著者: W H Geerts, J A Heit, G P Clagett, G F Pineo, C W Colwell, F A Anderson, H B Wheeler
雑誌名: Chest. 2001 Jan;119(1 Suppl):132S-175S.
Abstract/Text
PMID
11157647 Chest. 2001 Jan;119(1 Suppl):132S-175S.
著者: A K Asbury, D R Cornblath
雑誌名: Ann Neurol. 1990;27 Suppl:S21-4.
Abstract/Text
Criteria for the diagnosis of Guillain-Barré syndrome are reaffirmed. Electrodiagnostic criteria are expanded and specific detail added.
PMID
2194422 Ann Neurol. 1990;27 Suppl:S21-4.
著者: Fabienne Krauer, Maurane Riesen, Ludovic Reveiz, Olufemi T Oladapo, Ruth Martínez-Vega, Teegwendé V Porgo, Anina Haefliger, Nathalie J Broutet, Nicola Low, WHO Zika Causality Working Group
雑誌名: PLoS Med. 2017 Jan;14(1):e1002203. doi: 10.1371/journal.pmed.1002203. Epub 2017 Jan 3.
Abstract/Text
BACKGROUND: The World Health Organization (WHO) stated in March 2016 that there was scientific consensus that the mosquito-borne Zika virus was a cause of the neurological disorder Guillain-Barré syndrome (GBS) and of microcephaly and other congenital brain abnormalities based on rapid evidence assessments. Decisions about causality require systematic assessment to guide public health actions. The objectives of this study were to update and reassess the evidence for causality through a rapid and systematic review about links between Zika virus infection and (a) congenital brain abnormalities, including microcephaly, in the foetuses and offspring of pregnant women and (b) GBS in any population, and to describe the process and outcomes of an expert assessment of the evidence about causality.
METHODS AND FINDINGS: The study had three linked components. First, in February 2016, we developed a causality framework that defined questions about the relationship between Zika virus infection and each of the two clinical outcomes in ten dimensions: temporality, biological plausibility, strength of association, alternative explanations, cessation, dose-response relationship, animal experiments, analogy, specificity, and consistency. Second, we did a systematic review (protocol number CRD42016036693). We searched multiple online sources up to May 30, 2016 to find studies that directly addressed either outcome and any causality dimension, used methods to expedite study selection, data extraction, and quality assessment, and summarised evidence descriptively. Third, WHO convened a multidisciplinary panel of experts who assessed the review findings and reached consensus statements to update the WHO position on causality. We found 1,091 unique items up to May 30, 2016. For congenital brain abnormalities, including microcephaly, we included 72 items; for eight of ten causality dimensions (all except dose-response relationship and specificity), we found that more than half the relevant studies supported a causal association with Zika virus infection. For GBS, we included 36 items, of which more than half the relevant studies supported a causal association in seven of ten dimensions (all except dose-response relationship, specificity, and animal experimental evidence). Articles identified nonsystematically from May 30 to July 29, 2016 strengthened the review findings. The expert panel concluded that (a) the most likely explanation of available evidence from outbreaks of Zika virus infection and clusters of microcephaly is that Zika virus infection during pregnancy is a cause of congenital brain abnormalities including microcephaly, and (b) the most likely explanation of available evidence from outbreaks of Zika virus infection and GBS is that Zika virus infection is a trigger of GBS. The expert panel recognised that Zika virus alone may not be sufficient to cause either congenital brain abnormalities or GBS but agreed that the evidence was sufficient to recommend increased public health measures. Weaknesses are the limited assessment of the role of dengue virus and other possible cofactors, the small number of comparative epidemiological studies, and the difficulty in keeping the review up to date with the pace of publication of new research.
CONCLUSIONS: Rapid and systematic reviews with frequent updating and open dissemination are now needed both for appraisal of the evidence about Zika virus infection and for the next public health threats that will emerge. This systematic review found sufficient evidence to say that Zika virus is a cause of congenital abnormalities and is a trigger of GBS.
PMID
28045901 PLoS Med. 2017 Jan;14(1):e1002203. doi: 10.1371/journal･･･
著者: Inés González-Suárez, Irene Sanz-Gallego, Francisco Javier Rodríguez de Rivera, Javier Arpa
雑誌名: BMC Neurol. 2013 Jul 22;13:95. doi: 10.1186/1471-2377-13-95. Epub 2013 Jul 22.
Abstract/Text
BACKGROUND: Guillain-Barre syndrome (GBS) is characterized by acute onset and progressive course, and is usually associated with a good prognosis. However, there are forms of poor prognosis, needing ventilatory support and major deficits at discharge. With this study we try to identify the factors associated with a worse outcome.
METHODS: 106 cases of GBS admitted in our hospital between years 2000-2010 were reviewed. Epidemiological, clinical, therapeutical and evolutionary data were collected.
RESULTS: At admission 45% had severe deficits, percentage which improves throughout the evolution of the illness, with full recovery or minor deficits in the 87% of patients at the first year review. Ages greater than 55 years, severity at admission (p < 0.001), injured cranial nerves (p = 0.008) and the needing of ventilator support (p = 0.003) were associated with greater sequels at the discharge and at the posterior reviews in the following months. 17% required mechanical ventilation (MV). Values < 250 L/min in the Peak Flow-test are associated with an increased likelihood of requiring MV (p < 0.001).
CONCLUSIONS: Older age, severe deficits at onset, injured cranial nerves, requiring MV, and axonal lesion patterns in the NCS were demonstrated as poor prognostic factors. Peak Flow-test is a useful predictive factor of respiratory failure by its easy management.
PMID
23876199 BMC Neurol. 2013 Jul 22;13:95. doi: 10.1186/1471-2377-1･･･
著者: James J Sejvar, Katrin S Kohl, Jane Gidudu, Anthony Amato, Nandini Bakshi, Roger Baxter, Dale R Burwen, David R Cornblath, Jan Cleerbout, Kathryn M Edwards, Ulrich Heininger, Richard Hughes, Najwa Khuri-Bulos, Rudolf Korinthenberg, Barbara J Law, Ursula Munro, Helena C Maltezou, Patricia Nell, James Oleske, Robert Sparks, Priscilla Velentgas, Patricia Vermeer, Max Wiznitzer, Brighton Collaboration GBS Working Group
雑誌名: Vaccine. 2011 Jan 10;29(3):599-612. doi: 10.1016/j.vaccine.2010.06.003. Epub 2010 Jun 18.
Abstract/Text
PMID
20600491 Vaccine. 2011 Jan 10;29(3):599-612. doi: 10.1016/j.vacc･･･
著者: T W Ho, B Mishu, C Y Li, C Y Gao, D R Cornblath, J W Griffin, A K Asbury, M J Blaser, G M McKhann
雑誌名: Brain. 1995 Jun;118 ( Pt 3):597-605.
Abstract/Text
Guillain-Barré syndrome has been considered to be primarily an acute inflammatory demyelinating polyneuropathy (AIDP). Our experience with Guillain-Barré syndrome in northern China differs from the traditional concept. Electrophysiologically and pathologically, most of our patients have motor axonal degeneration with minimal cellular inflammation, which we have termed 'acute motor axonal neuropathy' (AMAN). The current studies were undertaken to characterize prospectively the clinical, electrophysiological, and serological features of Guillain-Barré syndrome, defined clinically, in northern China. In 1991 and 1992, we characterized by electrodiagnostic criteria 129 Chinese patients with Guillain-Barré syndrome. The AMAN form was present in 65% of patients, the AIDP form in 24% and 11% were unclassifiable. For the 38 patients who presented from January to October, 1992, we performed serological assays for antibodies to Campylobacter jejuni and to glycolipids. Of these 38 patients, 55% had AMAN, 32% had AIDP and 13% were unclassifiable. Sixty-six percent of the 38 had serological evidence of recent C. jejuni infection as compared with 16% of village controls (P = 0.001). Seventy-six percent of AMAN patients and 42% of AIDP patients were seropositive. IgG anti-GM1 antibodies were more frequent in Guillain-Barré syndrome patients compared with village controls (42% versus 6%; P < 0.01). However, no statistically significant correlations were found between the pattern of disease, AMAN or AIDP, anti-glycolipid antibodies, or C. jejuni antibodies. Based on electrophysiological criteria, Guillain-Barré syndrome in northern China can be divided into two predominant forms: AIDP and AMAN. The AMAN form is more common and predominates in the yearly summer outbreaks of Guillain-Barré syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID
7600081 Brain. 1995 Jun;118 ( Pt 3):597-605.
著者: M Färkkilä, E Kinnunen, E Haapanen, M Iivanainen
雑誌名: Neurology. 1987 May;37(5):837-40.
Abstract/Text
A prospective, controlled study with quantitative measurement of hand muscle-force for plasma exchange treatment in acute Guillain-Barré polyradiculitis was done. Of the 29 patients with severe symptoms, every second patient was selected to the plasma exchange group and all others to the control group. The muscle forces increased and CSF protein decreased significantly more in the plasma exchange group than in the control group, but there were no differences in hospitalization or recovery periods.
PMID
3553986 Neurology. 1987 May;37(5):837-40.
著者:
雑誌名: Neurology. 1985 Aug;35(8):1096-104.
Abstract/Text
We compared plasmapheresis with conventional therapy in 245 patients with the Guillain-Barré syndrome of recent onset. Statistically significant differences, favoring the plasmapheresis group, were found in terms of improvement at 4 weeks, time to improve one clinical grade, time to independent walking, and outcome at 6 months. Plasmapheresis was not effective for all patients, but was particularly effective for patients who received this treatment within 7 days of onset and for patients who required mechanical ventilation after entry into the study. Plasmapheresis appears to be of benefit in patients with Guillain-Barré syndrome of recent onset.
PMID
4022342 Neurology. 1985 Aug;35(8):1096-104.
著者:
雑誌名: Ann Neurol. 1987 Dec;22(6):753-61. doi: 10.1002/ana.410220612.
Abstract/Text
The goals of this multicenter controlled trial were: (1) to study the short-term effect of plasma exchange in the Guillain-Barré syndrome when applied alone within 17 days of onset of the disease; and (2) to compare two replacement fluids, diluted albumin and fresh frozen plasma (FFP) with regard to efficacy and morbidity. Two hundred twenty patients were included, 111 in the control group, 109 in the plasma exchange group, 57 of whom were assigned to receive albumin and 52 to receive fresh frozen plasma. Treatment consisted of four plasma exchanges of two plasma volumes each, initiated on the day of randomization and repeated on alternate days. Significant short-term benefits appeared in the group that received plasma exchange as demonstrated by the reduction in the proportion of patients who required assisted ventilation after randomization, and the decrease in time before beginning weaning from ventilator, time to onset of motor recovery, and time to walk with and without assistance. No statistically significant difference was found between the group that received albumin and the group that received fresh frozen plasma. Incidents during exchanges and complications related to the plasma exchange were more frequent in patients who received fresh frozen plasma. Plasma exchange is beneficial in Guillain-Barré syndrome when it is carried out early in the course of the disease. Given its risks and the lack of its clear superiority over albumin, however, we recommend that fresh frozen plasma be abandoned in the treatment of Guillain-Barré syndrome.
PMID
2893583 Ann Neurol. 1987 Dec;22(6):753-61. doi: 10.1002/ana.410･･･
著者:
雑誌名: Ann Neurol. 1997 Mar;41(3):298-306. doi: 10.1002/ana.410410304.
Abstract/Text
Plasma exchange (PE) is the standard treatment in Guillain-Barré syndrome (GBS) patients who have lost the ability to walk. The effect of exchanges before this stage and the optimal number of exchanges for the other patients are still unknown. We randomized 556 GBS patients according to severity and number of exchanges as follows: Zero versus 2 PEs for patients who could walk-with or without aid-but not run, or who could stand up unaided (mild group); 2 versus 4 PEs for patients who could not stand up unaided (moderate group); and 4 versus 6 PEs for mechanically ventilated patients (severe group). In the mild group, 2 PEs were more effective than none for time to onset of motor recovery (median, 4 vs 8 days, respectively). In the moderate group, 4 PEs were more beneficial than 2 for time to walk with assistance (median, 20 vs 24 days) and for 1-year full muscle-strength recovery rate (64% vs 46%). Six PEs were no more beneficial than 4 in the severe cases. Patients with mild GBS on admission should receive 2 PEs. Patients with moderate and severe forms should benefit from 2 further exchanges.
PMID
9066350 Ann Neurol. 1997 Mar;41(3):298-306. doi: 10.1002/ana.41･･･
著者: H S Patwa, V Chaudhry, H Katzberg, A D Rae-Grant, Y T So
雑誌名: Neurology. 2012 Mar 27;78(13):1009-15. doi: 10.1212/WNL.0b013e31824de293.
Abstract/Text
OBJECTIVE: To assess the evidence for the efficacy of IV immunoglobulin (IVIg) to treat neuromuscular disorders.
METHODS: The MEDLINE, Web of Science, and EMBASE databases were searched (1966-2009). Selected articles were rated according to the American Academy of Neurology's therapeutic classification of evidence scheme; recommendations were based on the evidence level.
RESULTS AND RECOMMENDATIONS: IVIg is as efficacious as plasmapheresis and should be offered for treating Guillain-Barré syndrome (GBS) in adults (Level A). IVIg is effective and should be offered in the long-term treatment of chronic inflammatory demyelinating polyneuropathy (Level A). IVIg is probably effective and should be considered for treating moderate to severe myasthenia gravis and multifocal motor neuropathy (Level B). IVIg is possibly effective and may be considered for treating nonresponsive dermatomyositis in adults and Lambert-Eaton myasthenic syndrome (Level C). Evidence is insufficient to support or refute use of IVIg in the treatment of immunoglobulin M paraprotein-associated neuropathy, inclusion body myositis, polymyositis, diabetic radiculoplexoneuropathy, or Miller Fisher syndrome, or in the routine treatment of postpolio syndrome or in children with GBS (Level U). IVIg combined with plasmapheresis should not be considered for treating GBS (Level B). More data are needed regarding IVIg efficacy as compared with other treatments/treatment combinations. Most studies concluded IVIg-related serious adverse effects were rare. Given the variable nature of these diseases, individualized treatments depending on patient need and physician judgment are important.
PMID
22454268 Neurology. 2012 Mar 27;78(13):1009-15. doi: 10.1212/WNL･･･
著者: V Bril, W K Ilse, R Pearce, A Dhanani, D Sutton, K Kong
雑誌名: Neurology. 1996 Jan;46(1):100-3.
Abstract/Text
We compared intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) in the treatment of 50 patients with Guillain-Barré syndrome (GBS). Standard outcome measures did not differ for the two groups. Sixty-one percent of the PLEX-treated group and 69% of the IVIG-treated group improved by one disability grade at 1 month. The complication rate was higher in the PLEX-treated group. We conclude that the efficacy of IVIG in the treatment of GBS is comparable with that of PLEX and that it can be used safely, although we had a small number of patients. We did not observe a higher relapse rate with IVIG. The usefulness of combination therapy is unknown at this time.
PMID
8559353 Neurology. 1996 Jan;46(1):100-3.
著者:
雑誌名: Lancet. 1997 Jan 25;349(9047):225-30.
Abstract/Text
BACKGROUND: The relative efficacy of plasma exchange (PE) and intravenous immunoglobulin (IVIg) for the treatment of Guillain-Barré syndrome has not been established. We compared PE with IVIg, and with a combined regimen of PE followed by IVIg, in an international, multicentre, randomised trial of 383 adult patients with Guillain-Barré syndrome.
METHODS: The patients were randomly assigned PE (five 50 mL/kg exchanges over 8-13 days), IVIg (Sandoglobulin, 0.4 g/kg daily for 5 days), or the PE course immediately followed by the IVIg course. The inclusion criteria were severe disease (aid needed for walking) and onset of neuropathic symptoms within the previous 14 days. Patients were followed up for 48 weeks.
FINDINGS: Four patients were excluded because they did not meet the randomisation criteria. All the remaining 379 patients were assessed for the major outcome criterion-change on a seven-point disability grade scale-by an observer unaware of treatment assignment, 4 weeks after randomisation. At that time, the mean improvement was 0.9 (SD 1.3) in the 121 PE-group patients, 0.8 (1.3) in the 130 IVIg-group patients, and 1.1 (1.4) in the 128 patients who received both treatments (intention-to-treat analysis). None of the differences between the groups for this major outcome criterion was significant. The difference between PE alone and IVIg alone was so small that a 0.5 grade difference was excluded at the 95% level of confidence. There was no significant difference between any of the treatment groups in the secondary outcome measures: time to recovery of unaided walking, time to discontinuation of ventilation, and trend describing the recovery from disability up to 48 weeks. There was a non-significant trend towards a more favourable outcome on some outcome measures with combined treatment.
INTERPRETATION: In treatment of severe Guillain-Barré syndrome during the first 2 weeks after onset of neuropathic symptoms, PE and IVIg had equivalent efficacy. The combination of PE with IVIg did not confer a significant advantage.
PMID
9014908 Lancet. 1997 Jan 25;349(9047):225-30.
Diener HC, Haupt WF, Kloss TM, Rosenow F, Philipp T, Koeppen S, Vietorisz A. A preliminary, randomized, multicenter study comparing intravenous immunoglobulin, plasma exchange, and immune adsorption in Guillain-Barré syndrome. Eur Neurol [Internet]. Eur Neurol; 2001 [cited 2020 Jul 2];46(2):107–109. Available from: https://pubmed.ncbi.nlm.nih.gov/11528165/
著者: S Kuwabara, M Nakajima, I Moroo, K Hirayama
雑誌名: Rinsho Shinkeigaku. 1996 Feb;36(2):289-92.
Abstract/Text
We studied the effect of double filtration and immunoadsorption plasmapheresis in Guillain-Barré syndrome retrospectively in 70 patients. Thirty three patients had plasmapheresis, of whom 23 had double filtration and 10 immunoadsorption. The rest of 37 patients consisted of a control group. Clinical disability was evaluated using the functional grading scale by Hughes. In patients having a maximum disability of grade 4 and 5, the double filtration plasmapheresis group showed statistically significant improvement at 3 months after the treatment. There was no significant difference in prognoses between the immunoadsorption plasmapheresis and control groups. In mildly-illed patients having grade 2 and 3, the prognoses were not different between the three groups. In Guillain-Barré syndrome, double filtration plasmapheresis, as well as well-established plasma exchange, had benefit for severely-illed patients.
PMID
8752682 Rinsho Shinkeigaku. 1996 Feb;36(2):289-92.
著者: T Araki, H Nakata, S Kusunoki, Y Arai, Y Katayama
雑誌名: Rinsho Shinkeigaku. 2000 Oct;40(10):979-85.
Abstract/Text
Immunoadsorption therapy (IAT) using TR-350 was performed for 14 patients with Guillain-Barré syndrome (GBS). Presence of serum antiganglioside antibodies (AGA) was investigated in all the patients in the acute phase. In 14 patients studied, 6 men and 8 women, ages from 24 to 74 years(mean, 42.5 years), 7 patients had suffered from common cold and 3 from diarrhea before neurological onset. Ophthalmoplegia was seen in 6 patients, facial palsy in 6, bulbar palsy in 3 and cerebellar sign in 2. Functional grade scores (FGS) by Hughes et al. of the patients were from 5 to 1 (mean, 3.3). In 4 patients, whose FGS were 1 or 2, IAT were performed, because of worsting of bulbar palsy, bilateral facial palsy and limb weakness. Relapse occurred in one patient. IAT was started from 2 to 18 days (mean, 8.4) after neurological onset and performed 3 to 14 times (mean, 7.5) for each patient. Mean FGS improved from 3.3 to 2.1 after IAT. The mean time to improve 1 grade was 10.3 days and mean time to improve 2 grades was 39.0 days. The mean FGS after 1 month was 1.4 and that after 3 months was 0.4. Some of 14 patients had elevated titers of AGA in sera in the acute phase. Four patients had anti-GQ1b IgG antibody and showed external ophthalmoplegia. One patient with anti-GD1b IgG antibody had cerebellar signs as well as peripheral neuropathy. Those AGAs decreased after IAT in parallel with improvement. IAT is an effective treatment in acute phase of GBS.
PMID
11296374 Rinsho Shinkeigaku. 2000 Oct;40(10):979-85.
著者: N K Singh, A Gupta
雑誌名: J Assoc Physicians India. 1996 Jan;44(1):22-4.
Abstract/Text
Forty-six patients of Guillain-Barre' Syndrome were randomized to receive either prednisolone (40 mg daily for 2 weeks and then tapered off) or placebo. The patients were followed up for 6 months and were assessed on an objective scale of disability. The improvement in mean disability grade was significantly better at 2 weeks and 4 weeks in the placebo group as compared to those who received corticosteroids. The difference persisted at 24 weeks, but was statistically insignificant. A greater proportion of patients in the placebo group had improved by at least 1 disability grade at all points of time. The group of patients treated with steroids took twice as long to improve by 1 disability grade as compared to those in the placebo group. At 6 months, 41.7% of the patients in the steroid group had recovered almost completely (good outcome) as compared to 54.5% of the patients is the placebo group. Corticosteroids, therefore, do not appear to benefit GBS patients, and may in fact, delay the recovery from acute illness.
PMID
8773088 J Assoc Physicians India. 1996 Jan;44(1):22-4.
著者:
雑誌名: Lancet. 1993 Mar 6;341(8845):586-90.
Abstract/Text
Steroids have been beneficial in the treatment of demyelinating diseases with features similar to those of Guillain-Barré syndrome (GBS). However, steroid treatment of GBS has been disappointing; in an earlier trial oral prednisolone was ineffective, although the dose was low and the sample small. We assessed the benefit of a high-dose steroid regimen in a large sample of patients with GBS in a multicentre, randomised, double-blind trial. 242 adult patients were randomised to receive intravenous methylprednisolone (IVMP) 500 mg (124 patients) or a placebo (118) daily for 5 days. Patients were diagnosed by standard clinical criteria and entered the trial within 15 days of onset of neurological symptoms. All patients were too weak to run. Some patients received plasma exchange depending on the practice of their centre. Disability was graded on a scale from 0 (healthy) to 6 (dead) at intervals for 48 weeks. There was no significant difference in any outcome variable between patients treated with IVMP and those given placebo. The most important outcome was the difference between the groups in disability grade 4 weeks after randomisation, which was only a 0.06 grade (95% Cl -0.23 to 0.36) greater improvement in the IVMP than the placebo group. The 39 patients in the IVMP group who required ventilation did so for a median of 18 days, 9 days fewer than the 44 patients who had a placebo and required ventilation (95% Cl -9.6 to 27.6). Median time to walk unaided was 38 days in the IVMP patients and 50 days in the placebo patients (difference 12 days, (95% Cl -21.3 to 45.3). A short course of high-dose IVMP given early in GBS is ineffective.
PMID
8094828 Lancet. 1993 Mar 6;341(8845):586-90.
著者: R van Koningsveld, P I M Schmitz, F G Avander Meché, L H Visser, J Meulstee, P A van Doorn, Dutch GBS study group
雑誌名: Lancet. 2004 Jan 17;363(9404):192-6.
Abstract/Text
BACKGROUND: Despite available treatment with intravenous immunoglobulin (IVIg), morbidity and mortality are considerable in patients with Guillain-Barré syndrome (GBS). Our aim was to assess whether methylprednisolone, when taken with IVIg, improves outcome when compared with IVIg alone.
METHODS: We did a double-blind, placebo-controlled, multicentre, randomised study, to which we enrolled patients who were unable to walk independently and who had been treated within 14 days after onset of weakness with IVIg (0.4 g/kg bodyweight per day) for 5 days. We assigned 233 individuals to receive either intravenous methylprednisolone (500 mg per day; n=116) or placebo (n=117) for 5 days within 48 h of administration of first dose of IVIg. Because age is an important prognostic factor, we split treatment groups into two age-groups-ie, younger than age 50 years, or 50 years and older. Our primary outcome was an improvement from baseline in GBS disability score of one or more grades 4 weeks after randomisation. Analysis was by intention to treat.
FINDINGS: We analysed 225 patients. GBS disability scores increased by one grade or more in 68% (76 of 112) of patients in the methylprednisolone group and in 56% (63 of 113) of controls (odds ratio [OR] 1.68, 95% CI 0.97-2.88; p=0.06). After adjustment for age and degree of disability at entry, treatment OR was 1.89 (95% CI 1.07-3.35; p=0.03). Side-effects did not differ greatly between groups.
INTERPRETATION: We noted no significant difference between treatment with methylprednisolone and IVIg and IVIg alone. Because of the relevance of prognostic factors and the limited side-effects of methylprednisolone, the potential importance of combination treatment with the drug and IVIg, however, warrants further investigation.
PMID
14738791 Lancet. 2004 Jan 17;363(9404):192-6.
著者: M Tripathi, S Kaushik
雑誌名: Crit Care Med. 2000 Mar;28(3):655-8.
Abstract/Text
OBJECTIVE: To evaluate carbamezapine (CBZ) for neuritic pain relief in Guillain-Barré syndrome (GBS) patients in the intensive care unit (ICU).
DESIGN: Prospective, double-blind, randomly allocated cross-over study days.
SETTING: ICU in a tertiary care university hospital.
PARTICIPANTS: Twelve consecutive, conscious adult (22-54 yrs) patients with GBS during recovery from the muscular weakness and receiving pressure-support ventilation in the ICU. All patients complained of severe backache and/or leg cramps and tenderness in muscles, and they required opioids for pain relief.
INTERVENTIONS: CBZ (100 mg every 8 hrs) or equivalent placebo was given to nursing staff in coded powder form. Medication was given to patients through a nasogastric feeding tube. The same coded medicine was given for 3 days, and after a 1-day omission, a second set of coded powder was given for the next 3 days in a randomized, double-blind, crossover fashion. Pethidine (1 mg x kg(-1)) was given intravenously in between, if the pain score was >2. Group 1 (n = 6) patients were given a placebo on the first 3 days, followed by CBZ. Group 2 (n = 6) patients were given CBZ on the first 3 days, followed by a placebo.
MEASUREMENTS AND MAIN RESULTS: In these two study periods of different medications, we observed and scored pain (1, no pain; 5, severe pain), sedation (1, alert; 6, asleep, does not respond to verbal command), and total pethidine requirement per day. In group 1 patients, a significant (p < .001) improvement in the sedation score and a low requirement for pethidine was observed 3 days later, when CBZ was started. However, in group 2 patients, a gradual increase in the pethidine requirement and a high sedation score were noteworthy in the later days of placebo medication. Observations were also analyzed for CBZ days vs. placebo days. Overall, the pain score (1.7 +/- 0.8) during the CBZ period of both regimens was significantly (p < .001) lower than during the placebo days (3.1 +/- 0.9). Significantly higher doses of pethidine (3.7 +/- 0.9 mg/kg/day) were used on the placebo days than on the CBZ days (1.7 +/- 1.0 mg/kg/day).
CONCLUSION: The pain in GBS has a dual origin, and we recommend CBZ as an adjuvant to treat pain in GBS patients, during the recovery phase in the ICU, to reduce the narcotic requirement.
PMID
10752810 Crit Care Med. 2000 Mar;28(3):655-8.
著者: N Attal, G Cruccu, R Baron, M Haanpää, P Hansson, T S Jensen, T Nurmikko, European Federation of Neurological Societies
雑誌名: Eur J Neurol. 2010 Sep;17(9):1113-e88. doi: 10.1111/j.1468-1331.2010.02999.x. Epub 2010 Apr 9.
Abstract/Text
BACKGROUND AND OBJECTIVES: This second European Federation of Neurological Societies Task Force aimed at updating the existing evidence about the pharmacological treatment of neuropathic pain since 2005.
METHODS: Studies were identified using the Cochrane Database and Medline. Trials were classified according to the aetiological condition. All class I and II randomized controlled trials (RCTs) were assessed; lower class studies were considered only in conditions that had no top-level studies. Treatments administered using repeated or single administrations were considered, provided they are feasible in an outpatient setting.
RESULTS: Most large RCTs included patients with diabetic polyneuropathies and post-herpetic neuralgia, while an increasing number of smaller studies explored other conditions. Drugs generally have similar efficacy in various conditions, except in trigeminal neuralgia, chronic radiculopathy and HIV neuropathy, with level A evidence in support of tricyclic antidepressants (TCA), pregabalin, gabapentin, tramadol and opioids (in various conditions), duloxetine, venlafaxine, topical lidocaine and capsaicin patches (in restricted conditions). Combination therapy appears useful for TCA-gabapentin and gabapentin-opioids (level A).
CONCLUSIONS: There are still too few large-scale comparative studies. For future trials, we recommend to assess comorbidities, quality of life, symptoms and signs with standardized tools and attempt to better define responder profiles to specific drug treatments.
PMID
20402746 Eur J Neurol. 2010 Sep;17(9):1113-e88. doi: 10.1111/j.1･･･
著者: Sibel Ozbudak Demir, Füsun Köseoğlu
雑誌名: Disabil Rehabil. 2008;30(8):593-9. doi: 10.1080/09638280701352626.
Abstract/Text
PURPOSE: To compare the health-related quality of life (HRQOL) in control subjects and patients with severe Guillain-Barré syndrome (GBS) 6 months after rehabilitation. To determine the relationship of several sociodemographic and medical factors with the HRQOL of the GBS survivors.
METHODS: Thirty-one patients with severe GBS and 31 control subjects were included in the study. Demographic and medical variables were recorded. The functional outcome was measured using the Functional Independence Measure (FIM), both at admission and discharge and also at the 6-month follow-up examination. The HRQOLs were assessed by the Nottingham Health Profile (NHP) at the 6-month follow-up examination.
RESULTS: There were significant improvements in functional status as measured by the FIM at discharge and also at 6 months. The scores of all of the NHP dimensions of the GBS patients were significantly higher than in the control subjects. Functional disability scores were highly related to the energy level, physical mobility and emotional reactions of the NHP domains. Education, gender, employment, mechanical ventilation and tendency to depression were the factors most related to the NHP domains. Age and marital status showed no significant correlation with the NHP scores.
CONCLUSION: The HRQOL of the GBS patients remains lower than that of the control subjects. In addition to functional scores, several sociodemographic and medical variables, such as education, psychological factors, gender, mechanical ventilation and employment may play a crucial role in determining the quality of life in persons with GBS.
PMID
17852306 Disabil Rehabil. 2008;30(8):593-9. doi: 10.1080/0963828･･･
