation, and in peripheral nerves. There are many current treatment options with varying efficacy, and to assess their effectiveness, we performed a network meta-analysis (NMA). The study protocol was registered at PROSPERO (CRD: 42019119178). Posted history: this manuscript was previously posted to medRxiv: doi: https://doi.org/10.1101/2020.06.03.20121780. METHODS The literature search database includes Web of Science, PubMed, Embase, and the Cochrane library that meets the requirements. We performed the NMA using controlled trials with 2 kinds of outcomes. We used the gemtc R package to perform the NMA to evaluate different GBS treatments' relative results. The consistency of direct and indirect evidence was also assessed by R software with gemtc package. RESULTS This NMA study included a total of 2474 subjects from 28 trials with 15 kinds of therapies. No improvement was observed in methylprednisolone and prednisolone compared with placebo. Conversely, plasma exchange (PE) and intravenous immunoglobulin (IVIg) were more effective than placebo. There was no significant difference between different doses and courses of PE and IVIg. For combination treatment, such as IVIg+eculizumab, immunoadsorption followed by IVIg and PE followed by IVIg, they didn't show significant advantages than IVIg and PE in NMA. On the consistency examination between direct and indirect evidence, there was no apparent heterogeneity between them. Funnel plots indicated there was little possibility of publication bias in this study. CONCLUSION PE or IVIg has significant efficacy for GBS patients. The effects of several kinds of therapies should be further explored. Corticosteroids have no considerable impact on GBS.
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Affiliation(s)
- Jingfeng Lin
- Hangzhou Seventh People's Hospital, Hangzhou, China
| | - Qiang Gao
- Beijing University of Chinese Medicine, Beijing, China
| | - Kang Xiao
- Beijing University of Chinese Medicine, Beijing, China
| | - Danfeng Tian
- Beijing University of Chinese Medicine, Beijing, China
| | - Wenyue Hu
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhenyun Han
- Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang), Shenzhen, China
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Jawaid W, Sana R, Umer SR, Nisa Q, Butt M, Shahbaz N. Relationship between cerebrospinal fluid protein level and electrophysiologic abnormalities in the acute inflammatory demyelinating polyradiculoneuropathy variant of Guillain-Barré syndrome. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2021; 19:Doc12. [PMID: 34539302 PMCID: PMC8422794 DOI: 10.3205/000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/02/2021] [Indexed: 11/30/2022]
Abstract
Objective: Guillain-Barré syndrome (GBS) is an autoimmune disease characterized by weakness in limbs or cranial nerve innervated muscles. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common variant. Electrophysiologic abnormalities and elevated cerebrospinal fluid (CSF) protein are frequently present in AIDP, but the relationship between these two parameters is not well known. We aimed to fill this gap by studying this relationship. Methods: This was a prospective cross-sectional study conducted for two years in the Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan. All 90 adult patients with the AIDP variant of GBS were selected. Nerve conduction studies were performed to determine the degree of demyelination through the four electrophysiologic demyelination criteria. The CSF sample was sent to lab immediately after lumbar puncture. SPSS version 20.0 was used. The CSF protein level was measured with mean ±SD. Demyelination criteria were measured in frequency and percentages. Chi-square test was applied to a number of demyelination criteria and T-test/ANOVA was applied on mean CSF protein level. Results: We found a mean CSF protein of 37.41 mg/dl (±3.69) with one demyelination criterion, 81.87 mg/dl (±17.39) with two demyelination criteria, 119.75 mg/dl (±31.42) with three demyelination criteria, and 134.00 mg/dl (±42.87) with four demyelination criteria (P-value <0.001). Conclusion: This study demonstrates a significant relationship between CSF protein levels and degree of demyelination in the AIDP variant of GBS. This is an under-researched area in GBS and this study adds favorably to limited data in this regard.
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Affiliation(s)
- Wajid Jawaid
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Sana
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
| | - Sumera Rafat Umer
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
| | - Qamar Nisa
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
| | - Mehwish Butt
- Department of Medicine & Allied, Jinnah Medical College Hospital Korangi, Karachi, Pakistan
| | - Naila Shahbaz
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
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Isenmann S. 52/w mit zunehmenden Paresen. DGNEUROLOGIE 2020. [PMCID: PMC7471516 DOI: 10.1007/s42451-020-00231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Isenmann
- Klinik für Neurologie und klinische Neurophysiologie, St. Josef Krankenhaus Moers, Asberger Str. 4, 47441 Moers, Deutschland
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Sejvar JJ. Zika Virus and Other Emerging Arboviral Central Nervous System Infections. Continuum (Minneap Minn) 2019; 24:1512-1534. [PMID: 30273250 DOI: 10.1212/con.0000000000000652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW In recent years, we have observed the emergence and reemergence of a number of arthropod-borne viruses (arboviruses). Zika virus is the most recent addition to this group, first causing sporadic cases of uncomplicated febrile illness followed by sizeable outbreaks in the Pacific. However, the epidemiology and clinical features of Zika virus infection have changed rapidly and dramatically; it is now recognized as causing Guillain-Barré syndrome (GBS) in children and adults and congenital abnormalities in infected fetuses. This article reviews the epidemiology, clinical features, and diagnosis of Zika virus-associated neurologic illness and briefly reviews features of West Nile virus and Japanese encephalitis virus. RECENT FINDINGS Zika virus has emerged as a significant human pathogen in recent years. In 2015, it began to cause large outbreaks of febrile rash illness in South America and the Caribbean. During these large Zika virus outbreaks, a significant increase in the incidence of GBS was also observed in multiple countries/territories. Zika virus-associated GBS has several unique features, including a relatively short interval between febrile illness and GBS onset, an unusually high incidence among older people, and prominent cranial nerve abnormalities. Congenital Zika syndrome includes a myriad of abnormalities, including microcephaly, lissencephaly, hydrocephalus, arthrogryposis, and parenchymal calcifications. Currently, no treatment has been identified for Zika virus, although work on vaccines is under way. SUMMARY Arboviruses continue to surprise us with unexpected emergence in various locations, the nature of clinical illness, and outcomes. Zika virus presents a classic example of this type of emergence. Ongoing surveillance will be needed to evaluate the long-term pattern of Zika virus and related arboviruses.
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Pediatric Emergency MRI: What You Need to Know to Make It Through the Night. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tezcan B, Bölükbaşi D, Kazanci D, Turan S, Suer Kaya G, Özgök A. The Use of Sugammadex in a Patient With Guillain-Barre Syndrome: A Case Report. ACTA ACUST UNITED AC 2017; 8:200-202. [PMID: 28151766 DOI: 10.1213/xaa.0000000000000465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain-Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation. We report the successful use of sugammadex to reverse rocuronium in a patient with chronic GBS, who presented for a hemicolectomy.
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Affiliation(s)
- Büşra Tezcan
- From the Department of Anesthesiology and Reanimation Clinic, Turkey Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Benefit in long-term response and mortality of treatment with intravenous immunoglobulin prior to plasmapheresis in peripheral polyneuropathies. Transfus Clin Biol 2016; 24:9-14. [PMID: 27865608 DOI: 10.1016/j.tracli.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/14/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The benefits of plasmapheresis (PA) for neurologic autoimmune diseases have been widely demonstrated. Little is known about the long-term neurologic prognosis and course after PA and immunosuppressive (IS) and/or intravenous immunoglobulin (IVIG) treatment. We aimed to analyse features associated with short-term response and long-term outcome and prognosis (neurologic status and mortality) of peripheral polyneuropathy (PP) and central nervous system acute inflammatory disease (CNSAID) treated with PA. PATIENTS AND METHODS A descriptive, retrospective single-centre study from January 2005 to December 2012. RESULTS There were 26 episodes, which included 16 CNSAID and 10 PP cases. First line therapy included PA (n=4), IS drugs (n=15), and IVIG (n=7). Responses were achieved in 80% and 50% of PP and CNSAID cases, respectively. For PP, first line treatment with IVIG and no IS treatment prior to or during PA were variables associated with short-term response (P=0.067), good or stable neurologic status at the end of follow-up (P=0.008), and lower mortality rate (P=0.008). For CNSAID, initial EDSS score≥7 (P=0.019) was related to long-term good or stable neurologic status. During the study period, 177 sessions were conducted; 3.4% had technical complications and 8.5% clinical complications. However, these incidents were all minor and no PA session had to be discontinued. CONCLUSION The response rates achieved in our patients were similar to those of other research. PA has a safe profile but double-blind, controlled studies are needed to evaluate the synergy of sequential treatment with IGIV followed by PA and the possible benefit for long-term outcome.
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