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Risk factors for treatment related clinical fluctuations in Guillain-Barré syndrome
  1. LH Vissera,
  2. FGA van der Mechéa,
  3. J Meulsteea,
  4. PA van Doorna,
  5. the Dutch Guillain-Barré study group
  1. aDepartment of Neurology, Erasmus Medical Center Rotterdam, The Netherlands, bPresent address for Dr LH Visser: Department of Neurology, St Elizabeth Hospital, Tilburg, The Netherlands
  1. 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.


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.

  • Guillain-Barré syndrome
  • risk factors
  • treatment related fluctuations
  • treatment
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