Timing of intravenous immunoglobulin treatment and outcome in Guillain-Barré syndrome: Is time nerve?

Autor: Min YG; Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.; Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea., Hong YH; Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.; Department of Neurology, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea., Rajabally YA; Aston Medical School, School of Health and Life Sciences, Birmingham, UK., Sung JJ; Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.; Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.; Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jazyk: angličtina
Zdroj: Muscle & nerve [Muscle Nerve] 2024 Dec; Vol. 70 (6), pp. 1215-1222. Date of Electronic Publication: 2024 Oct 03.
DOI: 10.1002/mus.28271
Abstrakt: Introduction/aims: Despite treatment, a considerable proportion of patients with Guillain-Barré syndrome (GBS) experience poor recovery, highlighting a therapeutic need. There is a lack of evidence that treatment timing affects recovery. This study aims to investigate the effects of intravenous immunoglobulin (IVIg) timing on disability and speed of recovery in GBS.
Methods: We performed a retrospective study of 136 IVIg-treated GBS patients admitted to two Korean centers between 2010 and 2021. We analyzed the effect of time to IVIg on the GBS disability scale (GBS-DS) and the degree of improvement from nadir (∆GBS-DS) at 1, 3, 6, and 12 months, as well as the time to regain the ability to walk or run unaided. Time to IVIg was treated either as a continuous variable or categorized into 1-week intervals to explore critical time windows. Known prognostic factors, the modified Erasmus GBS Outcome Scores on admission and pre-treatment serum albumin levels were adjusted as covariates.
Results: Shorter time to IVIg was independently associated with better GBS-DS, greater ∆GBS-DS, and shorter time to walk or run unaided at all time points. The therapeutic effect of IVIg was notably diminished when administered beyond the first 2 weeks of onset.
Discussion: Our study highlights the timing of IVIg as a modifiable prognostic factor in GBS. The earlier IVIg is initiated, the better the outcomes, with the ideal time window being within the first 2 weeks. These findings underscore the importance of prompt diagnosis and early intervention to optimize recovery in GBS patients.
(© 2024 The Author(s). Muscle & Nerve published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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