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For Health Care
Professionals
Updated
18-May-2006
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Do you, or your patients, need information on a GBS/CIDP
related issue not described in this website? Please email
your suggestions and comments, and I'll do my best to incorporate
these.
Your comments may be incorporated in the website and newsletters,
so please state whether you want your name acknowledged.
This month's
news
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Mayday Pain & Society Fellowship 2006: Call
For Applications
The Mayday Fund is dedicated to alleviating the incidence,
degree, and consequence of human physical pain. Applications
for the 2006 Mayday Pain & Society Fellowship: A
Media & Policy Fellows Initiative, are being accepted
until June 1, 2006.
The program is designed to equip physicians, nurses,
pharmacists, social workers, scientists, and legal scholars
with the necessary skills to become effective advocates
and spokespeople about pain issues in the United States
and Canada.
Endometrial
cancer patient developed Guillain-Barre syndrome after
adjuvant chemoradiotherapy [reg. reqd, free]
Neuropathic
Pain: An Update on Effective Management Strategies
Medscape. [reg. reqd, free]
Nursing
and supporting patients with chronic pain (PDF)
Nursing Standard Jan 18 2006; 20 (19): 60-65
Inadequate pain management results when nursing staff
dealing with chronic pain patients harbour misconceptions
and negative attitudes, as well as lack of knowledge.
Check "Research
& trials" for on-going research & trials
recruiting patients.
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Clinical features,
diagnosis, differentials, treatment etc.
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GBS
- diagnosis and misdiagnosis
J. Goldstein, MD Yale University School of Medicine,
USA.
New
Insights Into the Mechanisms of IVIg-Mediated Recovery
in GBS
K.A. Sheikh, Department of Neurology, Johns Hopkins,
USA. Partnership
for Prescription Assistance (USA only)
This website is for patients, caregivers, prescribers.
PPA helps qualifying patients who lack prescription
coverage get the medicines they need through the public
or private program that's right for them. Many will
get them free or nearly free. Call toll-free 1-888-4PPA-NOW
(1-888-477-2669).
Proinflammatory
cytokine responses induced by influenza A (H5N1) viruses
in primary human alveolar and bronchial epithelial cells
Chan, Cheung, Chui et al., Respiratory Research 2005,
6:135 (11 Nov. 2005).
EMG Findings of Axonal Polyneuropathy
[registration reqd, free]
Does an axonal polyneuropathy necessarily display increased
insertional activities? If nerve conduction velocity
studies are consistent with an axonal polyneuropathy,
can such a diagnosis be made even without fibrillation
or positive waves?
New guidelines for the treatment of GBS
[registration reqd, free of charge]
American Academy of Neurology (AAN)'s new guidelines
for the treatment of GBS, emphasizing early treatment
with either IVIg (preferred when available) or PE. More
on the implications.
Neurology. 2003;61:736-740
Decrease
in Guillain-Barre Syndrome Following Influenza Vaccination
[registration reqd, free of charge]
The Nov. 23 issue of JAMA reports that a 12-year
surveillance study has found the number of cases of
Guillain-Barre syndrome associated with influenza vaccination
have decreased.
Guillain-Barré
syndrome associated with central nervous system lesions
GBS associated with CNS manifestations is described
(encephalomyeloradiculoneuropathy).
Okamura et al. Archives of Disease in Childhood 2002;86:304-306
Childhood
Guillain-Barré Syndrome
Contrast-enhanced spinal MRI may prove useful in diagnosis.
Follow-up images may help predict the clinical course.
Acta Radiol 2003 Mar;44(2):230-5
Long-term
prognosis for Guillain-Barre syndrome: evaluation of
prognostic factors and clinical experience of automated
double filtration plasmapheresis
Disability at the nadir influences the outcomes, so
early diagnosis and appropriate treatment are essential,
to prevent further neurological deficits and maximise
survival.
J Clin Apheresis. 2003;18(4):175-80.
Potential
New Therapy for Patients with IVIG-Dependent CIDP
K.C. Gorson, M.D., Neuromuscular Service St. Elizabeths
Medical Center, Boston USA.
Acute
Flaccid Paralysis Linked to West Nile Virus
Patients presenting with AFP should be screened
for WNV before beginning treatment for presumed GBS.
Morb Mortal Wkly Rep. 2002;51(37):825-828
Methylprednisolone
Did Not Significantly Benefit Patients Treated With
Immunoglobulin for Guillain-Barre Syndrome
Adding methylprednisolone to standard IVIg treatment
in patients with GBS conferred no significant benefit
over IVIg alone.
Lancet 2004;363:192-96.
Corticosteroids
for Guillain-Barré syndrome (Cochrane Review)
Considering corticosteroids to hasten recovery and reduce
the long term morbidity from GBS? Reviewers conclude
corticosteroids should not be used in the treatment
of GBS.
Hughes RAC, van der Meché FGA. Cochrane Library,
Issue 2 2003.
Chronic
acquired demyelinating symmetric polyneuropathy classified
by pattern of weakness
Presence or absence of proximal weakness indicates differences
in clinical course, disability, and treatment response.
Mygland A, Monstad P. Arch Neurol 2003 Feb;60(2):260-4
eMedicine
- D. Fanion, MD, & D.M. Joyce, MD & eMedicine
- Angela Cha-Kim, MD.
Both links describe clinical features, differentials,
workup, treatment, medication, follow-up, etc.
Merck
Praxis.MD - Approach to the Patient with Peripheral
Neuropathy
Best Practice Brief. Checklist for diagnosis and treatment.
GBS
- A GP's guide
Diagnosis, clinical points, variants, etc.
Intravenous
immunoglobulin for Guillain-Barré syndrome (Cochrane
Review)
No adequate trials exist to determine if IVIG is more
beneficial than placebo. IVIG and PE have a similar
ability to speed recovery. Giving IVIG after PE is not
significantly better than PE.
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Mild
Guillain-Barré Syndrome
Study attempts to determine the frequency of mild
GBS with the persistent ability to walk. It also examines
possible predictors that indicate whether the illness
would remain mild.
Arch Neurol. 2001;58:1098-1101.
Infections
and course of disease in mild forms of Guillain-Barré
syndrome
The presence of residuals in patients with mild GBS
may advocate the use of early treatment in mildly affected
patients.
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Arcade
doubles as source of therapy - Fun and games provide
way to relearn skills
Therapists find that arcade games such as video
driving games can help patients relearn basic
skills requiring hand-eye coordination, fine motor skills
and balance.
Mechanical Ventilation in GBS: Imperative But Also Imperfect
Management of mechanical ventilation in GBS patients.
The Communicator, Spring 2002.
Use
of a Behavioural Pain Scale to assess pain in ventilated,
unconscious and/or sedated patients (PDF)
Young, Siffleeta, Nikoletti & Shaw. Intensive
and Critical Care Nursing 2006 Feb; 22(1):32-39.
The BPS was found to be reliable in assessing pain in
sedated/unconscious patients. More research is required
into objective pain assessment and identification of
painful routine procedures to enhance pain management
in these patients.
Early
predictors of mechanical ventilation in Guillain-Barre
syndrome
Predictors were identified in patients requiring mechanical
ventilation. The value of early mechanical ventilation
in high-risk patients showing these indicators may deserve
investigation.
Crit Care Med 2003 Jan;31(1):278-83
Electrophysiology
to predict mechanical ventilation in Guillain-Barre
syndrome
Electrophysiological demyelination may predict a need
for ETMV.
Eur J Neurol 2003 Jan;10(1):39-44
Guillain-Barre
syndrome--a patient guide and nursing resource
Axone. 2001 Jun; 22(4): 16-24
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Demoralization
- A Syndrome Which Should Not Be Confused With Depression
Cultural
Awareness: A Prescription for More Effective Medicine
Aliza Lifshitz, MD, Internist, Cedars-Sinai Medical
Center, USA.
[reg. reqd., free]
Psychotic
symptoms and emotional distress in patients with Guillain-Barre
syndrome
Caused by motor deprivation and loss of communication,psychotic
symptoms may indicate the need for continuous psychosocial
support and psychopharmacological measures.
Eur Neurol 2002;47(2):74-8
Towards
Understanding the Molecular Basis of Poor Recovery in
GBS
K.A. Sheikh, Dept of Neur., Johns Hopkins, USA.
A
few simple things I do for my GBS patients
B.O.Khatri, MD. Director, Center for Neuro. Disorders,
WI, USA
"Doctors told her the sudden, paralyzing illness
she contracted had no certain cause nor cure... Doctors
called it Guillain-Barré Syndrome, but deep inside,
she considered it punishment for placing her husband
in a nursing home..."
From an article about Hispanics attitude towards nursing
homes, this statement also describes the attitude of
many patients towards Guillain-Barre syndrome. Depending
on their culture and background, they fear, or may even
be told that the disease is a punishment for something
they've done, and that they will never recover... [Read
article]
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Post-GBS
symptoms and problems
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A dental hygienist with a GBS patient asks if there
is a correlation between the patient's condition and
her periodontal health. Read her
query and the replies from several healthcare professionals.
Webmaster, 01.2006
A
review of the management of Guillain-Barre syndrome
in a regional neurological rehabilitation unit
Many patients are discharged without access to rehab
services. These results suggest that rehabilitation
makes a significant difference and should be available
to all patients with GBS.
Int J Rehabil Res. 2003 Dec; 26(4): 297-302.
"Post-GBS":
Pain, sensory disturbances, motor problems, fatigue
and other residual symptoms experienced by ex-patients.
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Two-drug
combo lessens chronic nerve pain [reg. reqd, free]
A combination of morphine and gabapentin controls chronic
nerve pain better than either drug alone, and at lower
doses.
Fentanyl
Effervescent Buccal Tablets in Patients With Chronic
Pain
[reg. reqd, free]
Pain
Information at your Fingertips
A group of leading European specialists have launched
a new publication and website in an attempt to reduce
the high levels of under-treatment of chronic pain across
Europe. Paineurope
contains feature articles on treatment-based issues,
news updates, clinical comparisons, a research round-up
and an interactive question and answer section. Available
in several languages, Paineurope is free for healthcare
professionals interested in managing pain. Register
(online access) or email
(paper copy).
Neuropathy pain management guidelines published
Guidelines developed and published by leading international
experts in pain management, to help improve diagnosis
and management of patients suffering from chronic neuropathic
pain.
Advances
in neuropathic pain: diagnosis, mechanisms, and treatment
recommendations
Dworkin RH, Backonja M, Rowbotham MC, et al., Arch Neurol.
2003 Nov;60(11):1524-34
Gabapentin
for the treatment of pain in guillain-barre syndrome...
Gabapentin: an alternative for pain management of GBS
patients.
Anesth Analg 2002 Dec; 95(6):1719-23
Focus on Pain: Resources
on the internet
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Neurosexology
"Sexual dysfunction is observed in many neurological
disorders.... Although not as obviously limiting as..
paresis and pain, it is most disruptive for patients'
lives. With emerging awareness of the primary importance
of quality of life as the most important indicator of
good patient management, and with the advent of more
effective treatment of sexual dysfunction, it is no
longer acceptable to ignore this very important dimension
of life."
Lundberg et al., (2001), European Journal of Neurology,
Supplement, 8.
Ingen helhed uden sex. [Danish]
Vejledning til ergo- eller fysioterapeuter, hvis patienter
eller klienter, på grund af sygdom eller handicap,
også er berørt på deres seksualitet.
Om at bruge egne, almenmenneskelige erfaringer og patientens
egen viden om problemet, personligt mod, systematik,
og en stor lydhørhed overfor patientens behov.
Seksualitet
- for mennesker med nedsat funktionsevne [Danish]
Informationer om projekter, centre og litteratur.
GBS &
Intimacy: patient-to-patient forum at this
website.
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Does
informing patients of the risk of acquiring GBS following
influenza vaccination have an effect on their willingness
to be vaccinated?
Health Canada report (2000).
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CIDP, MFS and
other sub-variants
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Cytotoxic
drugs and interferons for chronic inflammatory demyelinating
polyradiculoneuropathy (Cochrane Review)
Insufficient evidence exists on whether azathioprine,
interferon beta or any other immunosuppressive drug
or interferon is beneficial in CIDP.
The Cochrane Library, Issue 1, 2004.
Intravenous
immunoglobulin for chronic inflammatory demyelinating
polyradiculoneuropathy (Cochrane Review)
IVIG improves disability for at least 2-6 weeks compared
with placebo. IVIG, PE and prednisolone seem to be equally
effective. Cost, side effects, duration of treatment,
dependency on regular hospital visits and ease of administration
all have to be considered before deciding which treatment
should be first choice.
Immunotherapy
for IgM anti-Myelin-Associated Glycoprotein paraprotein-associated
peripheral neuropathies (Cochrane Rev.)
Intravenous immunoglobulin is relatively safe and may
produce some short-term benefit.
The Cochrane Library, Issue 1 2003.
Review
of 1027 Patients With Newly Diagnosed Multiple Myeloma
Monoclonal gammopathy of undetermined significance
(MGUS) appears to be a significant risk factor in the
development of MM.
Mayo Clinic Proceedings. 2003;78(1):21-33
Orthoptic
treatment and eye movement recordings in Guillain-Barré
syndrome - a case report
Orthoptic therapy to improve oculomotor vergence control
in a patient with acquired bilateral sixth nerve paralysis.
Neuro-ophthalmology 1995, Vol. 15, No. 5, pp.
249-256 Management
of chronic inflammatory demyelinating polyradiculoneuropathy
Review of current concepts concerning the nosological
status, pathogenesis and management of CIDP.
Drugs 2003;63(3):275-87
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Anatomi,
fysiologi, årsager og faktorer, der påvirker
tarmfunktionen
".. Hvis sygeplejersker havde en bedre viden om
årsagerne til obstipation, diaré og afføringsinkontinens,
kunne de dels spare tid, dels forebygge smerter og ubehag
hos patienterne...."
Gerd Johnsen. Sygeplejersken 5/2001.
Rigshospital:
Sygepleje til patienter med Guillain-Barré
Vejledning til sygeplejersker.
Lægfolks
opfattelser af lægers ord
Lægestuderende undersøgte lægfolks
forståelse af udvalgte ord som bruges af læger
i den tro, at de er dele af det almene sprog.
Forslag til forbedring af dialogen.
Min
egen seniorpolitik: Om forbedringer i kroniske GBS'ere
behandling på Rigshospitalet.
Seniorsygeplejersken på Neurologisk afd. har indført
nye metoder til optimering af patienternes møde-
og behandlingsplaner, som bl.a. har ført til
besparelser og større patienttryghed.
"Den smilende Patient"
Om en sygeplejerskes overvejelser i forbindelse med
pasning af en totallammet GBS-patient.
Polyradiculitis
En sygeplejerske skriver om patientpleje og - omsorg.
Fra passiv til aktiv kommunikation
med IT
HIT, 1, 2002, s. 8-9.
Joan Hjøllund måtte finde alternative veje
til at kommunikere. Hun fik hjælp fra Center for
Kommunikation, Ringkjøbing Amt til at finde de
rigtige IT-løsninger.
Fødevarebårne
infektioner
De forskellige sygdomsfremkaldende organismer og konsekvens
for samfundet. Udforskningen af udbrud - store som små
- er vigtig bl.a. for at finde kilden og evt. erhverve
ny viden om kilder, og være bedre rustet til forebyggelse.
I dagligdagen i den primære sundhedstjeneste og
på sygehuse og institutioner bør man bidrage
til dette ved at anmelde mistænkte tilfælde
af fødemiddelinfektion til embedslægen
og om muligt sikre en mikrobiologisk diagnose, da dette
er en betingelse for at finde kilden.
Kåre Mølbak, Statens Serum Institut,
afdeling for mave-tarm-infektioner og afdeling for epidemiologisk
forskning.
GBS
- Docent Björn Ryberg, Neurologkliniken/Lunds Universitetssjukhus
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Your donations
keep this site running. Please consider making
one if you've been helped thru "All about GBS"!
These donors have helped keep this site running in 2004-5:
Pam Graf, US
Konrad Tiburzy, GDR
Gabriele Wennemer, France |
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