PhD defence C. (Christa) Walgaard

Dissertation in short:

The Guillain-Barré syndrome is an autoimmune disease of the nerves in arms and legs. Patients with this disease become severely paralysed in weeks to days, get sensory disturbances and often pain. A patient with Guillain-Barré syndrome often needs to be submitted to the hospital to receive treatment with intravenous immunoglobulins. Intravenous immunoglobulins are antibodies of blood donors that try to restore the immune system. De clinical severity of the disease is diverse. It is important to predict which patient with the Guillain-Barré syndrome gets severely paralysed or needs (prolonged) mechanical ventilation, to adjust supportive medical care and treatment early. In the first part of this thesis several prediction models for outcome and (prolonged) mechanical ventilation are described. In the second part of the thesis a Dutch double-blind, randomized study is described, in which 327 patients were included from 59 hospitals. Guillain-Barré syndrome patients with a poor predicted outcome were treated with 1 course of immunoglobulins (standard treatment) or with two courses of immunoglobulins (randomly). Guillain-Barré syndrome patients who were treated with two courses did not have a better outcome than patients who were treated with one course. Furthermore, it turned out that patients who received two courses had a higher risk of severe side effects. The conclusion of this study is that patients with a poor predicted outcome also need to be treated with one standard immunoglobulin course. The search for better treatment for this group of patients is continued.