The Guillain-Barre Syndrome: Clinical subgroups, prognosis and treatment Clinical subgroups, prognosis and treatment

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.

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