Relapsing Guillain-Barre syndrome in pregnancy and postpartum

Abstract

Guillain-Barre syndrome (GBS) rarely complicates pregnancy, but can be associated with high maternal and perinatal morbidity if not properly identified and treated. A high index of suspicion, supportive measures, access to intensive care unit and intravenous immunoglobulin (IVIG) therapy are cornerstones of management in GBS complicating pregnancy. Neurologists and Obstetricians should be aware of the risks of relapsing GBS in the immediate postpartum period. Surgery and anesthesia may be triggers for relapse in association with an overall increase in pro-inflammatory cytokines in the postpartum period. We report a unique case of GBS complicating pregnancy in the third trimester followed by a relapse in the postpartum period. She made a good recovery with supportive measures and a repeat course of IVIG during the relapse.

Guillain-Barré Syndrome During the Postpartum Period

“…To the best of our knowledge, only one case of GBS in a postpartum patient after cesarean section under spinal anesthesia has been described; however, there is no strong evidence supporting the association of neuraxial anesthesia and GBS [ 19 ]. Other rare presentations are described in the medical literature, such as relapsing GBS during pregnancy and postpartum and also congenital GBS in a newborn of an affected mother [ 20 ].…”

Síndrome de guillain-barré e encefalite de bickerstaff na gravidez / Guillain-barré syndrome and bickerstaff encephalitis in pregnancy

“…Estudos atuais apontam que o tratamento não difere de pacientes gestantes e não gestantes, o que leva a pensar com mais pesar na saúde materna e fetal após o atraso. (6,7) Logo, pode-se realizar a terapia com plasmaferese ou IgIV 0,4g/kg/dia por 5 dias, sendo esta preferível. (16,17) Vale ressaltar que o tratamento com IgIV para ser efetivo deve ser imposto nas primeiras semanas após o diagnóstico da síndrome.…”

“…(4,5) A gravidez geralmente resulta em remissão de imunomediados da doença, logo, é notado uma reincidência da síndrome duas semanas após o parto devido ao retorno da imunidade celular e um aumento na hipersensibilidade do tipo retardada. (7) O diagnóstico é feito pelo histórico, exame físico, avaliação do LCR e pelos resultados da eletroneuromiografia. (1,2) O tratamento é realizado através da plasmaférese ou da imunoglobulina intravenosa.…”

Uncommon case of Guillain-Barré Syndrome in Young Female in the First Trimester of Pregnancy

“…Treatment of GBS during pregnancy is similar to that of non pregnant individuals. Plasmapheresis or IVIG 1g/kg per day for 2 days or 0.4g/kg per day for 5 consecutive days [4,[8][9][10][11] is typically used. Close to 10% of patients may deteriorate although the proper treatment, even after an initial phase of improvement.…”