Current treatment practice of Guillain-Barré syndrome

Verboon, C. et al. (2019) Current treatment practice of Guillain-Barré syndrome. Neurology, 93(1), e59-e76. (doi: 10.1212/WNL.0000000000007719) (PMID:31175208)

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Abstract

Objective: To define the current treatment practice of Guillain-Barré syndrome (GBS). Methods: The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. Results: We excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE. Conclusions: In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.

Item Type:Articles
Additional Information:This study is funded by the GBS-CIDP Foundation International, Gain, Erasmus MC University Medical Centre Rotterdam, Glasgow University, CSL Behring, Grifols, and Annexon.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Davidson, Dr Amy and Willison, Professor Hugh
Authors: Verboon, C., Doets, A. Y., Galassi, G., Davidson, A., Waheed, W., Péréon, Y., Shahrizaila, N., Kusunoki, S., Lehmann, H. C., Harbo, T., Monges, S., Van den Bergh, P., Willison, H. J., Cornblath, D. R., and Jacobs, B. C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Neurology
Publisher:American Academy of Neurology
ISSN:0028-3878
ISSN (Online):1526-632X
Published Online:07 June 2019
Copyright Holders:Copyright © 2019 American Academy of Neurology
First Published:First published in Neurology 93(1):e59-e76
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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