PMID- 20396937
OWN - NLM
STAT- MEDLINE
DCOM- 20101101
LR  - 20220408
IS  - 1573-2592 (Electronic)
IS  - 0271-9142 (Print)
IS  - 0271-9142 (Linking)
VI  - 30 Suppl 1
IP  - Suppl 1
DP  - 2010 May
TI  - IVIG treatment and prognosis in Guillain-Barre syndrome.
PG  - S74-8
LID - 10.1007/s10875-010-9407-4 [doi]
AB  - INTRODUCTION: Guillain-Barre syndrome (GBS) is an acute, immune-mediated 
      polyneuropathy that often leads to severe weakness. Intravenous immunoglobulin 
      (IVIG) is a proven effective treatment for GBS (class 1 evidence). However, about 
      25% of patients need artificial ventilation and 20% are still unable to walk 
      unaided after 6 months. Important clinical factors associated with poor outcome 
      are age, presence of preceding diarrhea and the severity of disability in the 
      early course of disease. These clinical factors were combined in a clinical 
      prognostic scoring scale, the Erasmus GBS Outcome Scale (EGOS). MATERIALS AND 
      METHODS: GBS patients being unable to walk unaided are currently treated with a 
      standard single IVIg dose (0.4 g/kg bodyweight for 5 days). A recent 
      retrospective study in 174 GBS patients enrolled in one of our randomized 
      controlled clinical trials showed that patients with a minor increase of serum 
      IgG level after standard single IVIg dose recovered significantly slower. 
      Additionally, fewer patients reached the ability to walk unaided at six months 
      after correction for the known clinical prognostic factors (multivariate 
      analysis; P < 0.022). DISCUSSION: It is yet unknown why some GBS patients only 
      have a minor increase after standard IVIg treatment. By using the EGOS it is 
      possible to select GBS patients with a poor prognosis. These patients potentially 
      may benefit from a second IVIg dose. CONCLUSION: A standard dose of IVIG is not 
      sufficiently effective in many GBS patients. Whether these patients might benefit 
      from a second IVIg dose needs further investigation.
FAU - van Doorn, Pieter A
AU  - van Doorn PA
AD  - Department of Neurology, Erasmus MC, University Medical Center Rotterdam, room BA 
      450, s-Gravendijkwal 230, Rotterdam, The Netherlands. p.a.vandoorn@erasmusmc.nl
FAU - Kuitwaard, Krista
AU  - Kuitwaard K
FAU - Walgaard, Christa
AU  - Walgaard C
FAU - van Koningsveld, Rinske
AU  - van Koningsveld R
FAU - Ruts, Liselotte
AU  - Ruts L
FAU - Jacobs, Bart C
AU  - Jacobs BC
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Netherlands
TA  - J Clin Immunol
JT  - Journal of clinical immunology
JID - 8102137
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Animals
MH  - Campylobacter Infections/complications
MH  - Campylobacter jejuni/immunology
MH  - Combined Modality Therapy
MH  - Complement Activation
MH  - Cross Reactions
MH  - Disease Progression
MH  - Disease Susceptibility
MH  - Dose-Response Relationship, Immunologic
MH  - Guillain-Barre Syndrome/complications/immunology/microbiology/*therapy
MH  - Humans
MH  - Immunoglobulins, Intravenous/adverse 
      effects/immunology/pharmacokinetics/*therapeutic use
MH  - Mice
MH  - Molecular Mimicry
MH  - Paralysis/etiology
MH  - Plasma Exchange
MH  - Prognosis
MH  - Rabbits
MH  - Randomized Controlled Trials as Topic
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC2883091
COIS- B.C. Jacobs received an honorarium from Baxter for consultancy. P.A. van Doorn 
      received an unrestricted departmental research grant from Baxter to conduct a 
      randomized controlled trial comparing Gammagard S/D with Kiovig in CIDP, and to 
      conduct an RCT comparing Gammagard S/D with or without methylprednisolone in GBS. 
      He also has received personal and departmental payments for consultancy/RCT board 
      participation from Talecris Biotherapeutics, ZLB Plasma Germany, Baxter, and 
      Octapharma AG. The other authors have no conflicts of interest to disclose.
EDAT- 2010/04/17 06:00
MHDA- 2010/11/03 06:00
PMCR- 2010/04/16
CRDT- 2010/04/17 06:00
PHST- 2010/04/17 06:00 [entrez]
PHST- 2010/04/17 06:00 [pubmed]
PHST- 2010/11/03 06:00 [medline]
PHST- 2010/04/16 00:00 [pmc-release]
AID - 9407 [pii]
AID - 10.1007/s10875-010-9407-4 [doi]
PST - ppublish
SO  - J Clin Immunol. 2010 May;30 Suppl 1(Suppl 1):S74-8. doi: 
      10.1007/s10875-010-9407-4.