The acute autoimmune polyneuropathy...

The acute autoimmune polyneuropathy known as Guillain-Barre syndrome (GBS) is the greatest in quantity common cause of flaccid paralysis in make knowned countries and has an incidence rate of 1 to 15 by 100,000 persons. Most patients regain spontaneously within two weeks; however, symptoms, including paralysis, persist in a significant minority of patients. Standard treatment is based forward intravenous immunoglobulin plus supportive therapy. After mixed be deriveds from clinical trials, a Cochrane review conclud that corticosteroids provided no benefit in the management of GB Positive proceeds from trials of high-dose intravenous methylprednisolone in the treatment of other polyneuropathies l van Koningsveld and colleagues to studious mood this treatment as an adjunctive therapy in GBS

The authors recruited patients who had been admitted to 32 European health care center athwart a six-year period with confirmed GB that eventuateed in a score of at least 3 in succession a standardized disability rating scale. Patients had to be at least six years of age and to have had no prior episodes of GB serious harmonizing conditions, or contraindications to the investigation treatments. The initial assessment included extensive testing of descendants urine, and cerebrospinal fluid to shield for abnormalities and alternative explanations of symptoms.

The 233 participants were randomly assigned to treatment after stratification for age because prognosis in GB is eagerly related to age. All patients received intravenous immunoglobulin (04 g by kg for five days) and 116 patients also received 500 mg of intravenous methylprednisolone (children received 80 mg by kg) for five days. The remaining 117 patients received an equivalent bulk of saline as placebo. The patients were assessed weekly for eight weeks for cranial coolness dysfunction, GBS disability score, and a limb muscle function score (using the Medical Research Council sumscore). Patients were assessed each other week between weeks 9 and 14 then monthly until week 26 Patients were then reassessed individual year after entry to the inquiry The primary end point was improvement in GB disability score from baseline.

Overall, improvement of single or more grades on the GB score was recorded in 76 patients (68 percent) treated with methylprednisolone and 63 patients (56 percent) in the sway group. The difference did not quite achieve statistical significance (P = 06) in the intention to treat analysis. When proceeds were based only on patients who adhered to the protocol, improvement was recorded in 71 patients (70 percent) in the treatment collection and 58 patients (56 percent) in the bridle group. This difference was statistically significant (P = 03) The sum of two units treatment groups did not differ significantly in seven measures of secondary result (see accompanying table).

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After adjustments for age and stage of disability, the odds ratio for treatment was 189 The clusters did not differ significantly in adverse ends Four patients in the ascendency group and six in the treatment cluster died. Urinary tract infections disentangleed in 30 percent of patients in the reign over group and 16 percent in the treatment cluster Significant rises in serum grape-sugar levels were noted in 21 percent of patients in the treatment cluster compared with 6 percent in the have the direction of group. Hypertension was reported in 13 percent of patients in the rule group compared with 2 percent in the treatment group

The authors finish that adjunct therapy with high-dose methylprednisolone did not provide consistent significant benefit in patients with GB who received intravenous immunotherapy. Nevertheless, they believe the sum of two units treatments could be synergistic in selecteded patients and call for more research to identify subgroup of patients with GB who could benefit from combination therapy.

Van Koningsveld R et al. efficiency of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barre syndrome: randomised trial. Lancet January 17 2004;363:192-6

COPYRIGHT 2004 American Academy of Family Physicians

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