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This editorial comments on a large prospective study of GBS in which a second course of intravenous immunoglobulin was unhelpful
In 1988, in the first large-scale prospective study of Guillain-Barré syndrome (GBS), John Winer and colleagues collected and followed 100 patients from the London area.1 A year later, 20% of the patients were still unable to walk, and an additional 13% had died, 10% directly from the disease. The series was probably biased towards more severely affected patients. At that time only supportive treatment was available, plasma exchange was rarely used and intravenous immunoglobulin (IVIg) never. There have been many subsequent prospective studies of GBS but all have now been trumped by the International GBS Outcome Study (IGOS) which has collected more than 1800 patients.2 In an analysis of the first 1000 included patients, 8% were unable to walk and 7% had died after a year, with the prognosis being much worse in Bangladesh than in Europe/the Americas and the rest of Asia.3 It is likely that this study was also biased towards more severe disease as most patients were collected from large referral hospitals: this was confirmed in Denmark where the average severity was less in the population as a whole than in those captured by IGOS.4 In the series of Winer and colleagues, factors which predicted a worse prognosis were rapidity of onset, need for ventilation, older age and small distally evoked compound muscle action potentials.1 A Dutch study of 397 patients identified older age, more severe weakness …
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