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Importance of intensive and prolonged rehabilitative treatment on the Guillain-Barrè syndrome long-term outcome: a retrospective study

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Abstract

Background

Guillain-Barrè syndrome (GBS) is often associated with a residual disability. Nonetheless, poor and incomplete studies have been published addressed towards the assessment of importance of physiotherapy (FKT) in the recovery. The aim of the study was to explore the effects of prolonged FKT associated with medical therapy and to evaluate the long-term outcome.

Methods

A retrospective analysis was carried out on patients with GBS who needed to continue rehabilitation after hospitalization and admitted to the Neurological Department of La Spezia from 2003 to 2017. MRC and GBS-Disability scale (GBS-DS) were performed at the time of greatest clinical disability, after medical therapy, and at the end of the overall FKT. The final outcome evaluation was based on the ability to walk with or without support. ANOVA with Bonferroni post-test were used to compare MRC and GBS-DS.

Results

Ninety-six patients were admitted, but only 51 satisfied inclusion criteria. Forty patients performed intensive treatment for an average of 60.95 days, and 31 of them, once discharged, are required to continue FKT as outpatients for a mean period of 96.45 days. The mean value of MRC and GBS-DS post-FKT improved significantly compared with the post-medical therapy. Concerning walking, among the 40 patients who did not walk before therapy, 8 need support after the medical therapy and 4 (11.76%) cannot walk independently at the last follow-up.

Conclusions

In conclusion, FKT associated to medical therapy can improve the outcome of the disease, if performed for periods exceeding 6 months.

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References

  1. Asbury AK, Cornblath DR (1990) Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol 27 Suppl:S21–S24. https://doi.org/10.1002/ana.410270707

    Article  CAS  PubMed  Google Scholar 

  2. Sejvar JJ, Kohl KS, Gidudu J, Amato A, Bakshi N, Baxter R, Burwen DR, Cornblath DR, Cleerbout J, Edwards KM, Heininger U, Hughes R, Khuri-Bulos N, Korinthenberg R, Law BJ, Munro U, Maltezou HC, Nell P, Oleske J, Sparks R, Velentgas P, Vermeer P, Wiznitzer M, Brighton Collaboration GBS Working Group (2011) Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 29:599–612. https://doi.org/10.1016/j.vaccine.2010.06.003

    Article  PubMed  Google Scholar 

  3. Willison HJ, Jacobs BC, van Doorn PA (2016) Guillain-Barre syndrome. Lancet 388:717–727. https://doi.org/10.1016/S0140-6736(16)00339-1

    Article  PubMed  Google Scholar 

  4. Ruts L, Drenthen J, JL J et al (2010) Pain in Guillain-Barre syndrome: a long-term follow-up study. Neurology 75:1439–1447. https://doi.org/10.1212/WNL.0b013e3181f88345

    Article  CAS  PubMed  Google Scholar 

  5. van Doorn P, Ruts L, Jacobs B (2008) Clinical features, pathogenesis, and treatment of Guillain-Barré syndrome. Lancet Neurol 7:939–950. https://doi.org/10.1016/S1474-4422(08)70215-1

    Article  PubMed  Google Scholar 

  6. Benedetti MD, Pugliatti M, Dalessandro R et al (2015) A multicentric prospective incidence study of Guillain-Barre syndrome in Italy. The ITANG study. Neuroepidemiology 45:90–99. https://doi.org/10.1159/000438752

    Article  PubMed  Google Scholar 

  7. Granieri E, Andreasi NG, De Martin P et al (2019) Incidence study of Guillain-Barré syndrome in the province of Ferrara, Northern Italy, between 2003 and 2017. A 40-year follow-up. Neurol Sci 40:603–609. https://doi.org/10.1007/s10072-018-3688-4

    Article  PubMed  Google Scholar 

  8. McGrogan A, Madle GC, Seaman HE, De Vries CS (2009) The epidemiology of Guillain-Barré syndrome worldwide: a systematic literature review. Neuroepidemiology 32:150–163

    Article  PubMed  Google Scholar 

  9. Van Den Berg B, Walgaard C, Drenthen J et al (2014) Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 10:469–482

    Article  PubMed  Google Scholar 

  10. Islam Z, Jacobs BC, Van Belkum A et al (2010) Axonal variant of Guillain-Barré syndrome associated with Campylobacter infection in Bangladesh. Neurology 74:581–587. https://doi.org/10.1212/WNL.0b013e3181cff735

    Article  CAS  PubMed  Google Scholar 

  11. Hughes R, Swan A, van Doorn P (2014) Intravenous immunoglobulin for Guillain-Barré syndrome (Review) intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002063.pub6.Copyright

  12. Raphaël JC, Chevret S, Hughes RAC, Annane D (2012) Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev 7:CD001798. https://doi.org/10.1002/14651858.CD001798.pub2

    Article  Google Scholar 

  13. Hughes RAC, Wijdicks EFM, Benson E, Cornblath DR, Hahn AF, Meythaler JM, Sladky JT, Barohn RJ, Stevens JC, Multidisciplinary Consensus Group (2005) Supportive care for patients with Guillain-Barré syndrome. Arch Neurol 62:1194–1198. https://doi.org/10.1001/archneur.62.8.1194

    Article  PubMed  Google Scholar 

  14. Dhar R, Stitt L, Hahn AF (2008) The morbidity and outcome of patients with Guillain-Barré syndrome admitted to the intensive care unit. J Neurol Sci 264:121–128. https://doi.org/10.1016/j.jns.2007.08.005

    Article  PubMed  Google Scholar 

  15. Bernsen RA, Jacobs HM, de Jager AE, van der Meche FG (1997) Residual health status after Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry 62:637–640

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bersano A, Carpo M, Allaria S, Franciotta D, Citterio A, Nobile-Orazio E (2006) Long term disability and social status change after Guillain-Barré syndrome. J Neurol 253:214–218. https://doi.org/10.1007/s00415-005-0958-x

    Article  CAS  PubMed  Google Scholar 

  17. Merkies ISJ, Faber CG (2012) Fatigue in immune-mediated neuropathies. Neuromuscul Disord 22:S203–S207. https://doi.org/10.1016/j.nmd.2012.10.014

    Article  PubMed  Google Scholar 

  18. Merkies ISJ, Schmitz PIM, Samijn JPA, van der Meche FGA, van Doorn PA (1999) Fatigue in immune-mediated polyneuropathies. Neurology 53:1648–1654

    Article  CAS  PubMed  Google Scholar 

  19. Merkies IS, Schmitz PI, Samijn JP et al (1999) Fatigue in immune-mediated polyneuropathies. European Inflammatory Neuropathy Cause and Treatment (INCAT) group. Neurology 53:1648–1654

    Article  CAS  PubMed  Google Scholar 

  20. Garssen MPJ, Bussmann JBJ, Schmitz PIM, Zandbergen A, Welter TG, Merkies ISJ, Stam HJ, van Doorn PA (2004) Physical training and fatigue, fitness, and quality of life in Guillain-Barré syndrome and CIDP. Neurology 63:2393–2395. https://doi.org/10.1212/01.WNL.0000148589.87107.9C

    Article  CAS  PubMed  Google Scholar 

  21. Hughes RAC, Swan AV, Raphael J-C, Annane D, van Koningsveld R, van Doorn PA (2007) Immunotherapy for Guillain-Barre syndrome: a systematic review. Brain 130:2245–2257. https://doi.org/10.1093/brain/awm004

    Article  PubMed  Google Scholar 

  22. Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF (2000) Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurology 54:2311–2315. https://doi.org/10.1007/s00415-012-6806-x

    Article  CAS  PubMed  Google Scholar 

  23. Khan F, Amatya B (2012) Rehabilitation interventions in patients with acute demyelinating inflammatory polyneuropathy: a systematic review. Eur J Phys Rehabil Med 48:507–522

    CAS  PubMed  Google Scholar 

  24. Wakerley BR, Uncini A, Yuki N et al (2014) Guillain–Barré and Miller Fisher syndromes—new diagnostic classification. Nat Rev Neurol 10:537–544. https://doi.org/10.1038/nrneurol.2014.138

    Article  PubMed  Google Scholar 

  25. Lawn ND, Wijdicks EF (1999) Fatal Guillain-Barré syndrome. Neurology 52:635–638. https://doi.org/10.1212/WNL.52.3.635

    Article  CAS  PubMed  Google Scholar 

  26. Kleyweg RP, van der Meché FG, Schmitz PI (1991) Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve 14:1103–1109. https://doi.org/10.1002/mus.880141111

    Article  CAS  PubMed  Google Scholar 

  27. Uncini A, Manzoli C, Notturno F, Capasso M (2010) Pitfalls in electrodiagnosis of Guillain-Barré syndrome subtypes. J Neurol Neurosurg Psychiatry 81:1157–1163. https://doi.org/10.1136/jnnp.2010.208538

    Article  PubMed  Google Scholar 

  28. Hadden RDM, Cornblath DR, Hughes RAC, Zielasek J, Hartung HP, Toyka KV, Swan AV, The Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group (1998) Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Ann Neurol 44:780–788. https://doi.org/10.1002/ana.410440512

    Article  CAS  PubMed  Google Scholar 

  29. Khan F, Pallant JF, Amatya B, Ng L, Gorelik A, Brand C (2011) Outcomes of high- and low-intensity rehabilitation programme for persons in chronic phase after Guillain-Barre syndrome: a randomized controlled trial. J Rehabil Med 43:638–646

    Article  PubMed  Google Scholar 

  30. Simatos Arsenault N, Vincent P-O, Yu BHS, Bastien R, Sweeney A (2016) Influence of exercise on patients with Guillain-Barré syndrome: a systematic review. Physiother Can 68:367–376. https://doi.org/10.3138/ptc.2015-58

    Article  PubMed  PubMed Central  Google Scholar 

  31. Chiò a CD, Leone M et al (2003) Guillain-Barré syndrome: a prospective, population-based incidence and outcome survey. Neurology 60:1146–1150

    Article  PubMed  Google Scholar 

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Correspondence to Valeria Prada.

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Prada, V., Massa, F., Salerno, A. et al. Importance of intensive and prolonged rehabilitative treatment on the Guillain-Barrè syndrome long-term outcome: a retrospective study. Neurol Sci 41, 321–327 (2020). https://doi.org/10.1007/s10072-019-04077-x

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