Risk factors for treatment related clinical fluctuations in Guillain-Barré syndrome
- aDepartment of Neurology, Erasmus Medical Center Rotterdam, The Netherlands, bPresent address for Dr LH Visser: Department of Neurology, St Elizabeth Hospital, Tilburg, The Netherlands
- Professor FGA van der Meché, Department of Neurology, University Hospital Rotterdam, Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Telephone 0031 10 4633327; fax 0031 10 4633208.
- Received 4 March 1997
- Revised 7 October 1997
- Accepted 16 October 1997
The risk factors for treatment related clinical fluctuations, relapses occurring after initial therapeutic induced stabilisation or improvement, were evaluated in a group of 172 patients with Guillain-Barré syndrome. Clinical, laboratory, and electrodiagnostic features of all 16 patients with Guillain-Barré syndrome with treatment related fluctuations, of whom 13 were retreated, were compared with those who did not have fluctuations. No significant differences were found between patients with Guillain-Barré syndrome treated with plasma exchange and patients treated with intravenous immune globulins either alone or in combination with high dose methylprednisolone. None of the patients with Guillain-Barré syndrome with preceding gastrointestinal illness, initial predominant distal weakness, acute motor neuropathy, or anti-GM1 antibodies showed treatment related fluctuations. On the other hand patients with fluctuations showed a trend to have the fluctuations after a protracted disease course. It is therefore suggested that treatment related clinical fluctuations are due to a more prolonged immune attack. There is no indication that the fluctuations are related to treatment modality. The results of this study may help the neurologist to identify patients with Guillain-Barré syndrome who are at risk for treatment related fluctuations.