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Practice Parameter for Guillain Barré Syndrome
Abstract & Commentary
Source: Hughes RA, et al. Practice parameter: Immunotherapy for Guillain Barré syndrome. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003;61:736-740.
In case you missed it in the "green" journal, we abstract here in point form the treatment recommendations for plasma exchange (PE) or intravenous immunoglobulin (IVIG) for the adult with Guillain Barré syndrome.
1. Combining PE followed by IVIG is of no benefit. Don’t do it.
2. Corticosteroid is of no benefit. Don’t give it.
3. PE is recommended for the nonambulant patient up to 4 weeks after onset and for the ambulant patient within 2 weeks of onset. Go for it.
4. IVIG is equivalent to PE and is recommended for the nonambulant patient within 2 and possibly up to 4 weeks, following onset. Use it.
5. CSF filtration has not been adequately tested. Forget it.
6. Immunoabsorption, an alternative to PE that does not use human blood product as replacement fluid, has been insufficiently tested. Drop it.
Up to 35% of Guillain Barré syndrome patients remain with long-term disability despite PE or IVIG, underscoring the need for yet improved therapeutic strategies.1 Powerful immunomodulators (eg, leflunomide) or chemokine receptor/adhesion molecule/protease-blocking agents may interfere with the movement of immunocompetent cells across the blood-nerve barrier and prevent axonal degeneration. Alternatively, neurotrophic agents may promote remyelination or axonal regeneration after injury has already occurred.2 Both avenues must continue to be explored. — Michael Rubin
1. Rees JH, et al. J Neurol Neurosurg Psychiatry. 1998;64:74-77.
2. Kieseier BC, Hartung HP. Semin Neurol. 2003;23: 159-168.
Symposium on Dementia
Abstract & Commentary
Source: Knopman DS, et al. Essentials of the proper diagnoses of mild cognitive impairment, dementia, and major subtypes of dementia. Mayo Clin Proc. 2003;78:1290-1308.
Mild cognitive impairment defines cognitive difficulties that do not interfere with daily functioning. When daily functioning is impaired, dementia is diagnosed and in most instances is progressive, leading to total disability. Incidence for dementia is 1% per year, with a prevalence that rises with age to > 30% at 85+ years. Timely diagnosis will be crucial as new therapies are described in the foreseeable future. Review of this topic is thus in order, and we draw the attention of our readers to the paper cited above as a thorough and clinically relevant review of the subject. — Michael Rubin, MD, Professor of Clinical Neurology, New York Presbyterian Hospital-Cornell Campus, Assistant Editor, Neurology Alert.