History Of Guillain-Barre Syndrome Research Articles

Immune Checkpoint Inhibitors in Patients with Pre-existing Neurologic Autoimmune Disorders.

The use of immune checkpoint inhibitors (ICIs) for oncologic indications is associated with immune-related adverse events (irAEs). Patients with pre-existing autoimmune diseases are at increased risk of irAEs and have largely been excluded from clinical trials of ICIs. Therefore, there is limited data on the safety of safety of ICIs in patients with pre-existing neurologic autoimmune diseases (nAIDs) such as myasthenia gravis and multiple sclerosis. This review aims to synthesize the literature on the post-marketing experience with ICI in patients with pre-existing nAID and to discuss possible strategies for mitigating the risk of post-ICI nAID relapses. Patients with pre-existing myasthenia gravis (MG), myositis, and paraneoplastic encephalitis appear highly susceptible to neurologic relapses of their underlying neurologic disorder following ICI initiation; these relapses can cause considerable morbidity and mortality. In patients with multiple sclerosis (MS), the risk and severity of MS relapses following ICI appears to be relatively lower compared to MG. Preliminary evidence suggests that older MS patients with no recent focal neuroinflammatory activity may be safely treated with ICI. Among the several case reports of ICI in patients with a history of Guillain-Barre syndrome (GBS), neurologic worsening was only recorded in one patient who was in the acute phase of GBS at the time of ICI start. Initiating an ICI in a patient with pre-existing nAID involves a complex risk-benefit discussion between the patient, their oncologist, and neurologist. Relevant issues to consider before ICI include the choice of disease-modifying therapy for nAID (if any) and strategies for promptly identifying and managing nAID relapses should they occur. Currently, the literature consists mainly of case reports and case series, subject to publication bias. Prospective studies of ICI in patients with nAID are needed to improve the level of evidence.

MANAGEMENT OF GUILLAIN BARRE SYNDROME THROUGH AYURVEDA – A CASE STUDY.

Guillain Barre Syndrome is acute paralysis neuropathy. It is evolving reflexes motor paralysis with or without sensory disturbances. Characterised by rapidly developing motor weakness. It is autoimmune in nature and trigger by preceding infections. A 47year female patient was came in OPD of kayachikitsa in our institute with complaining of generalised body weakness, tingling sensation in both hands and legs with bilateral exaggerated reflexes and decrease muscle tone and power. Patient had history of Guillain Barre Syndrome 4 years ago. For this she had taken allopathic medicine like Intra Venous Immunoglobulin in government hospital. Patient started complaint about same symptoms, for this she started Ayurvedic treatment. In Ayurveda Guillain Barre Syndrome is not explain by name hence it is taken under the name of vata vyadhi like sarvangagat vata. While thoroughly understanding Guillain Barre Syndrome through modern as well as Ayurvedic aspect Guillain Barre Syndrome considered as sarvangagata vata vyadhi and managed by Ayurvedic treatment on the basis of basic principles, and found better improvement in this case. Due to Ayurvedic treatment and internal medicine with 15 days with follows up treatment for 1 months gives significant relief in all motor and sensory reflex with increase muscle tone and power

Vaccines Should Not Be a Sticking Point

Vaccines Should Not Be a Sticking Point

Increased risk of influenza among vaccinated adults who are obese.

BackgroundInfluenza infects 5–15% of the global population each year, and obesity has been shown to be an independent risk factor for increased influenza-related complications including hospitalization and death. However, the risk of developing influenza or ILI in a vaccinated obese adult population has not been addressed.ObjectiveThis study evaluated whether obesity was associated with increased risk of influenza and influenza-like illness among vaccinated adults.Subjects and MethodsDuring the 2013–2014 and 2014–2015 influenza seasons, we recruited 1042 subjects to a prospective observational study of trivalent inactivated influenza vaccine (IIV3) in adults.1022 subjects completed the study. Assessments of relative risk for laboratory confirmed influenza and influenza-like illness were determined based on BMI. Seroconversion and seroprotection rates were determined using pre-vaccination and 26–35 days post-vaccination serum samples. Recruitment criteria for this study were adults 18 years of age and older receiving the seasonal trivalent inactivated influenza vaccine (IIV3) for the years 2013–2014 and 2014–2015. Exclusion criteria were immunosuppressive diseases, use of immunomodulatory or immunosuppressive drugs, acute febrile illness, history of Guillain-Barre syndrome, use of theophylline preparations, or use of warfarin.ResultsAmong obese, 9.8% had either confirmed influenza or influenza-like-illness compared with 5.1% of healthy weight participants. Compared with vaccinated healthy weight, obese participants had double the risk of developing influenza or influenza-like illness (relative risk= 2.01, 95% CI 1.12, 3.60, p=0.020). Seroconversion or seroprotection rates were not different between healthy weight and obese adults with influenza or ILI.ConclusionsDespite robust serological responses, vaccinated obese adults are twice as likely to develop influenza and influenza-like illness compared to healthy weight adults. This finding challenges the current standard for correlates of protection, suggesting use of antibody titers to determine vaccine effectiveness in an obese population may provide misleading information.

Recurrent Guillain-Barre Syndrome- A Case Report

Guillain-Barre syndrome (GBS) manifests as acute flaccid weakness of limbs, and is considered a monophasic illness. But recurrences have been reported. Published case studies suggest that 1- 5% of patients who had GBS will have recurrent attacks. We describe a 66-year-old lady who presented with acute onset descending, symmetrical, areflexic, flaccid quadriparesis that progressed to respiratory failure. She had a history of GBS five years back of which she had made a complete recovery with no residual weakness. The diagnosis of recurrent GBS was made

Endoscopic Removal of UroLume Urethral Stent Using High-Power Holmium Laser

Introduction: The UroLume stent has been used for treatment of urethral stricture disease and benign prostatic hyperplasia since 1988.1 This procedure is not without complications, including migration, encrustation, epithelialization, pain, and irritative voiding symptoms.2 Holmium laser ablation of the prostate was introduced in 1994 by Gillings, Cass, and Cresswell.3 Multiple randomized studies have documented the safety and efficacy of laser ablation of the prostate.4 Only three cases in the literature document the use of the Holmium laser in the removal of a migrated UroLume stent.2,5 We present our experience with the removal of an infected, calcified UroLume stent using the Holmium laser. Materials and Methods: A 101-year-old male with a history of Guillain-Barre syndrome, gastroesophageal reflux disease, and hypertension underwent placement of a UroLume stent in 2006 for lower urinary tract symptoms. He had been voiding without difficulty and low postvoid residuals. However, over the past year he developed three prolonged admissions to the ICU for urosepsis. Cystourethroscopy revealed erosion and calcification at the 6 o'clock position of the urethral stent within the prostate. Using the 100 W Holmium laser, 550 nm end-fire laser fiber at settings of 2.5 J and 40 Hz, the UroLume stent was engaged with the laser. The stent was divided into four large sections by cutting at the 1, 5, 7, and 11 o'clock positions, extending from the bladder neck, where the proximal extent of the UroLume extended into the bladder, to just above the verumontanum. The median lobe was then enucleated. The end-fire fiber was then exchanged for a side fire DuoTome fiber and HoLAP of the remaining prostate tissue was performed. Residual fragments of the UroLume stent were retrieved with a rigid grasper. Results: The entire UroLume stent was removed without complications and the prostatic adenoma was successfully treated by HoLAP. Follow-up cystoscopy 6 weeks later revealed an open prostatic fossa with no evidence of any residual foreign body. Conclusion: Holmium laser excision is both safe and effective for the treatment of infected indwelling UroLume stents. The advantage of the Holmium laser in this setting is its unique combination of high-power energy delivery coupled with minimal depth of tissue penetration allowing cutting of metal over delicate tissues. Additionally, in the same setting, it serves the dual role of treating the prostatic adenoma underneath the UroLume stent using the HoLAP procedure. No competing financial interests exist. Runtime of video: 6 mins 49 secs

Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines: The risks and benefits

The influenza A (H1N1) 2009 vaccination program was the largest mass vaccination initiative in the USA, including 23 million people. A report published in The Lancet shows that the vaccination was associated with a very small increased risk of Guillain–Barre syndrome (GBS), and suggests that the benefits of influenza A (H1N1) vaccines outweighed the risks. Another recent large study has shown that none of the 550 people with a history of GBS had its recurrence after vaccination. At present, there is no evidence that modern vaccination is associated with recurrent GBS.

An Unusual Case of Recurrent Guillain-Barre Syndrome of a Different Subtype Five Years after Initial Diagnosis

We present a case of a previously healthy 17-year-old girl with history of Guillain-Barre Syndrome 5 years after initial presentation who presented with bilateral lower extremity pain, worsening dysphagia, subsequent weakness, and decreased reflexes. Cerebrospinal fluid analysis had a prominent lymphocytic pleocytosis. MRI of spine showed significant anterior nerve root enhancement. Electromyogram demonstrated a mild axonal greater than demyelinating motor polyneuropathy and intact sensory responses, with no evidence of conduction block or temporal dispersion, unlike her first presentation that revealed a demyelinating polyneuropathy. The patient recovered with mild subjective weakness following 5 days of intravenous immunoglobulin treatment. This case represents a recurrence of a predominantly motor variant polyradiculoneuropathy distinct from the initial presentation with a lymphocytic predominant CSF pleocytosis, nerve root enhancement on MRI spine, and rapid recovery following treatment with intravenous immunoglobulin.

Linkage of Multiple Sclerosis and Guillain-Barre Syndrome: A Population-Based Survey in Isfahan, Iran

Background. Multiple Sclerosis (MS) and Guillain Barre Syndrome (GBS) are autoimmune demyelinating disorders of Central and Peripheral Nervous system, respectively. The coexistence of these two syndromes in an individual's life span is rare. Objectives. To inspect throughout Isfahan MS society (IMSS) records for MS cases who had history of documented GBS whether before the onset of MS or after it. Methods. This retrospective survey was carried out by analyzing the clinical records of 3,522 MS patients who were registered with IMSS, from April 2003 to July 2010. Eligible cases were requested to attend to IMSS for final clinical/paraclinical examinations. Results. Among 3,522 (2,716 women and 806 men) MS subjects, we could identify seven patients (six females and one male) with documented diagnosis of GBS. Six patients (five women and one man) had developed MS within 6.5 ± 7.0 (range: 1–16) years after being diagnosed with GBS and one (a woman) had developed GBS three years after the diagnosis of MS. Conclusion. It seems that the development of MS in individuals with history of GBS is more than a simple incidental event.

Inactivated influenza vaccine is safe for children and adults with stable asthma

(2001) N Engl J Med 345, 1529. American Lung Association Asthma Clinical Research Centers. . The safety of inactivated influenza vaccine in adults and children with asthma. . Nov 22;...