Abstract Details

Title Predictive factors of Treatment-related fluctuations in patients with Guillain-Barre syndrome

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P12 - Poster Session 12 (12:00 PM-1:00 PM)

Poster/Presentation
Number 1-011

Objective To analyze predictive factors for the development of Treatment-related fluctuations (TRFs) in patients with Guillain-Barre syndrome (GBS).

Background TRFs in patients with GBS are defined as clinical deterioration within two months of symptom onset occurring after initial stabilization or improvement. It occurs in 5-26% of patients.

Design/Methods Clinical records of adult patients with GBS diagnosed at our institution between January/2006 - July/2019 were retrospectively reviewed. Demographic characteristics, clinical manifestations, treatment and long-term disability of patients with and without TRFs were compared.

Results A total of 124 patients with GBS were included, 7 of whom (5.6%) presented TRFs. Patients with TRFs had a higher frequency of mononucleosis-like syndrome preceding GBS (28.57% vs. 8.55%; p=0.0141), neuropathic pain (100% vs. 60%; p = 0.03), gastrointestinal symptoms (42.86% vs. 12.82%; p=0.02) and hyperhidrosis (28.57% vs. 6.84%; p=0.04). Patients initially treated with plasma exchange (PE) had a modest higher frequency of TRFs (14.29% vs. 1.70%; p=0.0349); those treated with intravenous immunoglobulin (IVIG) did not show significant differences (p=0.67). Combined treatment (71.43% vs. 4.27%; p<0.001) and steroid use (42.86% vs. 1.71%; p<0.001) were more frequent in the group with TRFs. Patients with TRFs had a significantly worse median disability score at the time of admission (4 vs. 2; p=0.01), without differences at 6 (p=0.08) and 12 months (p=0.86).

Conclusions GBS cases triggered by mononucleosis-like syndrome and those with a higher initial disability score were more likely to have TRFs. Despite this, long-term outcome appears not to be worse for those patients. Our experience suggests TRFs were slightly more frequent in patients treated with PE. Addition of steroids to IVIG treatment could be an option, however further studies are required to evaluate the efficacy in this select group of patients

Authors/Disclosures
Juan I. Castiglione, MD (FLENI) PRESENTER	Dr. Castiglione has nothing to disclose.
Lucas Alessandro, Sr., MD (FLENI)	Dr. Alessandro has nothing to disclose.
Patricio Brand, MD (FLENI)	Dr. Brand has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen.
Veronica A. Bruno, MD (University of Calgary Foothills)	Dr. Bruno has nothing to disclose.
Fabio Adrian Barroso, MD	Fabio Adrian Barroso, MD has nothing to disclose.

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Abstract Details