title: Risk factors for treatment related clinical fluctuations in Guillain-Barré syndrome. Dutch Guillain-Barré study group.
abstract: The risk factors for treatment related clinical fluctuations, relapses occurring after initial therapeutic induced stabilisation or improvement, were evaluated in a group of 172 patients with Guillain-Barré syndrome. Clinical, laboratory, and electrodiagnostic features of all 16 patients with Guillain-Barré syndrome with treatment related fluctuations, of whom 13 were retreated, were compared with those who did not have fluctuations. No significant differences were found between patients with Guillain-Barré syndrome treated with plasma exchange and patients treated with intravenous immune globulins either alone or in combination with high dose methylprednisolone. None of the patients with Guillain-Barré syndrome with preceding gastrointestinal illness, initial predominant distal weakness, acute motor neuropathy, or anti-GM1 antibodies showed treatment related fluctuations. On the other hand patients with fluctuations showed a trend to have the fluctuations after a protracted disease course. It is therefore suggested that treatment related clinical fluctuations are due to a more prolonged immune attack. There is no indication that the fluctuations are related to treatment modality. The results of this study may help the neurologist to identify patients with Guillain-Barré syndrome who are at risk for treatment related fluctuations.
authors.affiliation: Department of Neurology, Erasmus Medical Center Rotterdam, The Netherlands.
authors.forename: L H
authors.initials: LH
authors.lastname: Visser
authors.forename: F G
authors.initials: FG
authors.lastname: van der Meché
authors.forename: J
authors.initials: J
authors.lastname: Meulstee
authors.forename: P A
authors.initials: PA
authors.lastname: van Doorn
mesh_terms: D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects*; D008775:Methylprednisolone / Q000627:therapeutic use*; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology*; D010951:Plasma Exchange / Q000009:adverse effects*; D011129:Polyradiculoneuropathy / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D008775:Methylprednisolone