Thivakaran Thirunavukkarasu, Gamage Ranjanie, Gooneratne Inuka Kishara
Institute of Neurology, National Hospital of Sri Lanka, Sri Lanka.
J Neurosci Rural Pract. 2011 Jul;2(2):168-70. doi: 10.4103/0976-3147.83585.
Guillain-Barre syndrome (GBS) is usually a monophasic illness but relapses occur. A 55-year-old female with hypertension and vitiligo presented with acute inflammatory demyelinating polyradiculoneuropathy. She improved with immunoglobulin treatment started on day 6 of illness, but relapsed on day 14 warranting repeat immunoglobulin therapy. Thereafter recovery was complete. Her relapse was due to treatment-related fluctuation (TRF). TRF is improvement in the GBS disability scale of at least one grade after completion of immunotherapy followed by worsening of the disability scale of at least one grade within the first 2 months after disease onset. Recurrent GBS and chronic inflammatory demyelinating polyradiculoneuropathy were excluded. During the peak of the illness ANA titres were transiently high. The presence of other medical conditions, predominant proximal weakness and the absence of preceding diarrhea are predictors for TRF seen in this patient. Early treatment and evidence of ongoing immune activation have contributed toward TRF.
吉兰-巴雷综合征（GBS）通常为单相性疾病，但也会复发。一名患有高血压和白癜风的55岁女性出现急性炎症性脱髓鞘性多发性神经根神经病。她在发病第6天开始接受免疫球蛋白治疗后病情好转，但在第14天复发，需要再次进行免疫球蛋白治疗。此后完全康复。她的复发是由于治疗相关波动（TRF）。TRF是指在免疫治疗完成后GBS残疾量表至少改善一个等级，随后在疾病发作后的前2个月内残疾量表至少恶化一个等级。复发性GBS和慢性炎症性脱髓鞘性多发性神经根神经病被排除。在疾病高峰期，抗核抗体滴度短暂升高。该患者出现TRF的预测因素包括存在其他疾病、以近端肌无力为主以及无腹泻前驱症状。早期治疗和持续免疫激活的证据促成了TRF。
