Guillain-Barré syndrome: looking back… and forward

Hughes, Richard

doi:10.1136/jnnp-2019-322361

Cited by 6 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…GBS pathologically affects the peripheral nervous system (PNS) and is classified into several subtypes according to the distinct clinical and pathological features ( Table 1 ). Acute inflammatory demyelinating polyneuropathy (AIDP) due to acute inflammatory responses and demyelination of the peripheral nerves is prototypical of GBS ( Hughes, 2020 ). Axonal variants mainly including acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN) predominate in Asian countries ( Feasby et al, 1986 ; Peric et al, 2014 ; Benedetti et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Shang

Feng

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

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?

show abstract

Section: Introductionmentioning

confidence: 99%

Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Shang

Feng

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…6 Both plasma exchange (PE) and intravenous immunoglobulin (IVIg) are equally effective in GBS patients who are unable to walk independently (severe GBS). [7][8][9][10] One trial showed that the time to onset of motor recovery in patients still able to walk was shortened after two sessions of PE, 1 but no randomised controlled trials have been performed to evaluate the efficacy of IVIg in mild GBS. 7 11 Reasons not to treat mild GBS patients may include spontaneous recovery in a large proportion of patients due to the self-limiting nature of the disease, side effects including allergic reactions or thromboembolic events, and the fact that IVIg is expensive.…”

Section: Introductionmentioning

confidence: 99%

Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study

Verboon

Harbo

Cornblath

et al. 2021

J Neurol Neurosurg Psychiatry

Self Cite

View full text Add to dashboard Cite

ObjectiveTo compare the disease course in patients with mild Guillain-Barré syndrome (GBS) who were treated with intravenous immunoglobulin (IVIg) or supportive care only.MethodsWe 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.ResultsOf 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.ConclusionIn 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.

show abstract

“…6 Large prospective studies such as the International GBS Outcome Study (IGOS) have shown wide variations in outcomes. 7,8 Many patients, particularly those with mild forms of GBS, recover completely within 1-2 years, but others will have residual or long-lasting physical, psychological or social sequelae. Physical effects include pain, chronic fatigue and difficulty in walking.…”

Section: Introductionmentioning

confidence: 99%

Patient‐reported symptoms and experience following Guillain‐Barré syndrome and related conditions: Questionnaire development and validation

Siriwardena

Akanuwe

Botan

et al. 2021

Health Expectations

View full text Add to dashboard Cite

Background: Guillain-Barré syndrome (GBS) is a rare inflammatory peripheral nerve disorder with variable recovery. Evidence is lacking on experiences of people with GBS and measurement of these experiences. Objective: We aimed to develop and validate an instrument to measure experiences of people with GBS. Design: We used a cross-sectional design and online self-administered questionnaire survey. Question domains, based on a previous systematic review and qualitative study, covered experiences of GBS, symptom severity at each stage, healthcare and factors supporting or hindering recovery. Descriptive, exploratory factor and reliability analyses and multivariable regression analysis were used to investigate the relationships between variables of interest, explore questionnaire reliability and validity and identify factors predicting recovery. Setting and Participants: People with a previous diagnosis of GBS were recruited through a social media advert. Results: A total of 291 responders, of different sexes, and marital statuses, were included, with most diagnosed between 2015 and 2019. Factor analysis showed four scales: symptoms, information provided, factors affecting recovery and care received. Positive social interactions, physical activity including physiotherapy and movement, changes made at home and immunoglobulin treatment were important for recovery. Multivariable models showed that immunoglobulin and/or plasma exchange were significant predictors of recovery. Employment and recovery factors (positive interactions, work support and

show abstract

Guillain-Barré syndrome: looking back… and forward

Cited by 6 publications

References 17 publications

Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study

Patient‐reported symptoms and experience following Guillain‐Barré syndrome and related conditions: Questionnaire development and validation

Contact Info

Product

Resources

About