http://repub.eur.nl/res/aut/12255/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/8783/ 1998-01-01T00:00:00Z 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-Barre syndrome. Clinical, laboratory, and electrodiagnostic features of all 16 patients with Guillain-Barre 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-Barre 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-Barre 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-Barre syndrome who are at risk for treatment related fluctuations. http://repub.eur.nl/res/pub/18141/ 1997-05-14T00:00:00Z The Guillain-Barre syndrome (GBS) is a heterogeneous disease. The literature dealing with the clinical pattern, prognosis and therapy of GBS is reviewed in the first Chapter. New studies may define subgroups within the clinically defined syndrome on the basis of clinicaL epidemiological, electrophysiological, pathological, microbiological Of immunological criteria. The data obtained during the Dutch GBS study evaluating the effect of intravenous immune globulins (IVlg) in comparison with plasma exchange (PE) gave the opportunity to further investigate the clinical symptoms and the laboratory features of 147 GBS patients; a general summary of these features is given in Chapter 2. The first ain1 of this thesis was to evaluate whether clinical subgroups of GBS are prcscnt~ to describe the clinical features in relation to the antecedent infections, clectrodiagnostic and immunologic parameters and to evaluate treatment effect (PE or JVIg) in these subgroups. In Chapter 3 the clinical pattern of acute motor neuropathy and its relation with C(lmpy/obtlcterjejuni (c. jejlllJl) infection is described, while in Chapter 4 cytomegalovirus related GBS features are presented. In Chapter 5 the clinical and immunological differences between C jejuni induced acute motor-sensory neuropathy and C. jejulli induced acute motor neuropathy are described and discussed. Not only the clinical pattern is variable, but also the clinical course and outcome. The second objective was to identif}T prognostic factors related with outcome of GBS and to assess whether there are differences in prognostic factors between IVlg and PE treatment. The selection of patients with a poor prognosis may be helpful for future therapeutic studies (Chapter 6). One of these new therapies may be the combination of IVIg together with intravenous methylprednisolone (MP). Therefore, the third aim was to evaluate whether this combined treatment was more efFective than IVIg alone (Chapter 7). Finally, 8 to 10% of the GBS patients experience a secondary deterioration after IVIg, MP-IVIg or PE treatment. Since it is important to know who are at risk for such fluctuations we assessed the risk factors for these treatment related fluctuations in GBS patients (Chapter 8). A general discussion of the findings with recommendations for further research is given in Chapter 9.