Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study

Verboon, Christine; Harbo, Thomas; Cornblath, David R.; Hughes, Richard; Doorn, Pieter A. van; Lunn, Michael P.; Gorson, Kenneth C.; Barroso, Fabio; Kuwabara, Satoshi; Galassi, Giuliana; Lehmann, Helmar C.; Kusunoki, Susumu; Reisin, Ricardo; Binda, Davide; Cavaletti, Guido; Jacobs, Bart C.

doi:10.1136/jnnp-2020-325815

Cited by 12 publications

(5 citation statements)

References 27 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Bulbar dysfunction predicted respiratory failure in several studies [4–10, 15–18, 20, 23–27, 33, 36]. Our study confirms bulbar and neck weakness as significant predictors of MV.…”

Section: Discussionsupporting

confidence: 82%

“…Guillain−Barré syndrome (GBS) is a rapidly progressive, auto-immune polyradiculoneuropathy [1][2][3][4][5][6][7]. During the acute phase, patients may develop respiratory failure, eventually requiring mechanical ventilation (MV) [2,[4][5][6][7][8][9][10][11][12][13][14]. Early prediction of respiratory insufficiency is important to correctly triage the patients for appropriate level of care and to prevent complications related to delayed intubation [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Galassi,

Mazzoli,

Ariatti

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

Background and purposeThe study aimed to identify predictors of respiratory failure leading to mechanical ventilation (MV) and tracheostomy in Guillain−Barré syndrome (GBS).MethodsTwo hundred and thirty adult cases admitted to the Neurology Unit of Modena, Italy, between January 2000 and December 2021 were studied. A cut‐off of MV starting within 8 weeks from onset of weakness was used. Univariable, multivariable logistic and Cox regression analyses were used to determine which pre‐specified clinical and diagnostic characteristics were capable of predicting MV and tracheostomy, due to weaning failure. The model was internally validated within the full cohort. The Erasmus GBS Respiratory Insufficiency Score was retrospectively applied.ResultsOne hundred and seventy‐six cases (76.5%) were classified as classical sensorimotor GBS and 54 (23.4%) as variants. Thirty‐two patients (13.9%) needed MV: 84.3% required respiratory support within 7 days. Independent predictors of respiratory failure and MV were older age, facial, bulbar, neck flexor weakness, dysautonomia, axonal electrophysiological subtype, cardiovascular comorbidities and higher disability score at entry. There was no association with abnormal spinal fluid parameters nor with positive serology for recent infections. Twenty‐two patients (68.7%) were ventilated for more than 7 days; 4.7% died within 8 weeks. The patients who required MV were treated more often with plasma exchange. Independent predictors of tracheostomy due to weaning trial failure were facial, bulbar, neck flexor weakness, autonomic dysfunction, associated cardiovascular morbidities and axonal electrophysiological subtype on nerve conduction study.ConclusionsOur study indicates distinct predictors of MV and tracheostomy in GBS patients.

show abstract

“…Bulbar dysfunction predicted respiratory failure in several studies [4–10, 15–18, 20, 23–27, 33, 36]. Our study confirms bulbar and neck weakness as significant predictors of MV.…”

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Galassi,

Mazzoli,

Ariatti

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

show abstract

“…It is a worthy reminder that, except for KD [4,7], ITP [3,4,8,9], CIDP [4,10], MMN [4,11] and GBS [12][13][14], HD-IVIG is currently off-label for all the other immune-dysregulation disorders, such as RA, JIA, SLE, LN, CAPS, HLH, and MIS-C, playing generally a minor but non-negligible role [4].…”

Section: Discussionmentioning

confidence: 99%

“…Immunoglobulins are currently employed according to an approved indication by both the European Medicine Agency (EMA) and the Food and Drug Administration (FDA) [3][4][5][6] in the following pediatric disorders: KD in the acute phase [4,7], primary immune thrombocytopenia (ITP) [3,4,8,9], chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) [4,10] and MMN [4,11]. GBS deserves a separate discussion, as HD-IVIG utilization for its treatment is approved by the EMA but not by the FDA, despite being strongly recommended by evidenced-based medicine in severe forms presenting with an inability to walk independently [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Anti-Inflammatory and Immunomodulatory Effect of High-Dose Immunoglobulins in Children: From Approved Indications to Off-Label Use

Conti,

Moratti,

Leonardi

et al. 2023

Cells

View full text Add to dashboard Cite

Background: The large-scale utilization of immunoglobulins in patients with inborn errors of immunity (IEIs) since 1952 prompted the discovery of their key role at high doses as immunomodulatory and anti-inflammatory therapy, in the treatment of IEI-related immune dysregulation disorders, according to labelled and off-label indications. Recent years have been dominated by a progressive imbalance between the gradual but constant increase in the use of immunoglobulins and their availability, exacerbated by the SARS-CoV-2 pandemic. Objectives: To provide pragmatic indications for a need-based application of high-dose immunoglobulins in the pediatric context. Sources: A literature search was performed using PubMed, from inception until 1st August 2023, including the following keywords: anti-inflammatory; children; high dose gammaglobulin; high dose immunoglobulin; immune dysregulation; immunomodulation; immunomodulatory; inflammation; intravenous gammaglobulin; intravenous immunoglobulin; off-label; pediatric; subcutaneous gammaglobulin; subcutaneous immunoglobulin. All article types were considered. Implications: In the light of the current imbalance between gammaglobulins’ demand and availability, this review advocates the urgency of a more conscious utilization of this medical product, giving indications about benefits, risks, cost-effectiveness, and administration routes of high-dose immunoglobulins in children with hematologic, neurologic, and inflammatory immune dysregulation disorders, prompting further research towards a responsible employment of gammaglobulins and improving the therapeutical decisional process.

show abstract

“…Immunoglobulin therapy, also known as IVIG, plays a pivotal role in this context, involving the intravenous administration of concentrated antibodies derived from human plasma to modulate the immune system's response. Its mechanisms encompass immunomodulation, anti-inflammatory effects, and pathogen neutralization, making it a valuable treatment for autoimmune diseases, immunodeficiency disorders, and certain infections [11]. While its benefits include disease management, potential drawbacks encompass adverse reactions, limited duration of effect, risk of infection transmission, and the possibility of allergic responses [12].…”

Section: Introductionmentioning

confidence: 99%

A Study of Sensory Nerve Conduction in Pre- and Post-immunoglobulin Treatment of Guillain-Barré Syndrome

Shende,

Pawar

2024

Cureus

View full text Add to dashboard Cite

Background: Guillain-Barré syndrome (GBS) is a condition characterized by acute and progressive weakness that impacts the limbs, facial muscles, and bulbar muscles due to acute polyneuro-radiculopathy. Typically, an infection that results in immune-mediated nerve dysfunction is what starts the disease. Patients often encounter paresthesia or discomfort before progressing to muscle weakness, initially in the lower extremities (which may include some proximal components) and subsequently in the upper extremities. The features of polyneuropathy identified during electrophysiology tests, bolstered by evidence of acquired demyelination in the nerve conduction study (NCS), support the clinical diagnosis of GBS. In peripheral neuropathies, NCS often reveals abnormalities in nerve conduction parameters. A specific pattern observed in the sensory nerve conduction study (SNCS), referred to as "sural sparing," signifies that the sural nerve, located near the calf muscles, remains relatively unaffected compared to other sensory nerves. Very few studies have been conducted to investigate improvements in sensory nerve conduction (SNC) parameters before and after intravenous immunoglobulin (IVIG), offering limited clinical correlation for the recovery and prognosis of the disease. The study aimed to observe the NCS parameters of the sensory nerves in both the upper and lower limbs, before and after the infusion of IVIG.Methodology: This study was an observational investigation conducted in the neurophysiology laboratory of the Physiology Department at a rural medical college in central India. Fifty clinically diagnosed cases of GBS aged between 18 and 60 years were referred from the Department of Medicine to the Physiology Department for conducting the NCS. Basic sociodemographic information, along with clinical history, was collected. Subsequently, the RMS EMG EP Mark-II machine was employed to examine the sensory nerve action potentials (SNAPs), such as amplitude (in mV) and conduction velocity (in ms), of the sensory nerves in both the upper and lower limbs before and after IVIG infusion. The IVIG infusion occurs within one week of clinically diagnosing GBS. Following an initial NCS, a second NCS follow-up study was conducted one week after the IVIG infusion to analyze the changing trend in sensory nerves.Results: Upon analysis, no significant correlation was observed between the pre-and post-IVIG SNAPs of the median and ulnar nerves. However, the sural nerve conduction velocity's p-value of 0.033 demonstrated statistical significance, suggesting that the sural nerve is comparatively spared, confirming sural sparing. However, the SNAP of the sensory nerves in GBS patients showed a significant improvement overall, and only NCS quantified the percentage of improvement.Conclusion: According to the study, the NCS of sensory nerves showed a positive change in the parameters examined before and after the infusion of IVIG. This underscores the timely intervention of GBS with IVIG, and conducting the sensory conduction study diligen...

show abstract

Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study

Cited by 12 publications

References 27 publications

Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Predictors of respiratory failure in Guillain−Barré syndrome: a 22 year cohort study from a single Italian centre

Anti-Inflammatory and Immunomodulatory Effect of High-Dose Immunoglobulins in Children: From Approved Indications to Off-Label Use

A Study of Sensory Nerve Conduction in Pre- and Post-immunoglobulin Treatment of Guillain-Barré Syndrome

Contact Info

Product

Resources

About