An acute care guide for medical professionals introduction what is gbs. The international gbs outcome study igos is a new worldwide prognostic study that aims to get further insight in the immunepathophysiology and outcome of gbs, both in children and adults. A clinical prognostic scoring system for guillainbarre syndrome, the modified erasmus guillainbarre syndrome outcome score, has been proposed, 31 and such scales might be helpful to identify. Although the etiology of gbs is not totally understood, infectioninduced aberrant immune response including molecular mimicry and formation of cross reacting antibodies has been implicated in the immunopathogenesis of gbs 1,2.
However, about 25% of patients need artificial ventilation and 20% are still unable to walk unaided after 6 months. Guillainbarre syndrome gbs is a monophasic polyradiculoneuropathy with a highly variable clinical severity and outcome. Prognostic tools include the modified erasmus gbs outcome score megos, erasmus gbs respiratory insufficiency score egris, and the increase in serum igg levels. Methods from the international gbs outcome study, we selected patients whose modified erasmus gbs outcome score at week 1 predicted a poor prognosis. Some gbs patients have a severe course of disease and a slow recovery phase. The erasmus gbs outcome score for the second patient is 4, corresponding to a much better prognosis only 7% 95% ci 510 chance of not walking independently at 6 months. Recovery period varies and may take weeks to years. Recently, in one of these studies a prognostic model was developed, the erasmus gbs outcome score egos, which was based on three clinical characteristics. Patient data were collected at entry, and at weeks 1, 2, and 26, and included gbs disability score, medical research council mrc sum score, and the presence of sensory deficits, facial weakness, and prior diarrhea. Guillain barre syndrome gbs is an acute postinfectious immunemediated peripheral neuropathy with a variable clinical course and outcome. Guillain barre syndrome gbs is a set of clinical syndromes with a common pathophysiological basis, and is usually considered to be an immunemediated disorder of the peripheral nervous system 1, 2. A search service for abbreviation long form abbreviation long form. Gbs patients of 12 years and older with a poor prognosis, based on the modified erasmus gbs outcome score megos at 1 week after start of the first ivig course are eligible for randomization in this double. Guillain barre syndrome gbs is characterized by acute onset and progressive course, and is usually associated with a good prognosis.
Guillainbarre syndrome, more easily called gbs, is a rare disorder of the peripheral nerves typified by rapidly ascending weakness, and often paralysis, evolving usually over days to one to four weeks. Previous studies indicate that outcome in gbs depends on a defined set of clinical, laboratory and electrophysiological features. Gbs disability scoring system erasmus gbs outcome score was also assessed. Whether a second ivig dose is effective in patients with a poor prognosis is not known yet. Using the egos, the chance of walking unaided after 6 months can be. These clinical factors were combined in a clinical prognostic scoring scale, the erasmus gbs outcome scale egos. If you continue browsing the site, you agree to the use of cookies on this website. The primary endpoint, the gbs disability scale at 4 weeks, was assessed with multivariable ordinal regression. Erasmus gbs outcome scale egos can predict outcome. A clinical prognostic scoring system of guillainbarre. Events occurring during the period of hospitalization were noted. Important clinical factors associated with poor outcome are age.
Cocccurrence of guillainbarre syndrome and primary. Gbs is usually characterized by symmetrical flaccid paralysis with areflexia, which usually reaches a maximum severity within four weeks 3, 4. Current state of knowledge slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The erasmus gbs outcome score of the first patient is thus 6, corresponding to a chance of not walking independently at 6 months of 55% 95% ci 4862.
The prognosis at 6 month after discharge was described by modified erasmus gbs outcome score. Outcome in patients with gbs can be determined with the erasmus gbs outcome scale egos. Early recognition of poor prognosis in guillainbarre syndrome. The megos score modified erasmus gbs outcome scale can be used at 1 week, and replaces disability with the medical research council mrc scale for muscle strength score. The clinic gbs severity evaluation scale cgses, a newly established model in our study, was used to explore the role of chief complaints to predict intravenous immunoglobulin ivig. The model presented on this website for determining the prognosis of patients diagnosed with the guillainbarre syndrome is the result of carefully conducted scientific research. However, there are forms of poor prognosis, needing ventilatory support and major deficits at discharge.
Molecular mimicry and a crossreactive immune response play a crucial part in its pathogenesis, at least in those cases with a preceding campylobacter jejuni infection and with antibodies to gangliosides. The usefulness of chief complaints to predict severity. The patientspecific functional scale this useful questionnaire can be used to quantify activity limitation and measure functional outcome for patients with any orthopaedic condition. We compared those treated with one ivig course to those treated with two ivig courses. Modified erasmus gbs outcome score egos at day 7 of admission predict the probability of being unable to walk independently during follow up in patients with guillainbarre syndrome. International gbs outcome study about igos erasmus mc. This is the largest and most comprehensive study of nfl to date.
The type of preceding infection and patientrelated host factors seem to determine the form and severity. Guillainbarre syndrome gbs is an acute polyneuropathy with a variable degree of another prognostic model erasmus gbs outcome scale has been. Pdf early prediction factors of poor outcome in guillain. Modified erasmus gbs outcome score egos at hospital.
Overview and treatment of guillainbarre syndrome gbs. Hopefully these and other studies will further help to improve the understanding and especially the outcome in. With this study we try to identify the factors associated with a worse outcome. Increased serum neurofilament light chain concentration.
Intravenous immunoglobulin ivig is a proven effective treatment for gbs class 1 evidence. Materials and methods gbs patients being unable to walk unaided are currently treated with a standard single ivig dose 0. Guillain barre syndrome is a syndrome, not a single disease commonality of symptoms and signs not all cases are identical in pathogenesis. Recovery is affected by age, antecedent gastroenteritis, speed of onset, maximal disability and nerve conduction evidence of axon loss. Risk of respiratory failure can be predicted by the egris score erasmus gbs respiratory insufficiency score based on. Clinical profile of guillainbarre syndrome in a tertiary. Iv immunoglobulin ivig and plasma exchange pe are beneficial in patients who are severely affected, although onethird recover incompletely. Gbs patients of 12 years and older with a poor prognosis, based on the modified erasmus gbs outcome score megos at 1 week after start of the first ivig course are eligible for randomization in this doubleblind, placebocontrolled ivig or albumin clinical trial.
Complete at the end of the history and prior to physical examination. Improved functional outcome on the gbs disability scale after four weeks was the primary endpoint. Patients with poor prognosis may benefit from additional treatment, provided they can be identified early, when nerve degeneration is potentially reversible and treatment is most effective. The prognosis of gbs patients can be determined using the erasmus gbs outcome scale. The model should be used exclusively by health care professionals and must only be treated as a complementary tool to determine the prognosis and treatment of. They were subjected to nerve conduction study and cerebrospinal fluid analysis. Clinical features, pathogenesis, and treatment of guillain. Erasmus gbs outcome score8, gbs disability score, and. Early prediction factors of poor outcome in guillain barre syndrome.
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