The effectiveness and safety of acupuncture therapy for Guillain-Barré syndrome: A systematic review and meta-analysis protocol

[Restorative capability of traditional Chinese medicine in autoimmune diseases of nervous system: a literature review]

Autoimmune diseases of the nervous system are characterized by the formation of pronounced neurological deficiency and often lead to disability. Complementary medicine as an adjuvant or preventive therapy of various diseases, including autoimmune ones, is increasingly attracting the attention of doctors and researchers. Traditional Chinese medicine (TCM) has a complex of treatment methods, including acupuncture, phytotherapy, nutrition, physical exercises and other methods that are often used in common with the recognized approaches of the official medical science. The article describes the TCM methods application in autoimmune diseases of nervous system, presents the practical experience of using acupuncture, phytotherapy, diet, physical exercises. It was concluded that TCM is important and frequently underestimated health care resource, especially in prevention and treatment of autoimmune diseases of nervous system.

Clinical efficacy of high-dose intravenous gammaglobulin in acute Guillain-Barre syndrome and effect on serum concentration of inflammatory factors

OBJECTIVE

To explore the clinical efficacy of high-dose intravenous gammaglobulin (IVIG) in acute Guillain-Barre syndrome (GBS) and its effect on serum concentrations of inflammatory factors.

METHODS

A total of 111 patients with acute GBS were enrolled in this retrospective study. They were admitted to Ji'nan City People's Hospital from January 2019 to December 2020. According to the treatment method, the patients were divided into a control group (n=53, received routine treatment) and an observation group (n=58, received high-dose IVIG in addition to routine treatment). The clinical efficacy, Barthel index for activities of daily living (ADL), serum concentrations of inflammatory factors (IL-6, TNF-α, NO) in peripheral blood, potential of electromyography signals, abnormal rates of motor and sensory conduction velocity, and F wave abnormality rate were compared. Also, the risk factors affecting IVIG treatment efficacy were analyzed.

RESULTS

The overall response rate, and Barthel index for ADL were higher, while serum concentrations of IL-6, TNF-α, and NO were lower in the observation group than the control group (all P<0.05). There were differences in spontaneous potential and motor potential before and after treatment in both groups (both P<0.05). The observation group showed lower abnormal rates of motor and sensory conduction velocity, F wave abnormality rate, and prolonged latency rate than the control group (all P<0.05). Concomitant lung infection, respiratory muscle involvement, and treatment with high-dose IVIG >2 weeks from onset were independent risk factors for treatment efficacy.

CONCLUSION

High-dose IVIG has good clinical efficacy in treating acute GBS by reducing the serum concentrations of IL-6, TNF-α, and NO, improving patients' abnormal muscle electrical condition, and promoting recovery. It is recommended for use clinically at an early stage. At the same time, lung infection must be prevented.

Acupuncture Treatment of Guillain–Barré Syndrome After Using Immune Checkpoint Inhibitors: A Case Report

Guillain–Barré syndrome(GBS) is an autoimmune-mediated peripheral neuropathy. Immune checkpoint inhibitors (ICIs) are the standard treatment for cancer and may lead to immune-related adverse events (irAEs) such as GBS. Corticosteroids, plasma exchange (PE), and intravenous immunoglobulin (IVIG) are currently accepted treatments for ICI-induced GBS. However, there are still adverse reactions, and the effect of relieving symptoms is not as good as expected. Safe and effective complementary replacement therapy to alleviate GBS symptoms and ameliorate the quality of life is urgently required. In this case, a 63-year-old man received ICI therapy and antitumor chemotherapy for lung malignancy. After two courses of treatment, the patient gradually developed limb weakness, numbness, and pain at the ends of the limbs, with cerebrospinal fluid (CSF) albuminocytological dissociation, and electromyography (EMG) suggested demyelinating changes and was diagnosed as GBS. Although the patient received high doses of intravenous gamma globulin and limb weakness symptoms were alleviated, there was still significant numbness and pain in the extremities. After four times of acupuncture treatments, the patient complained that the symptoms of limb numbness and fatigue were significantly alleviated without any discomfort. This case report may provide a new alternative and complementary therapy for immune checkpoint inhibitor-induced GBS, but more definitive and robust evidence is needed to support its efficacy.

A Patient with Guillain-Barre Syndrome Treated with Combined Korean Medicine Treatments

A patient diagnosed with Guillain-Barre syndrome (GBS) suffering from numbness in the toes and fingers, paralysis in the face, and back pain received intravenous immunoglobulin on December 28, 2019. Without an improvement in symptoms the patient was admitted to a Korean medicine hospital on January 1, 2020 to receive combined Korean medicine treatment including herbal medicine (Sipjeondaebo-tanggami and Hyangbujasunkipalmul-tang), acupuncture treatment, moxibustion, cupping treatment, and physical therapy. Treatment was administered over 51 days, of which 17 days were during hospitalization. Paralysis of facial muscle, and numbness in fingers and toes were evaluated using the Yanagihara score and numeric rating scale (NRS) score, respectively. Facial paralysis improved (21 to 40 based on Yanagihara score) and paresthesia of the hands and feet disappeared (NRS score 6-7 to NRS score 0). There were no side effects or sequela. This study suggested combined Korean medicine treatment may be effective for the treatment of GBS.

Intensive Care and Treatment of Severe Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?