IVIG treatment and prognosis in Guillain-Barré syndrome.
BACKGROUND
Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyneuropathy that often leads to severe weakness. Intravenous immunoglobulin (IVIG) is a proven effective treatment for GBS (class 1 evidence). However, about 25% of patients need artificial ventilation and 20% are still unable to walk unaided after 6 months. Important clinical factors associated with poor outcome are age, presence of preceding diarrhea and the severity of disability in the early course of disease. These clinical factors were combined in a clinical prognostic scoring scale, the Erasmus GBS Outcome Scale (EGOS).


METHODS
GBS patients being unable to walk unaided are currently treated with a standard single IVIg dose (0.4 g/kg bodyweight for 5 days). A recent retrospective study in 174 GBS patients enrolled in one of our randomized controlled clinical trials showed that patients with a minor increase of serum IgG level after standard single IVIg dose recovered significantly slower. Additionally, fewer patients reached the ability to walk unaided at six months after correction for the known clinical prognostic factors (multivariate analysis; P < 0.022).


CONCLUSIONS
It is yet unknown why some GBS patients only have a minor increase after standard IVIg treatment. By using the EGOS it is possible to select GBS patients with a poor prognosis. These patients potentially may benefit from a second IVIg dose.


CONCLUSIONS
A standard dose of IVIG is not sufficiently effective in many GBS patients. Whether these patients might benefit from a second IVIg dose needs further investigation.
van Doorn
Pieter A
PA
Department of Neurology, Erasmus MC, University Medical Center Rotterdam, room BA 450, s-Gravendijkwal 230, Rotterdam, The Netherlands. p.a.vandoorn@erasmusmc.nl
Kuitwaard
Krista
K
Walgaard
Christa
C
van Koningsveld
Rinske
R
Ruts
Liselotte
L
Jacobs
Bart C
BC
D000818:Animals; D002169:Campylobacter Infections / Q000150:complications; D016123:Campylobacter jejuni / Q000276:immunology; D003131:Combined Modality Therapy; D003167:Complement Activation; D003429:Cross Reactions; D018450:Disease Progression; D004198:Disease Susceptibility; D004306:Dose-Response Relationship, Immunologic; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000276:immunology / Q000493:pharmacokinetics / Q000627:therapeutic use*; D051379:Mice; D018716:Molecular Mimicry; D010243:Paralysis / Q000209:etiology; D010951:Plasma Exchange; D011379:Prognosis; D011817:Rabbits; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous
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