Corticosteroids for Guillain-Barré syndrome

Hughes, Richard; Doorn, Pieter A. van

doi:10.1002/14651858.cd001446.pub4

Cited by 83 publications

(99 citation statements)

References 22 publications

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“…21 Corticosteroids are often used in GBS treatments but some guidelines state that these drugs do not improve outcomes and are not recommended. 19,22 These guidelines also emphasise that TPE treatment must commence with 2-4 weeks of onset to be effective and prevent long-term sequelae. The American Academy of Neurology Guidelines (2011) assigned class one evidence for the use TPE in GBS.…”

Section: Discussionmentioning

confidence: 99%

“…23 It is generally accepted that the mechanism of action of TPE in GBS is primarily the removal of auto antibodies and other protein factors and the replacement of plasma components (when FFP is used as the replacement fluid). 22 However, the treatment may also promote IVIG and PE appear to have equivalent efficacy in treatment of GBS. The optimal dose and schedule of both PE and IVIG for this condition is unclear.…”

Section: Discussionmentioning

confidence: 99%

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A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options A Centre’s Experience

Kozanoğlu¹,

Yerdelen²,

Büyükkurt³

et al. 2015

European Neurological Review

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Therapeutic plasma exchange (TPE) has been shown to hasten recovery in Guillain-Barré syndrome (GBS). In this study, the objective was to show the outcome of disability grade in a retrospective analysis of data of clinical experience of TPE using the COBE Spectra Apheresis system and other treatment options in selected patients from a series of 56 patients with GBS at a single treatment centre in Turkey.Ten patients had the acute motor axonal neuropathy (AMAN) subtype; 46 had the acute inflammatory demyelinating polyneuropathy (AIDP) subtype of GBS. Three hundred and eighteen TPE procedures were performed taking 2 to 3 hours: in 6.3 % of them a peripheral catheter was used; in 93.7 % of them a central catheter was used. Replacement fluids were fresh frozen plasma (FFP), lactated Ringer's solution or 3 % hydroxyethyl starch (HES). Among the patients, 12 (21.4 %) who had severe disease course received additional treatment to TPE -this was intravenous immunoglobulin (IVIG) in 11 patients. One patient was treated with steroids after rheumatology consultation due to another autoimmune disease. After 2 weeks, the mean GBS disability scores had significantly decreased from 3.75±0.48 to 2.44±0.96 (p=0.0001) and mean Medical Research Council (MRC) muscle strength scores significantly increased from 2.07±0.89 to 3.54±0.88 (p=0.0001). No difference in efficacy was observed between AMAN and AIDP subtypes. Adverse events occurred in 20 procedures (6.3 %) of TPE and were mostly transient hypocalcaemia and allergic reactions that did not necessitate treatment discontinuation. Difficulty in venous access was observed in 3.14 % of procedures. TPE using the COBE Spectra Apheresis system provides effective treatment of GBS with an acceptable safety profile using various replacement fluids and is an essential part of disease management. Although the benefit is controversial, other treatment options may be applied as an additional therapy in selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options A Centre’s Experience

Kozanoğlu¹,

Yerdelen²,

Büyükkurt³

et al. 2015

European Neurological Review

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“…112 PE has been shown to be efficient and safe and its use was reported since 1980s. [113][114][115][116] PE (five times in 2 weeks) has been associated with less damage to the nerves and clinical improvement and been particularly effective when started within 7 d of onset and in those who need mechanical ventilation. 117 In regards, most clinical trials have been lead on adult patients affected by GBS, while only one trial examined both adult and pediatric GBS, showing PE efficacy in the disease treatment and older age was associated with poor outcome in this study.…”

Section: Gbs Immunotherapeutic Approachesmentioning

confidence: 99%

The usefulness of immunotherapy in pediatric neurodegenerative disorders: A systematic review of literature data

Vitaliti

Tabatabaie

Matin

et al. 2015

Human Vaccines & Immunotherapeutics

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“…Also, GBS does not respond to treatment with steroids (Hughes, Newsom-Davis et al 1978, Hughes, Swan et al 2010. Finally, most autoimmune diseases show a clear genetic link to immune genes -most commonly HLA -which has not been consistently demonstrated in…”

Section: Gbs -An Autoimmune Disease?mentioning

confidence: 98%

“…However, treatment for GBS differs markedly from that of other autoimmune diseases. For example, GBS does not respond to oral or intravenous corticosteroids, and such therapy might even be harmful (Hughes, Newsom-Davis et al 1978, Hughes, Swan et al 2010). …”

Section: Treatmentmentioning

confidence: 99%

Immunogenetic studies of Guillain - Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy

Blum¹

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Guillain-Barre syndrome (GBS) is an acute inflammatory neuropathy that is frequently triggered by an infectious illness. It is thought to be autoimmune in origin, but differs from other autoimmune diseases in being of male predominance and not showing a HLA-association.Chronic inflammatory demyelinating polyradiculoneuropathy is a chronic inflammatory neuropathy, which shares some pathological features with GBS.We investigated the clinical features of GBS in an Australian cohort of subjects by performing a retrospective chart review. We obtained subjects from several public hospitals and private neurologists in Queensland and New South Wales.We found 335 patients, for 228 of whom electrophysiological data was available. Of these acute inflammatory demyelinating polyradiculoneuropathy (AIDP) with 168 cases was the most common form, whilst axonal and focal forms were rarer. We identified upper respiratory tract infections, occurring predominantly in winter months, as the most frequently named triggering factor for GBS.The illness severity in our cohort was similar to that in earlier Australian studies.Also, we identified a cohort of 78 subjects fulfilling diagnostic criteria for CIDP from similar sources.We investigated a possible underlying genetic susceptibility to develop GBS or CIDP by contacting members of this cohort and collecting their DNA. We embarked on both a candidate gene approach to investigate the killer immunoglobulin-like receptors (KIRs) and their HLA ligands, as well as performing a genome-wide association study (GWAS) of the subjects with GBS as a hypothesis-free method.For the KIR/HLA system, whilst no significant differences were detected in the frequency of KIR genes, HLA-C2 and HLA-B Bw4-T were more frequent in subjects with GBS than controls (p<0.001). The inhibitory pairs of KIR-2DL2/HLA-C2 and KIR-3DL1/HLA-B Bw4-T were more frequent in GBS than controls (p<0.005). Whilst there were some differences between CIDP subjects and controls, interestingly, there were no difference between subjects with GBS and CIDP.This could point to similarities of pathogenesis between these two inflammatory neuropathies.A GWAS was performed on a largely identical cohort of 190 subjects with GBS. Whilst this cohort is relatively small for a modern GWAS and no genome-wide significant results were expected, we were able to identify a number of regions of interest based on clusters of SNPs in linkage disequilibrium of increased significance. These included rs10519519 on Chromosome 2, which is associated with MYT1L, a transcription factor in neuronal development; rs7663689 on Chromosome 4, which is in the promotor region of IL15; rs11151180 on Chromosome 18 which is in a gene-free region; rs17095496 on Chromosome 14, which amongst other genes is associated with DACT1, which encodes a regulator of cell division involved in the NF-κB pathway; and rs2302524 on chromosome 19, associated among other genes with NFKBIB, which encodes an inhibitor of the NF-κB pathway. Relative negatives included the HLA region, a...

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Corticosteroids for Guillain-Barré syndrome

Abstract: Editorial group: Cochrane Neuromuscular Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 8, 2012.

Cited by 83 publications

References 22 publications

A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options A Centre’s Experience

A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options A Centre’s Experience

The usefulness of immunotherapy in pediatric neurodegenerative disorders: A systematic review of literature data

Immunogenetic studies of Guillain - Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy

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Corticosteroids for Guillain-Barré syndrome

Abstract: Editorial group: Cochrane Neuromuscular Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 8, 2012.

Cited by 83 publications

References 22 publications

A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options  A Centre’s Experience

A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options  A Centre’s Experience

The usefulness of immunotherapy in pediatric neurodegenerative disorders: A systematic review of literature data

Immunogenetic studies of Guillain - Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy

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Product

Resources

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A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options A Centre’s Experience

A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options A Centre’s Experience