Long-term outcome in patients with Guillain–Barré syndrome requiring mechanical ventilation

Fletcher, Dade D.; Lawn, Nicholas; Wolter, Troy D.; Wijdicks, Eelco F. M.

doi:10.1212/wnl.54.12.2311

Cited by 167 publications

(118 citation statements)

References 22 publications

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“…However, this pattern of improvement is consistent with observations of recovery from poliovirus infection, in which most strength gains occur within 6 months ( 3 ). Persons with GBLS experienced complete or near complete recovery, a commonly reported outcome of this syndrome ( 4 ). Facial weakness was associated with favorable prognosis; however, resolution of weakness took >5 months in some cases.…”

Section: Discussionmentioning

confidence: 99%

West Nile Virus–associated Flaccid Paralysis Outcome

Sejvar

Bode

Marfin

et al. 2006

Emerg. Infect. Dis.

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Section: Discussionmentioning

confidence: 99%

West Nile Virus–associated Flaccid Paralysis Outcome

Sejvar

Bode

Marfin

et al. 2006

Emerg. Infect. Dis.

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“…1,2 Although most patients start to recover spontaneously within 2 weeks after the maximum weakness is reached, symptoms that range from fatigue to complete paralysis of the lower limbs often persist. [3][4][5] Various treatments have been investigated based on the immune-mediated and inflammatory nature of the disease. The first randomised controlled trial 6 of a treatment for GBS was published in 1978, and noted no significant benefit of monotherapy with low-dose, oral prednisolone, and the results of a study published in 1993 7 showed no significant favourable effect at 4 weeks after randomisation of treatment with high-dose, intravenous methylprednisolone.…”

Section: Introductionmentioning

confidence: 99%

“…13,14 Despite these treatment options, however, the disease remains a serious one associated with great, longlasting morbidity. 5,15,16 There is a need, therefore, to develop new treatments. A positive treatment effect with prednisone in chronic inflammatory demyelinating polyneuropathy, a closely related illness to GBS, has been established, 17,18 and the results of a pilot study 19 on the effect of high-dose intravenous methylprednisolone when given as an add-on therapy to standard treatment with IVIg indicate a beneficial effect of this combination of drugs in patients with GBS, as measured with the GBS disability score.…”

Section: Introductionmentioning

confidence: 99%

Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial

Koningsveld¹,

Schmitz²,

Meché³

et al. 2004

The Lancet

329

197

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SummaryBackground Despite available treatment with intravenous immunoglobulin (IVIg), morbidity and mortality are considerable in patients with Guillain-Barré syndrome (GBS). Our aim was to assess whether methylprednisolone, when taken with IVIg, improves outcome when compared with IVIg alone.Methods We did a double-blind, placebo-controlled, multicentre, randomised study, to which we enrolled patients who were unable to walk independently and who had been treated within 14 days after onset of weakness with IVIg (0·4 g/kg bodyweight per day) for 5 days. We assigned 233 individuals to receive either intravenous methylprednisolone (500 mg per day; n=116) or placebo (n=117) for 5 days within 48 h of administration of first dose of IVIg. Because age is an important prognostic factor, we split treatment groups into two age-groups-ie, younger than age 50 years, or 50 years and older. Our primary outcome was an improvement from baseline in GBS disability score of one or more grades 4 weeks after randomisation. Analysis was by intention to treat.Findings We analysed 225 patients. GBS disability scores increased by one grade or more in 68% (76 of 112) of patients in the methylprednisolone group and in 56% (63 of 113) of controls (odds ratio [OR] 1·68, 95% CI 0·97-2·88; p=0·06). After adjustment for age and degree of disability at entry, treatment OR was 1·89 (95% CI 1·07-3·35; p=0·03). Side-effects did not differ greatly between groups.Interpretation We noted no significant difference between treatment with methylprednisolone and IVIg and IVIg alone. Because of the relevance of prognostic factors and the limited side-effects of methylprednisolone, the potential importance of combination treatment with the drug and IVIg, however, warrants further investigation.

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“…In fact, young patients may recover normal function despite prolonged ventilation. Older age and delayed transfer to a tertiary center have been identified as independent predictors of poor prognosis among ventilated patients with GBS [62]. Fig.…”

Section: Prognosismentioning

confidence: 99%

Guillain-Barre Syndrome

Rabinstein¹

2007

TOGMJ

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Guillain-Barré syndrome (GBS) is caused by an inflammatory polyradiculoneuropathy, which most commonly results from acute demyelination produced by a CD4 T-cell mediated response against myelin proteins. Axonal forms have also been recognized. Molecular mimicry between components of the bacterial wall of Campylobacter jejuni and gangliocytes in the membranes of peripheral axons may be responsible for some cases of axonal GBS. Immune therapy with plasma exchange or intravenous immunoglobulin is the standard of care for the treatment of patients with acute GBS. This review summarizes available information regarding the pathophysiology, clinical manifestations, therapeutic considerations, and prognosis of this disorder.

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Long-term outcome in patients with Guillain–Barré syndrome requiring mechanical ventilation

Abstract: Mechanically ventilated patients constitute the majority of GBS patients with a poor outcome, and mortality remains substantial in this subgroup (20%). Although recovery from severe GBS may be prolonged, most survivors regain independent ambulation.

Cited by 167 publications

References 22 publications

West Nile Virus–associated Flaccid Paralysis Outcome

West Nile Virus–associated Flaccid Paralysis Outcome

Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial

Guillain-Barre Syndrome

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