Prognosis in the Guillain-Barré syndrome

We studied 147 patients participating in the multicenter Dutch study for comparasion of the effectiveness of high doses of human immunoglobulin with the effectiveness of plasmapheresis in the Guillain-Barré syndrome in order to determine the influence of the following on the prognosis of the syndrome: age, duration of the disease (ó7 days), artificial respiration, compound muscle action potential (CMAP) < 3mV (20 per cent) - identified as prognostic factors in previous studies - and functional grading, grading by the summation of the Medical Research Council (MRC) scale, anti-GM1 antibodies and positive serology for Campylobacter jejuni - investigated in the present study. The main prognostic criterion was defined as improvement of at least one grade on the scale by the end of the 4th week. The secondary prognostic criterion was defined as the time needed for improvement of one grade and time needed to acquire independent locomotion (F = 2). Functional evaluation was also done in a more subtle manner by measuring muscle strength in 6 individual muscle groups on both sides of the body using the MRC. The factors influencing prognosis are listed below. A change in grading for the better if 1F or more by the end of the fourth week: age, intravenous human immunoglobulin, anti-GM1 antibodies and positive serology for Campylobacter. Time needed for grading to improve for the better by 1F or more: age, CMAP, GM1, summation by the MRC scale. Time needed to reach improvement of 2F: age, GM1, summation by the MRC scale. We are still investigating how the factors determined can be used to predict the time course of each patient individually. At present, we can state that if a patient is less than 50 years old, if no anti-GM1 antibodies are detected and the summation on the MRC scale is above 40, there is a probality of 90 per cent or more that he will succeed in walking unaided before a period of 6 months (functional grade 2). If these 3 factors differ from what has been described above, the probability falls to 30 per cent

High dose immunoglobulins and plasma exchange in the Guillain-Barré Syndrome

The background, design and preliminary results of the Dutch Guillain-Barré trial comparing high-dose immunoglobulins (IgIV) with plasma-exchange (PE) are described. This randomized trial was conservative in that the main aim was to show equal effect of both treatments within certain predefined limits. This approach was appropriate since IgIV is quickly and easily applicable, whereas PE is much more combersome leading to treatment delays and a considerable dropout rate. Moreover PE is not available in all hospitals. For these reasons IgIV would be preferable if the two treatments have a similar effect. We originally estimated that 200 patients would be needed to demonstrate a comparable effect of IgIV and PE (type I error = 0.05 and type II error = o.2). At the interim analysis after 150 patients the stopping criterion has been met. Four weeks after randomization 52.7 per cent in the IgIV group was functionally improved and 34.2 per cent in the PE-group, and advantage of 18.5 per cent for IgIV (p = 0.024)