Risk factors for treatment related clinical fluctuations in Guillain-Barré syndrome

The efficacy of immunomodulatory treatments, either plasma exchange or intravenous immune globulin (IVIg), is now well established in the management of Guillain-Barré syndrome. However, about 5% of patients deteriorate after a period of initial improvement or stabilisation, and two independent reports drew attention to a worryingly high relapse rate after treatment with IVIg.1 2 A second unrelated issue revolved around the severity of disease that required intervention and in particular whether patients should be treated while still ambulant. Cost and safety considerations preclude widespread adoption of this practice, but it is also …