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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(05): 516-522
DOI: 10.1590/0004-282X-ANP-2021-0226
Articles

Treatment-related fluctuations in Guillain-Barré syndrome: clinical features and predictors of recurrence

Fluctuaciones relacionadas al tratamiento en el Síndrome de Guillain-Barré: características clínicas y predictores de recurrencia
Lucas ALESSANDRO 
1   Raul Carrea Institute for Neurological Research, Department of Neurology, Buenos Aires, Argentina.
,
Juan Ignacio CASTIGLIONE 
1   Raul Carrea Institute for Neurological Research, Department of Neurology, Buenos Aires, Argentina.
,
Patricio BRAND 
2   Raul Carrea Institute for Neurological Research, Department of Neuromuscular, Buenos Aires, Argentina.
,
Veronica BRUNO 
3   University of Calgary, Hotchkiss Brain Institute, Department of Clinical Neurosciences, Calgary, Alberta, Canada.
,
Fabio BARROSO 
2   Raul Carrea Institute for Neurological Research, Department of Neuromuscular, Buenos Aires, Argentina.
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ABSTRACT

Background: A treatment-related fluctuation (TRF) in a patient with Guillain-Barré syndrome (GBS) is defined as clinical deterioration within two months of symptom onset following previous stabilization or improvements with treatment. Objective: To investigate the clinical characteristics and factors that could increase the risk of relapse of GBS in patients with and without TRFs. Methods: Retrospective review of medical records of patients (>18 years) with GBS evaluated between January/2006 and July/2019. Demographic and clinical characteristics, ancillary studies, treatment received, and the clinical course of patients with and without TRFs were analyzed. Results: Overall, 124 cases of GBS were included; seven (5.6%) presented TRFs. GBS-TRF cases were triggered more frequently by infectious mononucleosis (28.57 vs. 8.55%; p=0.01). GBS-TRF were initially treated with plasmapheresis more frequently than those without TRF (14.29 vs. 1.70%; p=0.0349). Combined treatment (71.43 vs. 4.27%; p<0.001) and corticosteroids (42.86 vs. 1.71%; p<0.001) were more commonly used in the GBS-TRF group. GBS-TRF patients presented a higher median initial disability score (4 vs. 2; p=0.01). Conclusions: Patients with GBS triggered by infectious mononucleosis and a high degree of initial disability have higher chances of developing TRFs. Although patients with TRF were treated with plasmapheresis more often, the total number was too low to suggest a link between plasma exchange and TRF.

RESUMEN

Antecedentes: Una fluctuación relacionada al tratamiento (FRT) en un paciente con síndrome de Guillain-Barré (SGB) se define como un deterioro clínico dentro de los dos meses posteriores al inicio de los síntomas después de una estabilización previa o mejoría con el tratamiento. Objetivo: Investigar las características clínicas y los factores que podrían incrementar el riesgo de recaída, comparando pacientes con SGB, con y sin FRT. Métodos: Revisión retrospectiva de historias clínicas de pacientes (>18 años) con SGB evaluados entre enero/2006 y julio/2019. Se analizaron las características demográficas y clínicas, los estudios complementarios, el tratamiento recibido y la evolución clínica de los pacientes con y sin FRT. Resultados: Se incluyeron 124 casos de SGB en el total; 7 (5,6%) presentaron FRT. Los casos de SGB con FRT se desencadenaron con mayor frecuencia por mononucleosis infecciosa (28,57 vs. 8,55%; p=0,01). Los casos de SGB con FRT se trataron inicialmente con plasmaféresis con más frecuencia que aquellos sin FRT (14,29 vs. 1,70%; p=0,0349). El tratamiento combinado (71,43 vs. 4,27%; p<0,001) y los corticosteroides (42,86 vs. 1,71%; p<0,001) se utilizaron con mayor frecuencia en el grupo de SGB con FRT. Los pacientes con FRT presentaron una escala de discapacidad inicial mediana más alta (4 vs. 2; p=0,01). Conclusiones: Aquellos SGB desencadenados por mononucleosis infecciosa y un alto grado de discapacidad inicial tienen una mayor probabilidad de desarrollar FRT. Aunque los pacientes con FRT fueron tratados con plasmaféresis con mayor frecuencia, el número total fue demasiado bajo para sugerir un vínculo entre la plasmaféresis y FRT.

Keywords:

Cytomegalovirus - Herpesvirus 4, Human - Guillain-Barré Syndrome - Infectious Mononucleosis

Palabras claves:

Citomegalovirus - Herpesvirus Humano 4 - Síndrome de Guillain-Barré - Mononucleosis Infecciosa

Authors’ contributions:

LA: collected the data, conceived and designed the analysis, wrote the paper; JIC: collected the data; PB, VB: performed the analysis; FB: conceived and designed the analysis.




Publication History

Received: 11 June 2021

Accepted: 05 August 2021

Article published online:
06 February 2023

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