Increasing the incidence of the Guillain-Barre syndrome in Curacao

OBJECTIVE: To confirm an observed increase in the occurrence of Guillain-Barre syndrome (GBS) in patients in Curacao. DESIGN AND METHODS: Between 1987 and 1999, medical records of all patients who fulfilled the National Institute of Neurological Communicative Disorders and Stroke (NINCDS) criteria for GBS were reviewed. RESULTS: Forty-nine patients were diagnosed as GBS resulting in an incidence rate (IR) of 2.53/100,000 inhabitants (95 percent CI 1.87-3.35). From 1987 to 1991, the IR remained stable, whereas from 1992 to 1999, there was a linear increase in the IR. There was a high IR in the colder months and a low IR in the warmer months. Patients showed a low percentage of sensory involvement (17 percent, generally 65 percent), rapid progression of the disease (83 percent, generally 30 percent), high percentage of artificial respiration (31 percent, generally 17 percent) and high mortality rate (23 percent, generally 3-5 percent). Fifty-five percent of the patients reported a preceding gastroenteritis (GE); 9/10 serum samples showed evidence of a recent Campylobacter jejuni infection. CONCLUSIONS: This is the first report of an increase in IR of GBS over a longer period, associated with low percentage of sensory involvement, a more severe course and a high mortality rate. The characteristics suggest a role for C jejuni. Prospective research is needed to show whether the increase in GBS is due to an overall increase in IR of C. jejuni infections on the island.(Au)

High dose immunoglobulins and plasma exchange in the Guillain-Barré Syndrome

The background, design and preliminary results of the Dutch Guillain-Barré trial comparing high-dose immunoglobulins (IgIV) with plasma-exchange (PE) are described. This randomized trial was conservative in that the main aim was to show equal effect of both treatments within certain predefined limits. This approach was appropriate since IgIV is quickly and easily applicable, whereas PE is much more combersome leading to treatment delays and a considerable dropout rate. Moreover PE is not available in all hospitals. For these reasons IgIV would be preferable if the two treatments have a similar effect. We originally estimated that 200 patients would be needed to demonstrate a comparable effect of IgIV and PE (type I error = 0.05 and type II error = o.2). At the interim analysis after 150 patients the stopping criterion has been met. Four weeks after randomization 52.7 per cent in the IgIV group was functionally improved and 34.2 per cent in the PE-group, and advantage of 18.5 per cent for IgIV (p = 0.024)

High dose immunoglobulins and plasma exchange in the Guillain-Barre Syndrome / High dose immunoglobulins and plasma exchange in the Guillain-Barre Syndrome

Apresentamos o desenho metodologico e comunicamos os resultados e comunicamos os resultados iniciais do estudo multicentrico holandes, comparando o tratamento da sindrome de Guillain-Barre com imunoglobulinas humanas endovenosas em altas doses (IgIV) e plasmaferese (PE). O estudo multicentrico e randomico e conservador no sentido de que a principal finalidade e demonstrar um efeito igual de ambas as terapeuticas dentro de certos limites pre-definidos. Esta abordagem foi adequada, uma vez que IgIV e facil e rapidamente aplicavel, enquanto que a PE e terapeutica complexa, o que pode conduzir a demoras e numero insuficiente de sessoes. IgIV seria preferivel se os dois tratamentos tivessem efeito semelhante. Inicialmente estimamos que 200 pacientes seriam necessarios para a demonstracao de efeito comparavel dos dois tratamentos IgIV x PE (erro do tipo I igual 0,05 e do tipo II igual a 0,2). Na analise preliminar, apos o tratamento de 150 pacientes, o criterio de ponto final foi atingido. Quatro semanas apos a randomizacao 52,7 por cento de pacientes no grupo que utilizou PE apresentaram melhora funcional. A diferenca a favor da IgIV foi de 18,5 por cento (P igual 0,024).