Merkies Ingemar S J, Kieseier Bernd C
Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Eur Neurol. 2016;75(3-4):199-206. doi: 10.1159/000445347. Epub 2016 Apr 15.
In the clinical evaluation of patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), scant attention is paid to symptoms such as fatigue, pain and anxiety/depression. We aimed at addressing seminal studies that focused on the burden of these symptoms and their impact on quality of life (QoL) in these conditions.
Fatigue, pain, and anxiety/depression are increasingly being recognized in patients with GBS and CIDP, although their pathophysiological provenance remains unknown. Fatigue and pain are significant in terms of prevalence and intensity, may be a presenting symptom, and can persist for years after apparent functional recovery, suggesting residual injury. Anxiety/depression has also been examined although studies are limited. Despite their negative impact on QoL, the long-term dynamics of these symptoms in patients with GBS and particularly CIDP receiving therapy in routine clinical practice have not been systematically evaluated. Such observations formed the basis for the ongoing (GAMEDIS) studies evaluating the effect of Gamunex on fatigue and depression in patients with CIDP, of which some preliminary data are presented.
Strength and sensory deficits are the main areas of focus in patients with GBS and CIDP, but they do not explain the total reduction in QoL, suggesting the possible role of other complaints. A more comprehensive approach to patient care demands that factors such as pain, fatigue and anxiety/depression receive greater attention. The non-interventional GAMEDIS studies are expected to provide valuable insight into the long-term effectiveness of Gamunex in everyday practice.
在吉兰-巴雷综合征(GBS)和慢性炎症性脱髓鞘性多发性神经根神经病(CIDP)患者的临床评估中,对疲劳、疼痛和焦虑/抑郁等症状关注甚少。我们旨在探讨一些重要研究,这些研究聚焦于这些症状的负担及其在这些疾病中对生活质量(QoL)的影响。
疲劳、疼痛和焦虑/抑郁在GBS和CIDP患者中越来越受到关注,尽管其病理生理来源尚不清楚。疲劳和疼痛在患病率和强度方面都很显著,可能是首发症状,并且在明显的功能恢复后可能持续数年,提示存在残余损伤。焦虑/抑郁也已得到研究,尽管相关研究有限。尽管这些症状对生活质量有负面影响,但在常规临床实践中接受治疗的GBS尤其是CIDP患者中,这些症状的长期动态变化尚未得到系统评估。这些观察结果构成了正在进行的(GAMEDIS)研究的基础,该研究评估了Gamunex对CIDP患者疲劳和抑郁的影响,本文展示了一些初步数据。
肌力和感觉障碍是GBS和CIDP患者的主要关注领域,但它们并不能解释生活质量的全部下降,这表明其他不适症状可能起作用。更全面的患者护理方法要求对疼痛、疲劳和焦虑/抑郁等因素给予更多关注。非干预性的GAMEDIS研究有望为Gamunex在日常实践中的长期有效性提供有价值的见解。