Long‐term prognosis for Guillain‐Barré syndrome: Evaluation of prognostic factors and clinical experience of automated double filtration plasmapheresis

Abstract

Sixty patients with Guillain-Barré syndrome (GBS), aged 16-83 years, have been identified over a period of 7 years. Of 60 patients, 30 received the double filtration plasmapheresis (DFP), 4 received intravenous immunoglobulin, and the other 26 received supportive care only. Therapeutic outcomes at 1 year were determined using a modified Barthel index. At a follow-up of 1 year or longer, 31 patients (52%) had recovered, 24 (40%) had residua, and 5 (8%) had died. According to the statistical analysis, disability at the nadir and electrophysiological signs significantly influenced the long-term outcomes. Complications associated with DFP procedures included physiologic change, technique-related complications, and vascular access-related complications. None of our patients had fatal complications related to DFP treatment. Contrary to the established belief that the disease has a favorable outcome, several hospital-treated patients may still die or present residua even several months after the onset of symptoms. Because disability at the nadir influences the outcomes, early diagnosis and choice of appropriate treatment, which might include DFP, to prevent further neurological deficits, are essential to maximize the potential for survival.

Guillain-Barré syndrome during childhood: Particular clinical and electrophysiological features

“…21,33 Patients who have axonal involvement or require ventilatory support during the acute stage have been reported to have poorer functional outcome. [34][35][36] In our series, with a 1-year follow-up, only 2 children (13%) needed assistance with walking. These included the patient with AMAN and 1 who required mechanical ventilation.…”

“…Several small series and case reports have suggested early treatment with plasmapheresis or IVIg in children with GBS is helpful in reducing morbidity and speeding recovery . Patients who have axonal involvement or require ventilatory support during the acute stage have been reported to have poorer functional outcome . In our series, with a 1‐year follow‐up, only 2 children (13%) needed assistance with walking.…”

Long-term outcomes of Guillain-Barré syndrome possibly associated with Zika virus infection

“…Cheng et al determined that 40% of 60 GBS patients remained with physical and functional sequelae at one year. [38] Alternately, another retrospective investigation into the long-term outcomes of ZIKV-associated GBS determined that 80% of 15 GBS patients experienced good recovery at one year, with 13% having physical / functional sequelae. [37] Our investigation demonstrated recovery patterns consistent with that of other published data assessing GBS attributable to etiologies other than ZIKV.…”

Advances in understanding and treatment of immune‐mediated disorders of the peripheral nervous system

“…Both treatments have proven to exhibit beneficial effects in various controlled trials by favorably altering the natural course of the disease. 20,32,63,101,215,216,225,243,255 In a large controlled trial, combined treatment with plasmapheresis followed by IVIg did not provide significant additional benefit. The number of plasma exchanges required for effective treatment was determined in a large prospective study: two exchanges were sufficient to shorten the disease in mildly affected patients, whereas four exchanges were appropriate for patients with moderate to severe GBS, and further exchanges did not generate any additional benefit.…”