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[High-dose intravenous immunoglobulins for treatment of optic neuritis in Guillain-Barré syndrome]
Klin Monatsbl Augenheilkd. 2007 Dec;224(12):932-4.
[Article in German]
Lüke C, Dohmen C, Dietlein TS, Brunner R, Lüke M, Krieglstein GK.
Zentrum für Augenheilkunde der Universität Köln.
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BACKGROUND:
Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating
disease of the peripheral nervous system. Treatment strategies include
systemic steroids, immune adsorption, plasmapheresis, and intravenous
immunoglobulins. Optic neuritis as an affectation of the central
nervous system does not belong to the normal spectrum of neurological
symptoms in GBS, which is thought to be restricted to the peripheral
nervous system.
CASE REPORT: A 55-year-old female patient with
unilateral optic neuritis secondary to GBS was referred to our
department. Visual acuity was 0.04 in the affected left eye, L. E. and
1.25 in the right eye, R. E. Visual field testing revealed a large
centrocecal scotoma. Ophthalmoscopy disclosed a slight oedema of the
left optic disc. High-dose steroid treatment based on the diagnosis of
optic neuritis secondary to GBS could not improve vision in the
patient's left eye. Therefore, a repetitive treatment with high-dose
intravenous immunoglobulins (IVIg) was initiated. The patient underwent
three treatment cycles - 0.4 g per kg daily for 5 days - with intervals
of two weeks between each cycle. Visual acuity and visual field
improved gradually after the initiation of the immunoglobulin
treatment. At the end of the last treatment course - 7 weeks after the
begin of ocular symptoms - visual acuity had recovered to 0.8. A small
residual paracentral scotoma resolved completely within the following
weeks. Further follow-up examinations revealed a complete recovery of
visual acuity to 1.0. Side effects of the immunoglobulin treatment were
not observed throughout the treatment period. CONCLUSIONS: Based on the
observation that the clinical improvement in our patient coincided with
the initiation of the IVIg treatment after steroid treatment had
failed, we feel justified in drawing attention to IVIg as a potential
treatment option in patients with GBS and involvement of the optic
nerve.
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