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

IF 2.8 3区 医学 Q2 CLINICAL NEUROLOGY
Muscle & Nerve Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI:10.1002/mus.28271
Young Gi Min, Yoon-Ho Hong, Yusuf A Rajabally, Jung-Joon Sung
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Abstract

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.

静脉注射免疫球蛋白的时机与格林-巴利综合征的治疗效果:时间就是神经吗?
引言/目的:尽管接受了治疗,但相当一部分吉兰-巴雷综合征(GBS)患者的康复效果不佳,这凸显了治疗的必要性。目前尚无证据表明治疗时机会影响患者的康复。本研究旨在探讨静脉注射免疫球蛋白(IVIg)的时机对 GBS 残疾和康复速度的影响:我们对 2010 年至 2021 年期间韩国两家中心收治的 136 名接受过 IVIg 治疗的 GBS 患者进行了回顾性研究。我们分析了接受 IVIg 治疗的时间对 GBS 残疾量表(GBS-DS)的影响、1、3、6 和 12 个月时从最低点(∆GBS-DS)的改善程度以及恢复独立行走或奔跑能力的时间。使用 IVIg 的时间被视为连续变量,或按 1 周间隔进行分类,以探索关键时间窗。已知的预后因素、入院时的改良伊拉斯谟GBS结果评分和治疗前的血清白蛋白水平作为协变量进行了调整:结果:在所有时间点上,较短的静脉注射时间与较好的GBS-DS、较大的∆GBS-DS和较短的步行或无助跑步时间都有独立关联。如果在发病的头两周后才给药,IVIg 的治疗效果会明显减弱:讨论:我们的研究强调,IVIg 的使用时机是 GBS 的一个可改变预后的因素。讨论:我们的研究强调,IVIg 的用药时机是 GBS 的一个可改变预后的因素。IVIg 用药越早,预后越好,理想的用药时间窗口是发病后的头两周内。这些发现强调了及时诊断和早期干预对优化 GBS 患者康复的重要性。
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来源期刊
Muscle & Nerve
Muscle & Nerve 医学-临床神经学
CiteScore
6.40
自引率
5.90%
发文量
287
审稿时长
3-6 weeks
期刊介绍: Muscle & Nerve is an international and interdisciplinary publication of original contributions, in both health and disease, concerning studies of the muscle, the neuromuscular junction, the peripheral motor, sensory and autonomic neurons, and the central nervous system where the behavior of the peripheral nervous system is clarified. Appearing monthly, Muscle & Nerve publishes clinical studies and clinically relevant research reports in the fields of anatomy, biochemistry, cell biology, electrophysiology and electrodiagnosis, epidemiology, genetics, immunology, pathology, pharmacology, physiology, toxicology, and virology. The Journal welcomes articles and reports on basic clinical electrophysiology and electrodiagnosis. We expedite some papers dealing with timely topics to keep up with the fast-moving pace of science, based on the referees'' recommendation.
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