RISK-FACTORS FOR TREATMENT RELATED CLINICAL FLUCTUATIONS IN GUILLAIN-BARRE-SYNDROME

The risk factors for treatment related clinical fluctuations, relapses occurring after initial therapeutic induced stabilisation or improvem ent, were evaluated in a group of 172 patients with Guillain-Barre syn drome. Clinical, laboratory, and electrodiagnostic features of all 16 patients with Guillain-Barre syndrome with treatment related fluctuati ons, of whom 13 were retreated, were compared with those who did not h ave fluctuations. No significant differences were found between patien ts with Guillain-Barre syndrome treated with plasma exchange and patie nts treated with intravenous immune globulins either alone or in combi nation With high dose methylprednisolone. None of the patients with Gu illain-Barre syndrome with preceding gastrointestinal illness, initial predominant distal weakness, acute motor neuropathy, or anti-GM1 anti bodies showed treatment related fluctuations, On the other hand patien ts with fluctuations showed a trend to have the fluctuations after a p rotracted disease course. It is therefore suggested that treatment rel ated clinical fluctuations are due to a more prolonged immune attack. There is no indication that the fluctuations are related to treatment modality. The results of this study may help the neurologist to identi fy patients with Guillain-Barre syndrome who are at risk for treatment related fluctuations.