1
|
Sprenger-Svačina A, Svačina MKR, Gao T, Zhang G, Sheikh KA. Emerging treatment landscape for Guillain-Barré Syndrome (GBS): what's new? Expert Opin Investig Drugs 2024:1-6. [PMID: 38980318 DOI: 10.1080/13543784.2024.2377323] [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: 03/21/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a monophasic immune neuropathic disorder characterized by acute paralysis. A significant portion of patients are left with residual deficits, which presents a considerable global healthcare challenge. The precise mechanisms underlying GBS pathogenesis are not fully elucidated. Recent studies have focused on postinfectious molecular mimicry and identified involvement of IgG autoantibodies and innate immune effectors in GBS. Intravenous immunoglobulins (IVIg) and plasma exchange (PE) are two established evidence-based immunomodulatory treatments for GBS, but a significant proportion of GBS patients fails to respond adequately to either therapy. This emphasizes an urgent need for novel and more potent treatments. AREAS COVERED We discuss novel immunomodulatory therapies presently at different phases of preclinical and clinical investigation. Some drugs in development target pathophysiologic mechanisms such as IgG autoantibody catabolism and complement activation, which are relevant to GBS. EXPERT OPINION There is an unmet need for more effective immune therapies for GBS. New immunomodulatory therapies under development may provide more potent options for GBS patients who do not respond to IVIg or PE. Future directions may include incorporating neuroprotective interventions based on evolving understanding of mechanisms underlying nerve injury and axonal degeneration.
Collapse
Affiliation(s)
- Alina Sprenger-Svačina
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Martin K R Svačina
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Tong Gao
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gang Zhang
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kazim A Sheikh
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
2
|
Zhu C, Wang H, Zhang Y, Wang W, Wang J, Li W. Experience of treatment in critical Guillain-Barre Syndrome case after COVID-19 vaccination. Int J Dev Neurosci 2024; 84:342-348. [PMID: 38590219 DOI: 10.1002/jdn.10325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The current study reported a case with a history of neuroradiculitis. Within 2 months of the COVID-19 vaccine, critical Guillain-Barre Syndrome (GBS) appeared after acute diarrhea, progressive myasthenia, and sudden respiratory and cardiac symptoms. METHODS The syndrome was addressed with measures, such as endotracheal intubation and cardiopulmonary resuscitation vasoactive drugs. Next, we conducted six cycles of human immunoglobulin treatment (dose of 400 mg/kg·d intravenously for 5 days consecutively) and three times plasma exchange (PE, 30 ml/kg), followed by methylprednisolone sodium succinate. Rehabilitation training was carried out continuously. RESULTS The consciousness of the patient returned to normal, wherein he carried out normal communication. The muscle strength recovered gradually but still could not stand independently. Presently, he is recovering at home. CONCLUSIONS For patients with previous radiculitis, COVID-19 vaccination may increase the susceptibility to GBS. Thus, it is recommended to extend the vaccination interval for these patients and ensure that any potential increased risk is continually assessed.
Collapse
Affiliation(s)
- Chunying Zhu
- Department of Neuroscience Critical Care Unit, The First Central Hospital of Baoding, Hebei Province, China
| | - Huan Wang
- Department of Neuroscience Intensive Care Unit, The First Central Hospital of Baoding, Hebei Province, China
| | - Yingfu Zhang
- Endoscopic Diagnosis and Treatment Center, The First Central Hospital of Baoding, Hebei Province, China
| | - Wentao Wang
- Department of Rehabilitation medicine, The First Central Hospital of Baoding, Hebei Province, China
| | - Jia Wang
- Department of Neuroscience Critical Care Unit, The First Central Hospital of Baoding, Hebei Province, China
| | - Wei Li
- Department of Neuroscience Critical Care Unit, The First Central Hospital of Baoding, Hebei Province, China
| |
Collapse
|
3
|
Albin CSW. Neuromuscular Emergencies. Continuum (Minneap Minn) 2024; 30:818-844. [PMID: 38830072 DOI: 10.1212/con.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This article aims to familiarize the reader with the clinical approach, diagnostic considerations, and treatment strategies for patients presenting with abrupt-onset or acutely worsening weakness due to neuromuscular disorders. LATEST DEVELOPMENTS Neuromuscular weakness is often the result of an inflammatory process. In recent years, there has been growing recognition of pathologic antibodies that cause neuromuscular injury. This has allowed clinicians to make a more accurate diagnosis. Additionally, neuromuscular junction disorders and myopathies are increasingly identified as the adverse effects of novel anticancer therapies, namely immune checkpoint inhibitors. More data are being incorporated into frameworks for neuroprognostication after neuromuscular emergencies, especially for commonly encountered disorders such as Guillain-Barré syndrome. ESSENTIAL POINTS Care of patients with neuromuscular emergencies requires prompt attention to respiratory status. Once supportive measures are in place to protect the airway and facilitate effective ventilation, diagnostic considerations should hinge on appropriate neurologic localization. Aggressive immunosuppression is often required for immune-mediated neuromuscular disorders, and clinicians must be thoughtful in selecting a strategy that best aligns with each patient's risk factors and comorbidities.
Collapse
|
4
|
Kalita J, Mahajan R, Kumar M. Effect of intravenous immunoglobulin and plasmapheresis on nerve conduction parameters compared to the natural course of Guillain-Barré syndrome. J Clin Neurosci 2024; 125:76-82. [PMID: 38759351 DOI: 10.1016/j.jocn.2024.05.016] [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: 12/19/2023] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIg) and plasmapheresis (PLEX) are recommended in moderate to severe Guillain-Barré Syndrome (GBS), but there is paucity of studies evaluating its effect on nerve conduction studies (NCS). We report the effect of IVIg and PLEX on the NCS parameters and clinical outcomes compared to natural course (NC) of GBS patients. METHOD Moderate to severe GBS patients were included based on clinical, cerebrospinal fluid, and NCS finding. Six motor and sensory nerves were evaluated at admission, one month and 3 months, and NCS subtyping was done. Axonal and demyelination burden in motor nerves and early reversible conduction block (ERCB) were noted. Patients receiving IVIg, PLEX or on NC were noted. Outcome was defined at 3 months into complete, partial and poor using a 0-6 GBS Disability Scale (GBSDS). RESULT Seventy-two patients were included, whose median age was 36 years and 22(30.6 %) were females. 44 patients received IVIg, 9 PLEX and 19 were in NC, and they had comparable peak disability. AIDP was the dominant subtype at admission (58.3 %), which remained so at 3 months (50 %). The shift of subtypes was the highest from the equivocal group followed by AMAN and the least from AIDP. IVIg and PLEX group had more reduction in axonal burden and had ERCB compared to NC. 33(44 %) patients had complete recovery, and 40(55.5 %) patients had concordance in clinical and neurophysiological outcome. CONCLUSION Transition of GBS subtype may occur at follow-up from all the subtypes, the highest from the equivocal and the lowest from the AIDP group. IVIg/PLEX treatment may help in reducing conduction block and axonal burden.
Collapse
Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
| | - Roopali Mahajan
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Mritunjai Kumar
- Department of Neurology, AIIMS Rishikesh, Uttarakhand 249203, India
| |
Collapse
|
5
|
Khan SA, Das PR, Nahar Z, Dewan SMR. An updated review on Guillain-Barré syndrome: Challenges in infection prevention and control in low- and middle-income countries. SAGE Open Med 2024; 12:20503121241239538. [PMID: 38533198 PMCID: PMC10964449 DOI: 10.1177/20503121241239538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Guillain-Barré syndrome is a rare condition that can be potentially life-threatening. Guillain-Barré syndrome does not have a definitive etiological agent. It is a syndrome that can arise from multiple factors, including various infectious diseases and immunizations. The severity of Guillain-Barré syndrome is exacerbated by these variables, especially in low-income and middle-income countries where healthcare systems are already constrained and struggle to meet the demands of other diseases. The primary aim of our article is to comprehensively examine the life-threatening nature and intensity of Guillain-Barré syndrome by assessing its etiology, progression, and prevalence in low- and middle-income nations while also considering global trends. Furthermore, we proposed the implementation of standard and efficacious treatment and diagnostic resources that are readily accessible and successful in affluent nations and should also be readily accessible in impoverished nations without any unnecessary delay. Our study also emphasized the epidemiological data with molecular epidemiological analysis and the utilization of artificial technology in low- and middle-income nations. The goal was to decrease the incidence of Guillain-Barré syndrome cases and facilitate early detection.
Collapse
Affiliation(s)
- Sakif Ahamed Khan
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | - Proma Rani Das
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | - Zabun Nahar
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | | |
Collapse
|
6
|
Liu S, Zhang WW, Jia L, Zhang HL. Guillain-Barré syndrome: immunopathogenesis and therapeutic targets. Expert Opin Ther Targets 2024; 28:131-143. [PMID: 38470316 DOI: 10.1080/14728222.2024.2330435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/10/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a group of acute immune-mediated disorders in the peripheral nervous system. Both infectious and noninfectious factors are associated with GBS, which may act as triggers of autoimmune responses leading to neural damage and dysfunction. AREAS COVERED Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccines as well as flaviviruses have been associated with GBS, although a robust conclusion has yet to be reached. Immunomodulatory treatments, including intravenous immunoglobulins (IVIg) and plasma exchange (PE), have long been the first-line therapies for GBS. Depending on GBS subtype and severity at initial presentation, the efficacy of IVIg and PE can be variable. Several new therapies showing benefits to experimental animals merit further investigation before translation into clinical practice. We review the state-of-the-art knowledge on the immunopathogenesis of GBS in the context of coronavirus disease 2019 (COVID-19). Immunomodulatory therapies in GBS, including IVIg, PE, corticosteroids, and potential therapies, are summarized. EXPERT OPINION The association with SARS-CoV-2 remains uncertain, with geographical differences that are difficult to explain. Evidence and guidelines are lacking for the decision-making of initiating immunomodulatory therapies in mildly affected patients or patients with regional subtypes of GBS.
Collapse
Affiliation(s)
- Shan Liu
- Department of Nuclear Medicine, Second Hospital of Jilin University, Changchun, China
| | - Wei Wei Zhang
- Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
| |
Collapse
|
7
|
Jiang D, Zhao M, Li X, Hu Q, Zhang Q. Case report and literature review: Acute rhabdomyolysis caused by overheating of electric blanket complicated with Guillain-Barré syndrome. Front Neurol 2024; 15:1362648. [PMID: 38450069 PMCID: PMC10915280 DOI: 10.3389/fneur.2024.1362648] [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: 12/28/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Rhabdomyolysis (RM) induced by electric blankets is exceedingly rare, with only three cases identified in our literature review. Both RM and Guillain-Barré syndrome (GBS) present with similar clinical manifestations of myalgia and muscle weakness, posing a potential challenge for accurate diagnosis in clinical settings. This report presents the case of a 22-year-old man who developed RM subsequent to the use of an electric blanket. Despite undergoing plasma exchange and renal replacement therapy, the patient continued to exhibit poor muscle strength in both lower limbs. Subsequent comprehensive evaluation revealed the presence of concurrent GBS. Following a 5-day course of intravenous gamma globulin treatment, the patient experienced rapid recovery of muscle strength and was discharged. Additionally, we reviewed seven cases from the literature of coexistent RM and GBS. This indicated that investigation of the timing of onset of muscle strength decline in RM patients could help to identify potential concurrent neurological or muscular disorders. In cases in which concurrent GBS and RM cannot be definitively ascertained during early hospitalization, prioritizing plasma exchange treatment may lead to improved patient outcomes.
Collapse
Affiliation(s)
- Dongyang Jiang
- Department of Nephrology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Ming Zhao
- Department of Nephrology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Xiaojun Li
- Department of Nephrology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| | - Qiongdan Hu
- Department of Nephrology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Institute of Integrated Chinese and Western Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Qiong Zhang
- Department of Nephrology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
| |
Collapse
|
8
|
Song Y, Zheng X, Fang Y, Liu S, Liu K, Zhu J, Wu X. Current status of Guillain-Barré syndrome (GBS) in China: a 10-year comprehensive overview. Rev Neurosci 2023; 34:869-897. [PMID: 37145885 DOI: 10.1515/revneuro-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy; a disease involving the peripheral nervous system which is the most common cause of acute flaccid paralysis worldwide. So far, it is still lack of a comprehensive overview and understanding of the national epidemiological, clinical characteristics, and the risk factors of GBS in China, as well as differences between China and other countries and regions in these respects. With the global outbreak of the coronavirus disease 2019 (COVID-19), an epidemiological or phenotypic association between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and GBS has attracted great attention. In this review, we outlined the current clinical data of GBS in China by retrieving literature, extracting and synthesizing the data of GBS in China from 2010 to 2021. Besides, we compared the characteristics of epidemiology, preceding events and clinical profiles of GBS between China and other countries and regions. Furthermore, in addition to conventional intravenous immunoglobulin (IVIG) and plasma exchange (PE) therapy, the potential therapeutic effects with novel medications in GBS, such as complement inhibitors, etc., have become the research focus in treatments. We found that epidemiological and clinical findings of GBS in China are approximately consistent with those in the International GBS Outcome Study (IGOS) cohort. We provided an overall picture of the present clinical status of GBS in China and summarized the global research progress of GBS, aiming to further understand the characteristics of GBS and improve the future work of GBS worldwide, especially in countries with the middle and low incomes.
Collapse
Affiliation(s)
- Yanna Song
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, 510000 Guangzhou, China
| | - Xiaoxiao Zheng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Yong Fang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Shan Liu
- The Second Hospital of Jilin University, Jilin University, Ziqiang Street 218, 130022 Changchun, China
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, 17177 Solna, Stockholm, Sweden
| | - Xiujuan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| |
Collapse
|
9
|
López-Hernández JC, Jorge de Saráchaga A, Briseño-Godínez ME, May-Mas RN, Bazán-Rodríguez L, León-Manriquez E, Cruz-Pérez J, Becerra-Hernández I, Vargas-Cañas ES. Deltoid muscle strength and autonomic dysfunction as independent risk factors for invasive mechanical ventilation in patients with Guillain-Barré syndrome. Int J Neurosci 2023; 133:1403-1410. [PMID: 35633066 DOI: 10.1080/00207454.2022.2082963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Almost a third of patients with Guillain-Barré Syndrome (GBS) require mechanical ventilation, increasing mortality by 15-30% and proving poor functional outcomes. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is the most frequently used scale to assess probability of respiratory insufficiency within the first week of admission. We aim to determine other clinical and electrophysiological prognostic factors for invasive mechanical ventilation (IMV) in patients with GBS. MATERIAL AND METHODS A cross-sectional ambispective cohort study was carried out in a referral center in Mexico City, from January 2015 to December 2019. Baseline demographics, MRC score, Hughes scale, EGRIS, dysautonomia and nerve conduction studies were performed on admission in GBS patients that required IMV. A multivariable analysis for IMV and a survival analysis for independent walk in prolonged-IMV (>14 days) were performed. RESULTS Forty-nine (32%) out of 153 GBS patients required IMV. Statistically significant prognostic factors in multivariable analysis were deltoid muscle strength ≤2 [OR 7.1 (1.6-31.1)], EGRIS [OR 2.5 (1.3-4.6)] and autonomic dysfunction [OR 6.6 (2.0-22.0)]. Electrodecrement <1 mV in the compound muscle action potential (CMAP) of distal motor median nerve was more prevalent in prolonged-IMV patients (44.8% vs. 21%, p = .049). A significant minor prevalence of prolonged-IMV patients regain independent walk at 6 months using the Kaplan-Meier method (log rank test p < .001). CONCLUSIONS We provide new specific clinical (deltoid muscle strength and autonomic dysfunction) and electrophysiological variables to discriminate GBS patients that will require IMV.
Collapse
Affiliation(s)
| | - Adib Jorge de Saráchaga
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Raúl Nathanael May-Mas
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Lisette Bazán-Rodríguez
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Elizabeth León-Manriquez
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jocelyn Cruz-Pérez
- Neurocritical Care Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Israel Becerra-Hernández
- Neurocritical Care Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Edwin Steven Vargas-Cañas
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| |
Collapse
|
10
|
Habib AA, Waheed W. Guillain-Barré Syndrome. Continuum (Minneap Minn) 2023; 29:1327-1356. [PMID: 37851033 DOI: 10.1212/con.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article summarizes the clinical features, diagnostic criteria, differential diagnosis, pathogenesis, and prognosis of Guillain-Barré syndrome (GBS), with insights into the current and future diagnostic and therapeutic interventions for this neuromuscular syndrome. LATEST DEVELOPMENTS GBS is an acute, inflammatory, immune-mediated polyradiculoneuropathy that encompasses many clinical variants and divergent pathogenic mechanisms that lead to axonal, demyelinating, or mixed findings on electrodiagnostic studies. The type of antecedent infection, the development of pathogenic cross-reactive antibodies via molecular mimicry, and the location of the target gangliosides affect the subtype and severity of the illness. The data from the International GBS Outcome Study have highlighted regional variances, provided new and internationally validated prognosis tools that are beneficial for counseling, and introduced a platform for discussion of GBS-related open questions. New research has been undertaken, including research on novel diagnostic and therapeutic biomarkers, which may lead to new therapies. ESSENTIAL POINTS GBS is among the most frequent life-threatening neuromuscular emergencies in the world. At least 20% of patients with GBS have a poor prognosis and significant residual deficits despite receiving available treatments. Research is ongoing to further understand the pathogenesis of the disorder, find new biomarkers, and develop more effective and specific treatments.
Collapse
|
11
|
Foster MA, Lunn MP, Carr AS. First-line immunosuppression in neuromuscular diseases. Pract Neurol 2023:pn-2023-003708. [PMID: 37173131 DOI: 10.1136/pn-2023-003708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/15/2023]
Abstract
Autoimmune neuromuscular diseases are common and often treatable causes for peripheral nervous system dysfunction. If not optimally managed, they result in meaningful impairments and disability. The treating neurologist should aim to maximise clinical recovery with minimal iatrogenic risk. This requires careful patient and medication selection, appropriate counselling and close monitoring of clinical efficacy and safety. Here, we summarise our consensus departmental approach to first-line immunosuppression in neuromuscular diseases. We combine multispecialty evidence and expertise with a focus on autoimmune neuromuscular diseases to create guidance on starting, dosing and monitoring for toxic effects of the commonly used drugs. These include corticosteroids, steroid-sparing agents and cyclophosphamide. We also provide efficacy monitoring advice, as clinical response informs dosage and drug choice. The principles of this approach could be applied across much of the spectrum of immune-mediated neurological disorders where there is significant therapeutic crossover.
Collapse
Affiliation(s)
- Michael A Foster
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Division of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael Pt Lunn
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Aisling S Carr
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| |
Collapse
|
12
|
Duong-Quy S, Huynh-Truong-Anh D, Tran-Xuan Q, Nguyen-Quang T, Nguyen-Thi-Kim T, Nguyen-Chi T, Tran-Ngoc-Anh T, Nguyen-Van-Hoai N, Do-Thi-Thu M, Tang-Thi-Thao T, Bui-Diem K, Hoang-Anh T, Nguyen-Ngoc-Phuong T, Nguyen-Nhu V. Bradycardia unresponded to atropin testing was successfully treated with therapeutic plasma exchange in a patient with severe COVID-19 complicated by Guillain-Barré syndrome: A case report. Front Cardiovasc Med 2023; 9:1035896. [PMID: 36741850 PMCID: PMC9892716 DOI: 10.3389/fcvm.2022.1035896] [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: 09/03/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been an alarming situation worldwide for the past 2 years. The symptoms of coronavirus disease 2019 (COVID-19) are not only confined to the respiratory system but also affect a multitude of organ systems. Bradycardia associated with Guillain-Barré syndrome (GBS) is a rare autonomic and peripheral neurological complication of COVID-19. In this case report, we present the case of a 26-year-old man diagnosed with bradycardia associated with GBS after contracting COVID-19. Initially, this patient had the classical symptoms of COVID-19 and was hospitalized in the intensive care unit (ICU) for acute respiratory distress syndrome (ARDS). Then, he developed weakness in the lower extremities, diminished tendon reflexes, a loss of sensation without sphincter muscle disorders, and bradycardia. His bradycardia did not respond to atropine. The patient was treated concurrently with a high-flow nasal cannula, systemic corticosteroids, anticoagulation, and therapeutic plasma exchange (TPE) for COVID-19-induced ARDS, bradycardia, and GBS. His ARDS and bradycardia improved after the first cycle of TPE and medical treatment. After three cycles of TPE, the patient progressively recovered his muscle strength in the lower limbs and regained peripheral sensation. He was discharged from the hospital in stable condition after 4 weeks of hospitalization and was followed up after 6 months for cardiorespiratory and neurological complications. This case report elucidates the potential difficulties and challenges that physicians may encounter in diagnosing and treating COVID-19-induced bradycardia and GBS during the pandemic outbreak. However, the patient outcomes with the treatment combining the conventional treatment with therapeutic plasma exchange seem to be optimistic.
Collapse
Affiliation(s)
- Sy Duong-Quy
- Biomedical Research Center, Lam Dong Medical College, Da Lat, Vietnam,COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam,Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, United States,Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam,*Correspondence: Sy Duong-Quy ✉
| | - Duc Huynh-Truong-Anh
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Quynh Tran-Xuan
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tien Nguyen-Quang
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Thanh Nguyen-Thi-Kim
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Thanh Nguyen-Chi
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Thuy Tran-Ngoc-Anh
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Nam Nguyen-Van-Hoai
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | - Mai Do-Thi-Thu
- COVID-19 Unit of Phu Chanh, Binh Duong General Hospital, Thu° Dãu Môt, Binh Duong, Vietnam
| | | | - Khue Bui-Diem
- Department of Physiology and Pathophysiology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tien Hoang-Anh
- Department of Cardiology. Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | | | - Vinh Nguyen-Nhu
- Department of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam,Department of Respiratory Functional Exploration, University Medical Center, Ho Chi Minh City, Vietnam,Vinh Nguyen-Nhu ✉
| |
Collapse
|
13
|
Elahi E, Ali ME, Zimmermann J, Getts DR, Müller M, Lamprecht A. Immune Modifying Effect of Drug Free Biodegradable Nanoparticles on Disease Course of Experimental Autoimmune Neuritis. Pharmaceutics 2022; 14:2410. [PMID: 36365228 PMCID: PMC9695102 DOI: 10.3390/pharmaceutics14112410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2023] Open
Abstract
Guillain-Barre syndrome (GBS) is an autoimmune disease of demyelination and inflammation of peripheral nerves. Current treatments are limited to plasma exchange and intravenous immunoglobulins. Cargo-free nanoparticles (NPs) have been evaluated here for their therapeutic benefit on the disease course of experimental autoimmune neuritis (EAN), mimicking the human GBS. NPs prepared from poly-lactic co-glycolic acid (PLGA) with variable size and surface charge (i.e., 500 nm vs. 130 nm, polyvinyl alcohol (PVA) vs. sodium cholate), were intravenously administered in before- or early-onset treatment schedules in a rat EAN model. NP treatment mitigated distinctly the clinical severity of EAN as compared to the P2-peptide control group (P2) in all treatments and reduced the trafficking of inflammatory monocytes at inflammatory loci and diverted them towards the spleen. Therapeutic treatment with NPs reduced the expression of proinflammatory markers (CD68 (P2: 34.8 ± 6.6 vs. NP: 11.9 ± 2.3), IL-1β (P2: 18.3 ± 0.8 vs. NP: 5.8 ± 2.2), TNF-α (P2: 23.5 ± 3.7 vs. NP: 8.3 ± 1.7) and elevated the expression levels of anti-inflammatory markers CD163 (P2: 19.7 ± 3.0 vs. NP: 41.1 ± 6.5; all for NP-PVA of 130 nm; relative to healthy control). These results highlight the therapeutic potential of such cargo-free NPs in treating EAN, which would be easily translatable into clinical use due to their well-known low-toxicity profile.
Collapse
Affiliation(s)
- Ehsan Elahi
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, 53127 Bonn, Germany
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk Str. 3, 53121 Bonn, Germany
| | - Mohamed Ehab Ali
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk Str. 3, 53121 Bonn, Germany
| | - Julian Zimmermann
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, 53127 Bonn, Germany
| | - Daniel R. Getts
- Myeloid Therapeutics, 300 Technology Sq., Suite 203, Cambridge, MA 02139, USA
| | - Marcus Müller
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, 53127 Bonn, Germany
| | - Alf Lamprecht
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk Str. 3, 53121 Bonn, Germany
| |
Collapse
|
14
|
Zhang B, Duan L, Ma L, Cai Q, Wu H, Chang L, Li W, Lin Z. Rapidly progressive Guillain-Barré syndrome following amitriptyline overdose and severe Klebsiella pneumoniae infection: A case report and literature review. Front Med (Lausanne) 2022; 9:991182. [PMID: 36267621 PMCID: PMC9576939 DOI: 10.3389/fmed.2022.991182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is a potentially life-threatening post-infectious autoimmune disease characterized by rapidly progressive symmetrical weakness of the extremities. Herein, we report a case of GBS associated with drug poisoning complicated by Klebsiella pneumoniae infection. A 38-year-old woman was admitted to the intensive care unit after taking an overdose of amitriptyline and was later diagnosed with coma, Klebsiella pneumoniae infection, and septic shock. Thirteen days after admission, she was diagnosed with GBS based on acute muscle pain, flaccid paralysis, hyporeflexia, reduced amplitude of compound muscle action potential, and albuminocytologic dissociation in the cerebrospinal fluid. GBS rarely occurs after a drug overdose and septic shock, and this is the first report of a rapidly progressive GBS following amitriptyline overdose and severe Klebsiella pneumoniae infection.
Collapse
Affiliation(s)
- Boyu Zhang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Liwei Duan
- Department of Emergency Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Linhao Ma
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China,*Correspondence: Linhao Ma
| | - Qingqing Cai
- Genoxor Medical & Science Technology Inc., Shanghai, China
| | - Hao Wu
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Liang Chang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wenfang Li
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhaofen Lin
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
15
|
Liu S, Wang J, Yang J, Wen Y. The underlying mechanism of Guillain-Barré syndrome in a young patient suffered from Japanese encephalitis virus infection: a case report. Virol J 2022; 19:139. [PMID: 36050705 PMCID: PMC9434870 DOI: 10.1186/s12985-022-01870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The presentation of Guillain–Barré syndrome (GBS) caused by Japanese encephalitis virus (JEV) is uncommon, although clusters of GBS cases were observed in China in 2018. The underlying mechanism is unclear, particularly in individuals vaccinated against Japanese encephalitis in childhood. Case presentation We report a patient with acute flaccid paralysis involving four extremities and respiratory muscles, while magnetic resonance imaging of the brain and spine were standard. Electrophysiological examination displayed slowed motor nerve conduction speed and reduced evoked velocity amplitude. GBS was finally considered which was related to JEV infection verified by positive anti-JEV immunoglobulin M antibody and positive immunoglobulin G antibody in the serum. Unfortunately, the patient refused intravenous immunoglobulin and declined the use of mechanical ventilation again. He voluntarily withdrew from the hospital and died on the 36th day after the onset of illness. We also performed a review of previously reported related cases and discussed the underlying mechanism. Conclusion JEV infection-associated GBS is unusual. We should pay attention to the atypical manifestations of JEV infection and explore possible pathogenesis in particular individuals.
Collapse
Affiliation(s)
- Sheng Liu
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Jinyong Wang
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Jun Yang
- Neurology Department, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Ying Wen
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China.
| |
Collapse
|
16
|
Therapies in Autoimmune Peripheral Neuropathies beyond Intravenous Immunoglobulin, Plasma Exchange and Corticosteroids: An Analytical Review. Transfus Med Rev 2022; 36:220-229. [DOI: 10.1016/j.tmrv.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/20/2022]
|
17
|
Population Pharmacokinetic Modelling of Intravenous Immunoglobulin Treatment in Patients with Guillain-Barré Syndrome. Clin Pharmacokinet 2022; 61:1285-1296. [PMID: 35781631 PMCID: PMC9439991 DOI: 10.1007/s40262-022-01136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/04/2022]
Abstract
Background and Objective Intravenous immunoglobulin (IVIg) at a standard dosage is the treatment of choice for Guillain–Barré syndrome. The pharmacokinetics, however, is highly variable between patients, and a rapid clearance of IVIg is associated with poor recovery. We aimed to develop a model to predict the pharmacokinetics of a standard 5-day IVIg course (0.4 g/kg/day) in patients with Guillain–Barré syndrome. Methods Non-linear mixed-effects modelling software (NONMEM®) was used to construct a pharmacokinetic model based on a model-building cohort of 177 patients with Guillain–Barré syndrome, with a total of 589 sequential serum samples tested for total immunoglobulin G (IgG) levels, and evaluated on an independent validation cohort that consisted of 177 patients with Guillain–Barré syndrome with 689 sequential serum samples. Results The final two-compartment model accurately described the daily increment in serum IgG levels during a standard IVIg course; the initial rapid fall and then a gradual decline to steady-state levels thereafter. The covariates that increased IgG clearance were a more severe disease (as indicated by the Guillain–Barré syndrome disability score) and concomitant methylprednisolone treatment. When the current dosing regimen was simulated, the percentage of patients who reached a target ∆IgG > 7.3 g/L at 2 weeks decreased from 74% in mildly affected patients to only 33% in the most severely affected and mechanically ventilated patients (Guillain–Barré syndrome disability score of 5). Conclusions This is the first population-pharmacokinetic model for standard IVIg treatment in Guillain–Barré syndrome. The model provides a new tool to predict the pharmacokinetics of alternative regimens of IVIg in Guillain–Barré syndrome to design future trials and personalise treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-022-01136-z.
Collapse
|
18
|
Faustino P, Coutinho M, Brum M, Medeiros L, Ladeira F. Outcomes in Guillain-Barré Syndrome following a second therapeutic cycle – A single-centre retrospective observational study. J Neurol Sci 2022; 441:120368. [DOI: 10.1016/j.jns.2022.120368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/05/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
|
19
|
Moranne O, Roux C, Ion IM, Chkair S. [Therapeutic plasmapheresis procedures: An alternative to the disruption of the supply of polyvalent immunoglobulin in autoimmune pathologies. Medico-economic study]. Nephrol Ther 2022; 18:172-179. [PMID: 35644771 DOI: 10.1016/j.nephro.2022.02.004] [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: 12/03/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The supply of human polyvalent immunoglobulin has been under severe pressure for several years. This has led to a prioritisation of indications and a record increase in the amount of reimbursement without solving the problem of demand. Treatment by therapeutic plasmapheresis appears to be an alternative to be considered for the treatment of certain dysimmune diseseases. To discuss this alternative, we are conducting a medico-economic study comparing the polyvalent immunoglobulin strategy versus different therapeutic plasmapheresis system in the treatment of a chronic dysimmune disease. POPULATION AND METHOD The medico-economic study was conducted using the example of a 75 kg patient with chronic polyradiculoneuritis dependent on chronic therapy with a comparison of sequential treatment with one session of therapeutic plasmapheresis versus a course of intravenous polyvalent immunoglobulin. The medico-economic study includes an evaluation from a public health care system perspective complemented by a hospital-based approach that justifies estimating the cost of different therapeutic plasmapheresis systems based on a bottom-up micro-costing approach. RESULTS From the point of view of the care system, for information, a 20 g bottle of polyvalent immunoglobulin has a similar cost to a therapeutic plasmapheresis session. In our example, the cost of a maintenance treatment repeated every 2 to 4 weeks in chronic polyradiculoneuritis in a 75 kg patient is 1284.13 euros for a therapeutic plasmapheresis session versus 7331.60 to 9426.84 euros for a 1.5 to 2 mg/kg polyvalent immunoglobulin treatment. Furthermore, from the point of view of the hospital system, the cost of the different TT techniques evaluated varies moderately with the cost depending mainly on the quantity of albumin infused or the medical device used. CONCLUSION In the chronic sequential treatment of chronic polyradiculoneuritis, the cost of therapeutic plasmapheresis could be lower than with polyvalent immunoglobulin from a healthcare system perspective. The cost to the health care facility between different therapeutic plasmapheresis techniques differs little. This study provides arguments suggesting that if therapeutic plasmapheresis can be implemented with a dedicated technical platform, it is a serious alternative to be considered without additional costs.
Collapse
Affiliation(s)
- Olivier Moranne
- Service nephrology dialyse apherese, hôpital universitaire Caremeau, Nîmes, France; IDESP, UMR-Inserm, Montpellier, France.
| | - Clarisse Roux
- IDESP, UMR-Inserm, Montpellier, France; Service pharmacie, hôpital universitaire Caremeau, Nîmes, France; Observatoire des médicaments, des dispositifs médicaux et des innovations thérapeutiques, OMEDIT Occitanie, Occitanie, France
| | - Ioana Maria Ion
- Service de neurologie, hôpital universitaire Caremeau, Nîmes, France
| | - Sihame Chkair
- IDESP, UMR-Inserm, Montpellier, France; Service Bespim, hôpital universitaire Caremeau, Nîmes, France
| |
Collapse
|
20
|
Duong-Quy S, Huynh-Truong-Anh D, Nguyen-Thi-Kim T, Nguyen-Quang T, Nguyen-Chi T, Tran-Xuan Q, Nguyen-Nhu V, Ngo C, Craig T. Guillain-Barré Syndrome in Patient With SARS-CoV-2 PCR Positivity Treated Successfully With Therapeutic Exchange Plasma: A First Case Report From Vietnam. Front Neurol 2022; 13:868667. [PMID: 35693014 PMCID: PMC9175001 DOI: 10.3389/fneur.2022.868667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Since the first case of Guillain-Barré syndrome (GBS)-associated SARS-CoV-2 (COVID-19) infection reported in 2020, a series of cases have been published in some countries. In this case report, we present a young patient with GBS, whose clinical and laboratory data were appropriate for the diagnosis of GBS due to COVID-19 infection. Neurological examination revealed the muscular weakness of lower limbs with Medical Research Council (MRC) scale of 2/5 associated with diminished reflexes. Laboratory studies showed the positive nasal swab RT-PCR test for COVID-19, leukopenia, increased ferritin and LDH levels, normal electrolyte and liver and kidney function, and normal chest X-ray. The result of cerebrospinal fluid showed the albuminocytologic dissociation. The patient was treated with remdesivir, dexamethasone, anticoagulation, and therapeutic plasma exchange (TPE). Patient's muscle weakness was significantly improved after 1 week of admission. He was discharged at 23rd days of hospitalization and followed-up in the out-patients department.
Collapse
Affiliation(s)
- Sy Duong-Quy
- Department of Clinical Research, Biomedical Research Center, Lam Dong Medical College, Dalat, Vietnam
- Department of Intensive Care Unit, Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
- Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, United States
- Department of Expert Consultation, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam
- *Correspondence: Sy Duong-Quy
| | - Duc Huynh-Truong-Anh
- Department of Intensive Care Unit, Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Thanh Nguyen-Thi-Kim
- Department of Intensive Care Unit, Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Tien Nguyen-Quang
- Department of Intensive Care Unit, Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Thanh Nguyen-Chi
- Department of Intensive Care Unit, Covid-19 Unit of Phu Chanh, Binh Duong General Hospital, Binh Duong, Vietnam
| | - Quynh Tran-Xuan
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Vinh Nguyen-Nhu
- Department of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
- Department of Respiratory Functional Exploration. University Medical Center, Ho Chi Minh, Vietnam
| | - Carine Ngo
- Department of Pathology, Institute Gustave Roussy, Villejuif, France
| | - Timothy Craig
- Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, PA, United States
| |
Collapse
|
21
|
Bijoy George T, Kainat A, Pachika PS, Arnold J. Rare occurrence of Guillain-Barré syndrome after Moderna vaccine. BMJ Case Rep 2022; 15:15/5/e249749. [PMID: 35534045 PMCID: PMC9086602 DOI: 10.1136/bcr-2022-249749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
A Caucasian man in his 60s with a medical history significant for ruptured left middle cerebral artery aneurysm status post clipping 2005 with residual right eye blindness and right leg weakness with gait instability presented with loss of balance, weakness of his legs and fatigue for 3 days. No other antecedent event was identified other than receiving Moderna COVID-19 vaccine 4 weeks before the presentation and 3 days before symptom onset. CT head and CT angiogram of the head and neck were performed and demonstrated no acute intracranial bleeding and no vascular abnormalities. With the findings of diffuse hyporeflexia and cerebrospinal fluid showing albumino-cytological dissociation, Guillain-Barré syndrome was high on the differentials. Electromyogram showed evidence of demyelination. He was treated with intravenous immune globulin (IVIG) and was discharged to rehab with complete symptom resolution.
Collapse
Affiliation(s)
- Tissa Bijoy George
- Internal Medicine, University of Pittsburgh Medical Center Health System, McKeesport, Pennsylvania, USA
| | - Aleesha Kainat
- Internal Medicine, University of Pittsburgh Medical Center Health System, McKeesport, Pennsylvania, USA
| | | | - Jonathan Arnold
- Internal Medicine, University of Pittsburgh Medical Center Health System, McKeesport, Pennsylvania, USA
| |
Collapse
|
22
|
Rajabally YA. Immunoglobulin and Monoclonal Antibody Therapies in Guillain-Barré Syndrome. Neurotherapeutics 2022; 19:885-896. [PMID: 35648286 PMCID: PMC9159039 DOI: 10.1007/s13311-022-01253-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 12/29/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy affecting 1-2 subjects per 100,000 every year worldwide. It causes, in its classic form, symmetric weakness in the proximal and distal limb muscles with common involvement of the cranial nerves, particularly facial weakness. Respiratory function is compromised in a case in four. Randomised controlled trials have demonstrated the benefit of therapeutic plasma exchange in hastening time to recovery. Intravenous immunoglobulin was subsequently shown to be as efficacious as plasma exchange in adult subjects. In children, few trials have shown the benefit of intravenous immunoglobulin versus supportive care. Pharmacokinetic studies suggested a relationship between increase in immunoglobulin G level post-infusion and outcome, implying administration of larger doses may be beneficial in subjects with poor prognosis. However, a subsequent trial of a second dose of immunoglobulin in such subjects failed to show improved outcome, while demonstrating a higher risk of thromboembolic side-effects. Monoclonal antibody therapy has more recently been investigated for GBS, after multiple studies in animal models, with different agents and variable postulated mechanisms of action. Eculizumab, a humanised monoclonal antibody against the complement protein C5, was tested in in two randomised, double-blind, placebo-controlled phase 2 trials. Neither showed benefit versus immunoglobulins alone on disability level at 4 weeks, although one study importantly suggested possible, clinically highly relevant, late effects on normalising function. A phase 3 trial is in progress. Preliminary results of a placebo-controlled ongoing study of ANX005, a humanised recombinant antibody against C1q inhibiting the complement cascade, have been promising.
Collapse
Affiliation(s)
- Yusuf A Rajabally
- Aston Medical School, Aston University, Birmingham, B4 7ET, UK.
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
| |
Collapse
|
23
|
Kenan G, Regev T, Kushnir M, Cohen O, Gandelman-Marton R, Kimiagar I, Armon C. Reasons for delayed treatment initiation in Guillain-Barre syndrome. J Neurol Sci 2022; 434:120179. [DOI: 10.1016/j.jns.2022.120179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/16/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
|
24
|
Alessandro L, Castiglione JI, Brand P, Bruno V, Barroso F. Treatment-related fluctuations in Guillain-Barré syndrome: clinical features and predictors of recurrence. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:516-522. [PMID: 35195232 DOI: 10.1590/0004-282x-anp-2021-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND A treatment-related fluctuation (TRF) in a patient with Guillain-Barré syndrome (GBS) is defined as clinical deterioration within two months of symptom onset following previous stabilization or improvements with treatment. OBJECTIVE To investigate the clinical characteristics and factors that could increase the risk of relapse of GBS in patients with and without TRFs. METHODS Retrospective review of medical records of patients (>18 years) with GBS evaluated between January/2006 and July/2019. Demographic and clinical characteristics, ancillary studies, treatment received, and the clinical course of patients with and without TRFs were analyzed. RESULTS Overall, 124 cases of GBS were included; seven (5.6%) presented TRFs. GBS-TRF cases were triggered more frequently by infectious mononucleosis (28.57 vs. 8.55%; p=0.01). GBS-TRF were initially treated with plasmapheresis more frequently than those without TRF (14.29 vs. 1.70%; p=0.0349). Combined treatment (71.43 vs. 4.27%; p<0.001) and corticosteroids (42.86 vs. 1.71%; p<0.001) were more commonly used in the GBS-TRF group. GBS-TRF patients presented a higher median initial disability score (4 vs. 2; p=0.01). CONCLUSIONS Patients with GBS triggered by infectious mononucleosis and a high degree of initial disability have higher chances of developing TRFs. Although patients with TRF were treated with plasmapheresis more often, the total number was too low to suggest a link between plasma exchange and TRF.
Collapse
Affiliation(s)
- Lucas Alessandro
- Raul Carrea Institute for Neurological Research, Department of Neurology, Buenos Aires, Argentina
| | - Juan Ignacio Castiglione
- Raul Carrea Institute for Neurological Research, Department of Neurology, Buenos Aires, Argentina
| | - Patricio Brand
- Raul Carrea Institute for Neurological Research, Department of Neuromuscular, Buenos Aires, Argentina
| | - Veronica Bruno
- University of Calgary, Hotchkiss Brain Institute, Department of Clinical Neurosciences, Calgary, Alberta, Canada
| | - Fabio Barroso
- Raul Carrea Institute for Neurological Research, Department of Neuromuscular, Buenos Aires, Argentina
| |
Collapse
|
25
|
Sardar Z, Bano S, Ahmar M, Liaquat S, Shafiq B, Numan A. Clinical spectrum and outcome of guillain-barré syndrome with plasmapheresis. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
26
|
El-Abassi RN, Soliman M, Levy MH, England JD. Treatment and Management of Autoimmune Neuropathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
27
|
Oo WM, Giri P, de Souza A. AstraZeneca COVID-19 vaccine and Guillain- Barré Syndrome in Tasmania: A causal link? J Neuroimmunol 2021; 360:577719. [PMID: 34560365 PMCID: PMC8447540 DOI: 10.1016/j.jneuroim.2021.577719] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/08/2021] [Indexed: 01/05/2023]
Abstract
The emergence of the coronavirus 2019 (COVID-19) pandemic has presented an unprecedented global challenge. Vaccines against COVID have been developed to date. Covid-19 has been linked with the development of Guillain-Barre Syndrome (GBS), a rare immune-mediated demyelinating neuropathy. We report three cases of Guillain-Barre Syndrome and one case of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), presenting to a Tasmanian hospital, and review 15 other reported cases and discuss likely immunopathology. Nearly all reported cases of post-COVID-19 vacciation inflammatory demyelinating polyneuropathy are linked to AstraZeneca vaccination and a variant with bifacial weakness is the most reported form of GBS globally.
Collapse
Affiliation(s)
- Wai M Oo
- Department of Medicine, Launceston General Hospital, Tasmania, Australia; Department of Neurology, Launceston General Hospital, Tasmania, Australia; Faculty of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Pradeep Giri
- Department of Medicine, Launceston General Hospital, Tasmania, Australia; Department of Infectious Diseases, Launceston General Hospital, Tasmania, Australia
| | - Aaron de Souza
- Department of Neurology, Launceston General Hospital, Tasmania, Australia; Faculty of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| |
Collapse
|
28
|
Verboon C, Harbo T, Cornblath DR, Hughes RAC, van Doorn PA, Lunn MP, Gorson KC, Barroso F, Kuwabara S, Galassi G, Lehmann HC, Kusunoki S, Reisin RC, Binda D, Cavaletti G, Jacobs BC. Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study. J Neurol Neurosurg Psychiatry 2021; 92:1080-1088. [PMID: 34103340 PMCID: PMC8458059 DOI: 10.1136/jnnp-2020-325815] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the disease course in patients with mild Guillain-Barré syndrome (GBS) who were treated with intravenous immunoglobulin (IVIg) or supportive care only. METHODS We selected patients from the prospective observational International GBS Outcome Study (IGOS) who were able to walk independently at study entry (mild GBS), treated with one IVIg course or supportive care. The primary endpoint was the GBS disability score four weeks after study entry, assessed by multivariable ordinal regression analysis. RESULTS Of 188 eligible patients, 148 (79%) were treated with IVIg and 40 (21%) with supportive care. The IVIg group was more disabled at baseline. IVIg treatment was not associated with lower GBS disability scores at 4 weeks (adjusted OR (aOR) 1.62, 95% CI 0.63 to 4.13). Nearly all secondary endpoints showed no benefit from IVIg, although the time to regain full muscle strength was shorter (28 vs 56 days, p=0.03) and reported pain at 26 weeks was lower (n=26/121, 22% vs n=12/30, 40%, p=0.04) in the IVIg treated patients. In the subanalysis with persistent mild GBS in the first 2 weeks, the aOR for a lower GBS disability score at 4 weeks was 2.32 (95% CI 0.76 to 7.13). At 1 year, 40% of all patients had residual symptoms. CONCLUSION In patients with mild GBS, one course of IVIg did not improve the overall disease course. The certainty of this conclusion is limited by confounding factors, selection bias and wide confidence limits. Residual symptoms were often present after one year, indicating the need for better treatments in mild GBS.
Collapse
Affiliation(s)
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard A C Hughes
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Michael P Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Kenneth C Gorson
- Department of Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| | - Fabio Barroso
- Department of Neurology, Instituto de Investigaciones Neurológicas Raúl Carrea, FLENI, Buenos Aires, Argentina
| | | | - Giuliana Galassi
- Department of Neurology, University Hospital of Modena, Modena, Italy
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | | | - Ricardo C Reisin
- Department of Neurology, Hospital Britanico, Buenos Aires, Argentina
| | - Davide Binda
- Department of Neurology, University Milano-Bicocca, Monza, Italy
| | - Guido Cavaletti
- Department of Neurology, University Milano-Bicocca, Monza, Italy
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands .,Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | | | | |
Collapse
|
29
|
Real-world treatment of adult patients with Guillain-Barré syndrome over the last two decades. Sci Rep 2021; 11:19170. [PMID: 34580356 PMCID: PMC8476500 DOI: 10.1038/s41598-021-98501-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 12/28/2022] Open
Abstract
This study investigated treatment characteristics of Guillain-Barré syndrome (GBS) in a real-world setting between 2000 and 2019. We analyzed clinical improvement between nadir and last follow-up in patients with severe GBS (defined as having a GBS disability scale > 2 at nadir) and aimed to detect clinical factors associated with multiple treatments. We included 121 patients (74 male; median age 48 [IQR 35-60]) with sensorimotor (63%), pure motor (15%), pure sensory (10%) and localized GBS (6%) as well as Miller Fisher syndrome (6%). 44% of patients were severely affected. All but one patient received at least one immunomodulatory treatment with initially either intravenous immunoglobulins (88%), plasma exchange (10%) or corticosteroids (1%), and 25% of patients received more than one treatment. Severe GBS but not age, sex, GBS subtype or date of diagnosis was associated with higher odds to receive more than one treatment (OR 4.22; 95%CI 1.36-13.10; p = 0.01). Receiving multiple treatments had no adjusted effect (OR 1.30, 95%CI 0.31-5.40, p = 0.72) on clinical improvement between nadir and last follow-up in patients with severe GBS. This treatment practice did not change over the last 20 years.
Collapse
|
30
|
Luo HY, Li XJ, Cheng M, Wang J, Xie LL, Yao ZX, Jiang L. Clinical characteristics of children with Guillain-Barré syndrome and factors associated with disease severity. J Clin Neurosci 2021; 92:120-125. [PMID: 34509238 DOI: 10.1016/j.jocn.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/20/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
Guillain-Barré syndrome (GBS) is the leading cause of pediatric acute flaccid paralysis. This study aimed to summarize the clinical features of children with GBS and to explore factors associated with the severity of weakness. One hundred and twenty-two children with GBS (73 males and 49 females) were retrospectively analysed. The median age (IQR) at diagnosis was 4.0 years (2.9-7.2 years), and 26.2% of patients were at the age of 2-3 years. Of the 122 cases, 71 (58.2%) had an antecedent infection, 58 (47.5%) had cranial nerve involvement, 36 (29.1%) had dysautonomia, 77 (63.1%) had sensory symptoms, 28 (23.0%) had difficulty in breathing of which 15 (12.3%) patients required mechanical ventilation, and 8 (6.6%) had normal tendon reflex or hyperreflexia. Cytoalbuminologic dissociation of the cerebrospinal fluid was observed in 97 cases (82.9%). Further, 120 patients underwent nerve conduction studies: 76 (63.3%) exhibited demyelinating features whereas 36 (30.0%) had axonal type of CBS. 70.2% of patients could walk independently at 12 weeks. Fourteen (11.5%) patients were classified into the mild group [GBS disability score (GBS-DS) < 3] and 108 (88.5%) were classified into the severe group (GBS-DS ≥ 3). The incidence of cranial involvement (P = 0.038) and decreased tendon reflexes (P = 0.048) were significantly different between the two groups. These findings suggested that cranial nerve involvement is associated with severe muscle weakness in children with GBS.
Collapse
Affiliation(s)
- Han-Yu Luo
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Xiu-Juan Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Min Cheng
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Juan Wang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Ling-Ling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Zheng-Xiong Yao
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China.
| |
Collapse
|
31
|
Abnormal sweating and "skin flushing" as possible predictive factor for treatment related fluctuations in Guillain-Barré syndrome: a case series and a review of the literature. J Neurol Sci 2021; 428:117589. [PMID: 34325159 DOI: 10.1016/j.jns.2021.117589] [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: 01/21/2021] [Revised: 06/21/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022]
Abstract
Treatment related fluctuations (TRFs) in Guillain-Barré Syndrome (GBS) are described as one or more episodes of deterioration manifesting within two months after disease onset and following an initial improvement or stabilisation after treatment. They may be encountered in 8% to 16% of patients, but currently predictive factors of TRF occurrence and severity are poorly known. To this end, we evaluated the frequency and clinical features of TRFs in a cohort of GBS patients admitted to the Neurological unit of Sant'Andrea Hospital (La Spezia, Italy) from January 1st, 2003 to December 31st, 2017. Among the 98 GBS collected patients, five (5.1%) developed a TRF during disease course. Consistently with the literature, the majority of our GBS patients who developed a TRF did not report a preceding diarrhoea, had a predominant proximal weakness and all of them had sensory disturbances at the clinical onset. Interestingly, 80% of our TRF patients manifested since GBS onset an autonomic dysfunction with abnormal sweating and a peculiar 'skin flushing' in face, neck and chest. Two patients developed respiratory insufficiency at the TRF time, and they both died. We would advise to pay attention to GBS patients with particular 'skin flushing' in face, neck and chest and abnormal sweating, because these findings could be a red flag for TRF.
Collapse
|
32
|
Ángel-Páez JA, Hurtado-Bugna S, Aragón-Mendoza RL, Altman-Restrepo M, Díaz-Yamal IJ, Centanaro-Meza GA. Miller Fisher syndrome treated with plasmapheresis during pregnancy: Case report and review of the literature. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2021; 72:210-218. [PMID: 34506707 PMCID: PMC8425356 DOI: 10.18597/rcog.3611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/03/2021] [Indexed: 11/09/2022]
Abstract
Objetivo: Reportar el caso de una paciente gestante con síndrome de Guillain-Barré (SGB) presentado en la variante denominada síndrome de Miller Fisher (SMF), y realizar una revisión en torno al diagnóstico, tratamiento y pronóstico de esta variedad de SGB durante la gestación. Materiales y métodos: Se presenta el caso de una gestante de 27 semanas con síndrome de Miller Fisher, quien fue tratada con plasmaféresis en un hospital militar de referencia, con evolución satisfactoria a los 15 días y continuación normal del embarazo, parto a las 38 semanas con recién nacido sano. Se realizó una búsqueda bibliográfica en bases de datos electrónicas: Medline vía PubMed, Lilacs, SciELO, ScienceDirect, Ovid, con los términos “Embarazo”, “Síndrome de Miller Fisher”, “Síndrome de Guillain-Barré”. Se incluyeron cohortes, series y reportes de casos de mujeres gestantes con síndrome de Miller Fisher; se extrajo información sobre los métodos diagnósticos, el tratamiento utilizado y el pronóstico materno y perinatal. La búsqueda se hizo en junio de 2020, sin restricción por fecha, pero sí por tipo de idioma (español e inglés). Resultados: Se identificaron 423 títulos, tres estudios cumplieron los criterios de inclusión, los tres correspondieron a reportes de caso. Todos los casos mostraron seropositividad para antigangliósidos GQ1b positivos; en ningún caso hubo alteración imagenológica. Dos pacientes recibieron inmunoglobulina intravenosa y la tercera paciente se dejó en observación. Hasta el momento no se documentan complicaciones obstétricas. Conclusión: Existen pocos casos reportados de SMF durante la gestación, el diagnóstico se basa en el examen clínico; el tratamiento con inmunoglobulina IV representa la alternativa utilizada con mayor frecuencia. En el caso presentado se utilizó la plasmaféresis. Se desconoce el impacto de la variedad del síndrome de Miller Fisher sobre el curso normal de la gestación y sobre los resultados perinatales a largo plazo. Se requieren más estudios que aborden el diagnóstico, el tratamiento y el pronóstico de esta entidad.
Collapse
Affiliation(s)
- Julián Andrés Ángel-Páez
- Médico residente Ginecología y Obstetricia, Universidad Militar Nueva Granada, Bogotá (Colombia).
| | - Silvana Hurtado-Bugna
- Médica residente Ginecología y Obstetricia, Universidad Militar Nueva Granada, Bogotá (Colombia).
| | | | - Marcela Altman-Restrepo
- Médico ginecobstetra, especialista Medicina Materno Fetal, Hospital Militar Central, Bogotá (Colombia).
| | - Ivonne Jeannette Díaz-Yamal
- Médico ginecobstetra, especialista en Medicina Reproductiva, Hospital Militar Central, Bogotá (Colombia). Docente titular Universidad Militar Nueva Granada, Bogotá (Colombia).
| | - Gabriel Adolfo Centanaro-Meza
- Médico, especialista en Neurología Clínica, doctor en Bioética, Hospital Militar Central, Bogotá. (Colombia). Docente titular Universidad Militar Nueva Granada, Bogotá, Colombia.
| |
Collapse
|
33
|
Khedr EM, Shoyb A, Mohamed KO, Karim AA, Saber M. Case Report: Guillain-Barré Syndrome Associated With COVID-19. Front Neurol 2021; 12:678136. [PMID: 34239495 PMCID: PMC8258108 DOI: 10.3389/fneur.2021.678136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/14/2021] [Indexed: 12/31/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is a potentially fatal, immune-mediated disease of the peripheral nervous system that is usually triggered by infection. Only a small number of cases of GBS associated with COVID-19 infection have been published. We report here five patients with GBS admitted to the Neurology, Psychiatry, and Neurosurgery Hospital, Assiut University/Egypt from July 1 to November 20, 2020. Three of the five patients were positive for SARS-CoV-2 following polymerase chain reaction (PCR) of nasopharyngeal swabs on day of admission and another one had a high level of IgM and IgG; all had bilateral ground-glass opacities with consolidation on CT chest scan (GGO) and lymphopenia. All patients presented with two or more of the following: fever, cough, malaise, vomiting, and diarrhea with variable duration. However, there were some peculiarities in the clinical presentation. First, there were only 3 to 14 days between the onset of COVID-19 symptoms and the first symptoms of GBS, which developed into flaccid areflexic quadriplegia with glove and stocking hypoesthesia. The second peculiarity was that three of the cases had cranial nerve involvement, suggesting that there may be a high incidence of cranial involvement in SARS-CoV-2-associated GBS. Other peculiarities occurred. Case 2 presented with a cerebellar hemorrhage before symptoms of COVID-19 and had a cardiac attack with elevated cardiac enzymes following onset of GBS symptoms. Case 5 was also unusual in that the onset began with bilateral facial palsy, which preceded the sensory and motor manifestations of GBS (descending course). Neurophysiological studies showed evidence of sensorimotor demyelinating polyradiculoneuropathy, suggesting acute inflammatory polyneuropathy (AIDP) in all patients. Three patients received plasmapheresis. All of them had either full recovery or partial recovery. Possible pathophysiological links between GBS and COVID-19 are discussed.
Collapse
Affiliation(s)
- Eman M Khedr
- Department of Neurology and Psychiatry, Assiut University, Asyut, Egypt.,Department of Neuropsychiatry, Aswan University, Aswan, Egypt
| | - Ahmed Shoyb
- Department of Neuropsychiatry, Aswan University, Aswan, Egypt
| | - Khaled O Mohamed
- Department of Neurology and Psychiatry, Assiut University, Asyut, Egypt
| | - Ahmed A Karim
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Health Psychology and Neurorehabilitation, SRH Mobile University, Riedlingen, Germany
| | - Mostafa Saber
- Department of Neuropsychiatry, Aswan University, Aswan, Egypt
| |
Collapse
|
34
|
Shang P, Feng J, Wu W, Zhang HL. Intensive Care and Treatment of Severe Guillain-Barré Syndrome. Front Pharmacol 2021; 12:608130. [PMID: 33995011 PMCID: PMC8113987 DOI: 10.3389/fphar.2021.608130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?
Collapse
Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Changchun, China.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Wei Wu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
| |
Collapse
|
35
|
Korinthenberg R, Eckenweiler M, Fuchs H. Severe Locked-In-Like Guillain-Barré's Syndrome: Dilemmas in Diagnosis and Treatment. Neuropediatrics 2021; 52:19-26. [PMID: 33111302 DOI: 10.1055/s-0040-1715480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Guillain-Barré's syndrome in childhood can follow an atypical course, increasing the challenges in diagnosis and decisions regarding immunomodulatory treatment. Here, we report the case of on a 13-year-old boy with acute onset Guillain-Barré's syndrome progressing over 40 days to a very severe, locked-in-like syndrome despite intensive immunomodulatory treatment. After a plateau phase lasting 3 months and characterized by fluctuating signs of ongoing inflammatory disease activity, we were prompted to perform repeated and maintenance immunomodulatory treatment, which resulted in a continuous and nearly complete recovery of function. Atypical features at disease onset, the severe "total" loss of all peripheral and cranial nerve function, and an apparent late response to treatment give rise to reviewing the dilemmas of diagnosis and treatment in such severe and protracted courses of Guillain-Barré syndrome.
Collapse
Affiliation(s)
- Rudolf Korinthenberg
- Department of Neuropediatrics and Muscular Disorders, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscular Disorders, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Hans Fuchs
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| |
Collapse
|
36
|
Guillain-Barré Syndrome in a COVID-19 Patient: A Case Report and Review of Management Strategies. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2021; 9:198-200. [PMID: 33553616 PMCID: PMC7864392 DOI: 10.12691/ajmcr-9-3-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Guillain-Barré syndrome (GBS) in an immune mediated disease that affects peripheral nerves with possible life-threatening complications. GBS has multiple subtypes including acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN), which can make GBS difficult to diagnose. GBS commonly presents after viral infections such as influenza virus, campylobacter jejuni, and zika virus. GBS commonly presents with a prolonged clinical course leading to increased morbidity among affected patients. It is not surprising that COVID-19 has been connected with multiple cases of GBS, which may alter the recovery course for several patients post-COVID. In this report, we present a case of 69-year-old-female who presented with progressive motor weakness and loss of sensation in her extremities after testing positive for antibodies to COVID-19 one-month prior to presentation. Her presentation and treatment of GBS in the setting of COVID-19 is an example of one of the many COVID-19 complications and sheds light on the prolonged recovery course that we may experience as clinicians in the wake of this pandemic.
Collapse
|
37
|
Papri N, Islam Z, Leonhard SE, Mohammad QD, Endtz HP, Jacobs BC. Guillain-Barré syndrome in low-income and middle-income countries: challenges and prospects. Nat Rev Neurol 2021; 17:285-296. [PMID: 33649531 PMCID: PMC7920001 DOI: 10.1038/s41582-021-00467-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
The epidemiology, clinical characteristics, management and outcome of Guillain-Barré syndrome (GBS) differ between low-income and middle-income countries (LMIC) and high-income countries (HIC). At present, limited data are available on GBS in LMIC and the true incidence of GBS in many LMIC remains unknown. Increased understanding of GBS in LMIC is needed because poor hygiene and high exposure to infections render populations in LMIC vulnerable to GBS outbreaks. Furthermore, insufficient diagnostic and health-care facilities in LMIC contribute to delayed diagnosis in patients with severe presentations of GBS. In addition, the lack of national clinical guidelines and absence of affordable, effective treatments contribute to worse outcomes and higher mortality in LMIC than HIC. Systematic population-based surveillance studies, cohort and case-control studies are required to understand the incidence and risk factors for GBS. Novel, targeted and cost-effective treatment strategies need to be developed in the context of health system challenges in LMIC. To ensure integrative rehabilitation services in LMIC, existing prognostic models must be validated, and responsive outcome measures that are cross-culturally applicable must be developed. Therefore, fundamental and applied research to improve the clinical management of GBS in LMIC should become a critical focus of future research programmes.
Collapse
Affiliation(s)
- Nowshin Papri
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh ,grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Zhahirul Islam
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sonja E. Leonhard
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Quazi D. Mohammad
- grid.489064.7National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hubert P. Endtz
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.434215.50000 0001 2106 3244Fondation Mérieux, Lyon, France
| | - Bart C. Jacobs
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.5645.2000000040459992XDepartment of Immunology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
38
|
Leonhard SE, Cornblath DR, Endtz HP, Sejvar JJ, Jacobs BC. Guillain-Barré syndrome in times of pandemics. J Neurol Neurosurg Psychiatry 2020; 91:1027-1029. [PMID: 32732383 PMCID: PMC7509514 DOI: 10.1136/jnnp-2020-324230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 01/26/2023]
Affiliation(s)
| | | | - Hubert P Endtz
- Medical Microbiology & Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Fondation Mérieux, Lyon, France
| | - James J Sejvar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bart C Jacobs
- Neurology and Immunology, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
39
|
Arsenijević M, Berisavac I, Mladenović B, Stanarčević P, Jovanović D, Lavrnić D, Peric S. Rate of progression of Guillain-Barré syndrome is not associated with the short-term outcome of the disease. Ir J Med Sci 2020; 190:357-361. [PMID: 32666503 DOI: 10.1007/s11845-020-02310-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/11/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There are no many data on association between progression rate of Guillain-Barré syndrome (GBS) and disease outcome. AIM The aim of our study was to analyze short-term outcome of GBS in relation to the rate of disease progression. METHODS Our retrospective study included patients diagnosed with GBS in seven tertiary healthcare centers from 2009 to 2014. According to the rate of disease progression from onset of symptoms to the nadir, patients were divided in three groups: rapid-onset GBS (nadir reached in maximum 48 h), gradual-onset (nadir reached in three to 14 days), and slow-onset (nadir in 15 to 28 days). GBS disability scale (GDS) was used to assess functional disability at nadir and on discharge. RESULTS Among 380 patients included in the study, 24 (6.3%) patients had rapid-onset, 274 (72.1%) gradual-onset, and 82 (21.6%) slow-onset GBS. Time from the onset of the disease to the hospital admission was much shorter in faster-onset forms (3.0 ± 4.1 days in rapid-onset vs. 6.8 ± 9.5 days in gradual-onset and 21.0 ± 9.6 days in slow-onset GBS, p < 0.01). Preceding events were less commonly identified in slow-onset forms. Patients with rapid-onset GBS were more likely to have axonal variants (p < 0.05). All three groups of patients were treated in a similar way, and there were no differences in GDS score at nadir (p > 0.05) and on discharge (p > 0.05) and no differences in the duration of hospital stay. CONCLUSION Faster progression of GBS does not imply a poorer short-term functional outcome of the disease.
Collapse
Affiliation(s)
- Mirjana Arsenijević
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 6, Belgrade, 11129, Serbia
| | - Ivana Berisavac
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 6, Belgrade, 11129, Serbia
| | - Branka Mladenović
- Physical Medicine and Rehabilitation Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Predrag Stanarčević
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 6, Belgrade, 11129, Serbia
| | - Dejana Jovanović
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 6, Belgrade, 11129, Serbia
| | - Dragana Lavrnić
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 6, Belgrade, 11129, Serbia
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotića 6, Belgrade, 11129, Serbia.
| |
Collapse
|
40
|
López-Hernández JC, Colunga-Lozano LE, Garcia-Trejo S, Gomez-Figueroa E, Delgado-Garcia G, Bazán-Rodríguez L, Cervantes-Uribe R, Burgos-Centeno J, Fernandez-Valverde F, Vargas-Cañas ES. Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with Guillain-Barré syndrome, a single center experience. J Clin Neurosci 2020; 80:292-297. [PMID: 32674942 DOI: 10.1016/j.jocn.2020.04.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical characteristics of electrophysiological subtypes and prognostic factors of Mexican adults diagnosed with Guillain-Barré Syndrome (GBS) have not been described. MATERIALS AND METHODS A single center, ambispective, cohort study was performed (2015-2019). GBS was defined following the Asbury and Cornblath criteria. Electrodiagnosis was made according to Hadden criteria. Clinical, biochemical and electrodiagnostic parameters were described, compared and analyzed using a multivariate model. Only patients who completed a 3-month follow-up were included. RESULTS 137 GBS patients (92 males; mean age 46.6 ± 16.6).132 (96.3%) underwent an electrodiagnostic assessment.68 (51.5%) were classified as axonal GBS, with further classified into two groups: acute motor axonal neuropathy (AMAN) 45.4%, and acute motor and sensory axonal neuropathy (AMSAN) 8,6%. The following characteristics were lower in the AMAN group: Medical Research Counsel sumscore (MRC) 30.1 ± 16.3 vs 36.4 ± 14.4, unilateral facial palsy 10% vs 25.9% and albuminocytologic dissociation 41.3% vs. 71.7%.Multivariate analysis found AMAN as an independent predictor of an unfavorable outcome OR: 3.34 (p = 0.03) CONCLUSIONS: AMAN subtype is the most frequent presentation of GBS in Mexican adult patients and an independent predictor of inability to walk independently at 3 months after discharge.
Collapse
Affiliation(s)
| | | | - Sofia Garcia-Trejo
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Enrique Gomez-Figueroa
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Lisette Bazán-Rodríguez
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Roberto Cervantes-Uribe
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jorge Burgos-Centeno
- Department of Clincal Neuphysiology, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Edwin Steven Vargas-Cañas
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| |
Collapse
|
41
|
Korinthenberg R, Trollmann R, Felderhoff-Müser U, Bernert G, Hackenberg A, Hufnagel M, Pohl M, Hahn G, Mentzel HJ, Sommer C, Lambeck J, Mecher F, Hessenauer M, Winterholler C, Kempf U, Jacobs BC, Rostasy K, Müller-Felber W. Diagnosis and treatment of Guillain-Barré Syndrome in childhood and adolescence: An evidence- and consensus-based guideline. Eur J Paediatr Neurol 2020; 25:5-16. [PMID: 31941581 DOI: 10.1016/j.ejpn.2020.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022]
Abstract
This evidence- and consensus-based practical guideline for the diagnosis and treatment of Guillain-Barré Syndrome (GBS) in childhood and adolescence has been developed by a group of delegates from relevant specialist societies and organisations; it is the result of an initiative by the German-Speaking Society of Neuropediatrics (GNP), and is supported by the Association of Scientific Medical Societies (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften). A systematic analysis of the literature revealed that only a few adequately-controlled studies exist for this particular age group, while none carries a low risk of bias. For this reason, the diagnostic and therapeutic recommendations largely rely on findings in adult patients with GBS, for which there are a higher number of suitable studies available. Consensus was established using a written, multi-step Delphi process. A high level of consensus could be reached for the crucial steps in diagnosis and treatment. We recommend basing the diagnostic approach on the clinical criteria of GBS and deriving support from CSF and electrophysiological findings. Repetition of invasive procedures that yield ambiguous results is only recommended if the diagnosis cannot be ascertained from the other criteria. For severe or persistently-progressive GBS treatment with intravenous immunoglobulin (IVIG) is recommended, whereas in cases of IVIG intolerance or inefficacy we recommended treatment with plasmapheresis. Corticosteroids are ineffective for GBS but can be considered when acute onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) is suspected due to a prolonged disease course. The full German version of the Guideline is available on the AWMF website (https://www.awmf.org/leitlinien/detail/ll/022-008.html).
Collapse
Affiliation(s)
- R Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University Medical Center (UMC), University of Freiburg, Germany.
| | - R Trollmann
- Department of Neuropediatrics, UMC, Friedrich- Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - G Bernert
- Department of Pediatrics, Kaiser-Franz-Joseph-Hospital with Preyer's Childrens Hospital, Vienna, Austria
| | - A Hackenberg
- Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland
| | - M Hufnagel
- Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, UMC, University of Freiburg, Germany
| | - M Pohl
- Section Pediatric Nephrology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, UMC, University of Freiburg, Germany
| | - G Hahn
- Department of Radiological Diagnostics, UMC, University of Dresden, Germany
| | - H J Mentzel
- Section Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Jena, Germany
| | - C Sommer
- Department of Neurology, UMC, University of Wuerzburg, Germany
| | - J Lambeck
- Department of Neurology and Neurophysiology, UMC, University of Freiburg, Germany
| | - F Mecher
- Physio Deutschland, German Federal Association for Physiotherapy, Germany
| | - M Hessenauer
- Centre for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Germany
| | - C Winterholler
- German Federal Association of Logopedics (dbl e.V. Deutscher Bundesverband für Logopädie e.v), Germany
| | - U Kempf
- Mother of a GBS PPatient, Kraichtal-Neuenbürg, Germany
| | - B C Jacobs
- Departments of Neurology and Immunology, Erasmus MC, UMC Rotterdam, the Netherlands
| | - K Rostasy
- Department of Neuropediatrics, Children´s Hospital Datteln, University Witten/Herdecke, Germany
| | | |
Collapse
|
42
|
Verboon C, van den Berg B, Cornblath DR, Venema E, Gorson KC, Lunn MP, Lingsma H, Van den Bergh P, Harbo T, Bateman K, Pereon Y, Sindrup SH, Kusunoki S, Miller J, Islam Z, Hartung HP, Chavada G, Jacobs BC, Hughes RAC, van Doorn PA. Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study. J Neurol Neurosurg Psychiatry 2020; 91:113-121. [PMID: 31586949 DOI: 10.1136/jnnp-2019-321496] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses. METHODS From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression. RESULTS Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course. CONCLUSIONS This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.
Collapse
Affiliation(s)
| | | | - David R Cornblath
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Esmee Venema
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Kenneth C Gorson
- Department of Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| | - Michael P Lunn
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hester Lingsma
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Kathleen Bateman
- Department of Neurology, University of Cape Town, Cape Town, South Africa
| | - Yann Pereon
- Department of Clinical Neurophysiology, Reference Centre for NMD, Nantes University Hospital, Nantes, France
| | - Søren H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan
| | - James Miller
- Department of Neurology, Royal Victoria Infirmary, Newcastle, UK
| | - Zhahirul Islam
- Department of Laboratory Sciences and Services Division, The International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Bart C Jacobs
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Richard A C Hughes
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | |
Collapse
|
43
|
Di Stefano V, Barbone F, Ferrante C, Telese R, Vitale M, Onofrj M, Di Muzio A. Inflammatory polyradiculoneuropathies: Clinical and immunological aspects, current therapies, and future perspectives. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220942340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammatory polyradiculoneuropathies are heterogeneous disorders characterized by immune-mediated leukocyte infiltration of peripheral nerves and nerve roots leading to demyelination or axonal degeneration or both. Inflammatory polyradiculoneuropathies can be divided into acute and chronic: Guillain–Barré syndrome and chronic inflammatory demyelinating polyneuropathy and their variants. Despite major advances in immunology and molecular biology have been made in the last years, the pathogenesis of these disorders is not completely understood. This review summarizes the current literature of the clinical features and pathogenic mechanisms of inflammatory polyradiculoneuropathies and focuses on current therapies and new potential treatment for the future.
Collapse
Affiliation(s)
- Vincenzo Di Stefano
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Filomena Barbone
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Camilla Ferrante
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Roberta Telese
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Michela Vitale
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Marco Onofrj
- Department of Neurosciences, Imaging and Clinical Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - Antonio Di Muzio
- Department of Neurology, “SS. Annunziata” Hospital, Chieti, Italy
| |
Collapse
|
44
|
Doxaki C, Papadopoulou E, Maniadaki I, Tsakalis NG, Palikaras K, Vorgia P. Case Report: Intracranial Hypertension Secondary to Guillain-Barre Syndrome. Front Pediatr 2020; 8:608695. [PMID: 33553071 PMCID: PMC7857149 DOI: 10.3389/fped.2020.608695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
Guillain-Barre Syndrome (GBS), a common cause of acute flaccid paralysis, is characterized by a rapidly progressive, usually symmetric weakness of the extremities. Headache and intracranial hypertension (ICHT) are very rare complications of GBS. Herein we report our current case of an obese girl with typical signs of GBS associated with autonomic dysfunction, cranial nerve deficits and increased intracranial pressure (ICP). We also perform a systematic study presenting and discussing previous case reports of GBS associated with ICHT, papilledema or hydrocephalus, highlighting the differences of the current case compared to previous studies. Although intracranial hypertension is a rare complication of pediatric GBS, clinicians should promptly detect it. Obesity may be a predisposing factor, given the strong association between idiopathic intracranial hypertension (IIH) and weight gain. Neurological evaluation, fundus examination and low threshold for intracranial imaging should be an integral part of medical practice in case of obesity, headache or visual changes in GBS patients.
Collapse
Affiliation(s)
- Christina Doxaki
- Department of Pediatrics, University General Hospital of Heraklion, Crete, Greece
| | | | - Iliana Maniadaki
- Department of Pediatrics, University General Hospital of Heraklion, Crete, Greece
| | - Nikolaos G Tsakalis
- Department of Ophthalmology, University General Hospital of Heraklion, Crete, Greece
| | - Konstantinos Palikaras
- Institute of Molecular Biology and Biotechnology (IMBB), Foundation for Research and Technology - Hellas (FORTH), Crete, Greece
| | - Pelagia Vorgia
- Department of Pediatrics, University General Hospital of Heraklion, Crete, Greece
| |
Collapse
|
45
|
Content Ed Net. Improving Intravenous Immunoglobulin Dosing in Autoimmune Neuropathies. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10314832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This symposium took place on Monday 24th June 2019, as part of the 2019 Peripheral Nerve Society (PNS) Annual Meeting in Genoa, Italy. Immune-mediated neuropathies such as Guillain–Barré Syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN) are diverse inflammatory peripheral nerve disorders. International consensus guidelines recommend intravenous Ig (IVIG) as Level A for the treatment of GBS, CIDP, and MMN. Suggested induction doses of IVIG are 2 g/kg divided over 2–5 days, but maintenance doses are purposely less clearly defined and left up to the judgement of the clinician, depending upon the specific needs of the individual patient. Community-based neurologists treating patients with these rare inflammatory neuropathies may be unaware of optimal dosing regimens and patient response to treatment may therefore be inadequate. In this symposium, world-renowned experts in GBS, CIDP, and MMN shared their expertise and review of the literature to provide reasonable dosing regimens for neurologists who may rarely encounter these conditions.
Collapse
|
46
|
Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, van Doorn PA, Dourado ME, Hughes RAC, Islam B, Kusunoki S, Pardo CA, Reisin R, Sejvar JJ, Shahrizaila N, Soares C, Umapathi T, Wang Y, Yiu EM, Willison HJ, Jacobs BC. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019; 15:671-683. [PMID: 31541214 PMCID: PMC6821638 DOI: 10.1038/s41582-019-0250-9] [Citation(s) in RCA: 401] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Abstract
Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
Collapse
Affiliation(s)
- Sonja E Leonhard
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Melissa R Mandarakas
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Francisco A A Gondim
- Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Kathleen Bateman
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maria L B Ferreira
- Department of Neurology, Hospital da Restauração, Recife, Pernambuco, Brazil
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mario E Dourado
- Department of Integrative Medicine, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Richard A C Hughes
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Badrul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - James J Sejvar
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Cristiane Soares
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Eppie M Yiu
- Department of Neurology, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
- Neurosciences Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Hugh J Willison
- College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands.
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.
| |
Collapse
|
47
|
Verboon C, Doets AY, Galassi G, Davidson A, Waheed W, Péréon Y, Shahrizaila N, Kusunoki S, Lehmann HC, Harbo T, Monges S, Van den Bergh P, Willison HJ, Cornblath DR, Jacobs BC. Current treatment practice of Guillain-Barré syndrome. Neurology 2019; 93:e59-e76. [PMID: 31175208 DOI: 10.1212/wnl.0000000000007719] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/13/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To define the current treatment practice of Guillain-Barré syndrome (GBS). METHODS The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. RESULTS We excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE. CONCLUSIONS In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.
Collapse
Affiliation(s)
- Christine Verboon
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alex Y Doets
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Giuliana Galassi
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amy Davidson
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Waqar Waheed
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yann Péréon
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nortina Shahrizaila
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susumu Kusunoki
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Helmar C Lehmann
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas Harbo
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Soledad Monges
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter Van den Bergh
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hugh J Willison
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - David R Cornblath
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bart C Jacobs
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD.
| | | |
Collapse
|
48
|
Abstract
Intravenous immunoglobulin (IVIg) is used in the treatment of autoimmune diseases, including immune-mediated central and peripheral nervous system disorders. This article will review the indications, proposed mechanism of actions, and administration of immunoglobulin treatment in various neuropathies, neuromuscular junction disorders, and myopathies. IVIg may have more than one mechanism of action to alter the pathogenesis of underlying neuromuscular disease. IVIg treatment has been used as a first-line treatment in Guillain-Barre syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy, and second-line off-label treatment in medically refractory cases of polymyositis, dermatomyositis, and myasthenia gravis. IVIg is a well-tolerated and effective treatment for these neuromuscular diseases. With this review article, we hope to increase clinicians' awareness of the indications and efficiencies of IVIg in a broad spectrum of neuromuscular diseases.
Collapse
Affiliation(s)
- Ahmet Z Burakgazi
- Department of Internal Medicine, Neuroscience Section, Virginia Tech Carilion School of Medicine, Carilion Clinic Neurology, Roanoke, VA
| |
Collapse
|
49
|
Abstract
PURPOSE OF REVIEW The clinical presentation of Guillain-Barré syndrome (GBS) is highly variable, which can make the diagnosis challenging. Intravenous immunoglobulin (IVIg) and plasma exchange are the cornerstones of treatment since decades. But despite these treatments, 25% initially progress in muscle weakness, 25% require artificial ventilation, 20% is still not able to walk independently after 6 months, and 2-5% die, emphasizing the need for better treatment. We summarize new developments regarding the diagnosis, prognosis, and management of GBS. RECENT FINDINGS GBS is a clinical diagnosis that can be supported by cerebrospinal fluid examination and nerve conduction studies. Nerve ultrasound and MRI are potentially useful techniques to diagnose inflammatory neuropathies. Several novel infections have recently been associated to GBS. Evidence from experimental studies and recent phase 2 clinical trials suggests that complement inhibition combined with IVIg might improve outcome in GBS, but further studies are warranted. Prognostic models could guide the selection of patients with a relatively poor prognosis that might benefit most from additional IVIg or otherwise intensified treatment. SUMMARY New diagnostic tools may help to have early and accurate diagnosis in difficult GBS cases. Increased knowledge on the pathophysiology of GBS forms the basis for development of new, targeted, and personalized treatments that hopefully improve outcome.
Collapse
|
50
|
Bazaraa HM, Rady HI, Mohamed SA, Rabie WA, ElAnwar NH. Initial Response and Outcome of Critically Ill Children With Guillain Barre' Syndrome. Front Pediatr 2019; 7:378. [PMID: 31620410 PMCID: PMC6759753 DOI: 10.3389/fped.2019.00378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Guillain-Barre syndrome is the most common cause of acute flaccid paralysis worldwide since the eradication of poliomyelitis. Severe cases may require intensive care and mechanical ventilation. Purpose: was to study pediatric patients with severe GBS requiring intensive care unit (ICU) admission, to assess their course and response to initial treatment modality plasma exchange (PE) or intravenous immunoglobulins (IVIg) and their final outcome. Methods: children with severe GBS who had either actual or impending respiratory failure, bulbar involvement or rapid progression of acute flaccid paralysis with trunk, upper limb and neck involvement within 24 h of the onset of weakness were enrolled. Results: 40 children were included. Following the initial treatment (33 subjects had 5 PE sessions each and IVIg in 7), 16 patients improved (40%), two died and 22 (55%) showed initial treatment failure. Axonal neuropathy, rapid progression and severe motor weakness significantly predicted poor response to therapy. At discharge, favorable outcomes (patient can walk unaided) were present in 22 cases (58%). Conclusion: Despite relatively low mortality, critically ill children with severe GBS have increased prevalence of axonal neuropathy and guarded response to initial therapy with PE or IVIg.
Collapse
Affiliation(s)
- Hafez M Bazaraa
- Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanaa I Rady
- Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shereen A Mohamed
- Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Walaa A Rabie
- Clinical and Chemical Pathology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha H ElAnwar
- Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|