Prediction of Early Beneficial Response to Plasma Exchange in Guillain-Barre Syndrome

Gruener, Gregory; Bosch, E. Peter; Strauss, Ronald G.; Klugman, Marie; Kimura, Jun

doi:10.1001/archneur.1987.00520150043019

Cited by 31 publications

(13 citation statements)

References 22 publications

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“…Our study is in agreement with others [2,5,7,8,10,15,21,28] in showing that an early decrease in distal CMAP amplitude and/or EMG signs of acute denervation, both reflecting pre-existing axonal degeneration, were associated with a poor outcome; however, this has been disproved by Smith and Hughes [26]. In our series, this prognostic factor applied mainly to adults (bad outcome in 85% of adults and 50% of children), which concurs with the study of Bradshaw and Jones [6], who concluded that the above electrodiagnostic criteria that predict a bad outcome in adult GBS may not apply to childhood GBS.…”

Section: Discussionsupporting

confidence: 94%

“…improvement by 1 grade or more at 4 weeks, our study shows, in agreement with most uncontrolled [14,19] and controlled [9,11,15,16,21,26] series, that PE is more likely to be helpful if begun early and pursued vigorously (see Table 4). improvement by 1 grade or more at 4 weeks, our study shows, in agreement with most uncontrolled [14,19] and controlled [9,11,15,16,21,26] series, that PE is more likely to be helpful if begun early and pursued vigorously (see Table 4).…”

Section: Discussionsupporting

confidence: 85%

“…As already reported in most other series [4,10,15,21,24,27,28] there was a poor correlation in our patients between the amount of CSF protein and/or cells and the degree of functional disability.…”

Section: Discussionsupporting

confidence: 66%

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Guillain-barré syndrome: A series observed at riyadh armed forces hospital january 1984–January 1994

1996

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A consecutive series of 47 hospitalized cases of Guillain-Barre syndrome seen over a 10-year period was analysed with respect to: (1) age and sex; (2) antecedent events and seasonal distribution; (3) patterns of clinical presentation; (4) CSF and neurophysiological findings; (5) results of treatment with plasma exchange; and (6) outcome. Twenty-two were children, 20 middle-aged and 5 aged; 37 were male and 10 were female. The most frequent antecedent event was upper respiratory tract infections; a seasonal peak incidence was found in winter. Clinical, CSF and neurophysiological findings concurred with those in the Western literature; 79% of the cases were severe. Plasma exchange performed within the first 2 weeks of onset benefitted in the short-term outcome, i.e. improvement by 1 grade at 4 weeks, but the long-term benefit, i.e. the ability to regain independent locomotion, was questionable. Plasma exchange helped in curtailing the time to walking unaided but had no benefit on the duration of artificial ventilation. Factors associated with an adverse outcome were: age over 15 years, severity of motor electrodiagnostic findings (especially a decreased distal CMAP amplitude and EMG signs of acute denervation), requirement for ventilation and slow progression (>3 weeks) to maximum deficit. After a mean follow-up of 11 months, 55% of the patients regained independent locomotion, which is a comparatively low proportion.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 85%

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Guillain-barré syndrome: A series observed at riyadh armed forces hospital january 1984–January 1994

1996

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“…Improvement percentage for second category minus improvement percentage for first Category. (Gruener et al, 1987;Miller et af., 1988). This wide variation may be explained by several factors.…”

Section: Discussionmentioning

confidence: 99%

“…Electrophysiologically demyelination is reflected by lower amplitudes of evoked motor responses with conduction block and slowed conduction (Brown et al, 198 1 ;McLeod, 198 1 ;Brown and Feasby, 1984;Albers et al, 1985;Kimura et al, 1988;van der Mecht et al, 1988). Several studies have indicated that low CMAPs are associated with a poor clinical outcome (Gruener et al, 1987;Cornblath et al, 1988;McKahn et al, 1988;Miller et al, 1988;Winer et al, 1988). In these reports electrodiagnostic studies were not always performed at similar stages of the disease.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of electrodiagnosis in the Dutch Guillain–Barré study

Meulstee

Meché

Kleyweg

et al. 1995

Euro J of Neurology

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In the Dutch Guillain-Barré trial, three EMGs were performed according to a rigid protocol at early stages of the disease in 147 Guillain-Barré patients who were unable to walk independently. Independent locomotion 8 weeks and 6 months after entry were considered to be the outcome measures of most clinical value. Electrodiagnostic data obtained 1 week after entry were concluded to be most important for studying prognostic value. This has been attributed to the fact that 87% of the patients were in the nadir of their disease at that moment In univariate analysis, CMAP amplitudes of thenar and hypothenar muscles obtained after distal and proximal stimulation, as well as the recruitment pattern on maximal voluntary effort in these tested muscles, were significant predictors for outcome 8 weeks and 6 months after entry to the study. Motor nerve conduction velocity and distal motor latencies of ulnar and median nerves were weak predictors for outcome at 8 weeks after entry. In multivariate analysis the hypothenar CMAP amplitude on distal stimulation and recruitment pattern of abductor digiti minimi muscle both had an independent predictive value for independent locomotion 8 weeks after entry.

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Therapeutic apheresis in neurological disorders

Weinstein

2000

J. Clin. Apheresis

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Prediction of Early Beneficial Response to Plasma Exchange in Guillain-Barre Syndrome

Cited by 31 publications

References 22 publications

Guillain-barré syndrome: A series observed at riyadh armed forces hospital january 1984–January 1994

Guillain-barré syndrome: A series observed at riyadh armed forces hospital january 1984–January 1994

Prognostic value of electrodiagnosis in the Dutch Guillain–Barré study

Therapeutic apheresis in neurological disorders

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