Hyperacute or fulminant GBS is when the maximal incapacity or the nadir is reached within a day or two .
Electrophysiological study have demonstrated increased distal latencies on nerve conduction evaluation and conduction blocks on the 4 limbs. Reduced sensory action potentials were also observed
Do someone has experience with the long-term evolution of a GBS despite IV-Ig therapy and plasmaphereses, the patient did not improve and had a persistent respiratory failure at 3 month after symptom onset
There are write a lot about your acute period, but there is little or almost nothing about long-term evolution
Hello. In such cases either repeated Plasma exchange followed by additive therapies as cyclophosphamide or rituximab might be useful. What does CSF reveal?
Cerebral spinal fluid examination showed 20 lymphocytes/mm3 and increased protein level to 1.97 g/L with normal glucose values.
In our case we used Plasma exchange ( 7 ) and intravenous immunoglobulin therapy gammaglobilina. The patient not recovered and 1 year later recovered cephalic control and trunk control
Lift arms but he is not able to move fingers
No bipedestation
In such cases we often use Cyclophosphamide. However after one year it could be helpful to perform muscle imaging and EMG to look how much recovery Potential might be left. Further imaging of the Roots and CSF reanalysis might help to look whether there is still Inflammation going on. If not, immunosupressive Medication might not help anymore. Best regards
OK, I will do Further imaging of the Roots and CSF reanalysis
Thanks
Best Regards
What experience do you have in this pathology? Long term outcome in hyperacute Guillain Barre?
i`m afraid I have no good experience , I remember one case with this evolution and no recover at all or a very torpid course
Dear Marta,
This population based study from Iceland might be of interest (1). At follow-up, 13% of GBS-patients still required a walking aid, but most survivors (74%) had minor or no symptoms. In patients requiring ventilation support, however, outcome is mostly unfavorable (2). I hope this helps...
Best regards,
Raoul
1. Hafsteinsdóttir B, Ólafsson E, Jakobsson F. Acta Neurol Scand. 2018 Nov;138(5):454-458.
2. van den Berg B, Storm EF, Garssen MJP, et al. J Neurol Neurosurg Psychiatry. 2018 Sep;89(9):949-954.