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GBS – Treatment-Related Fluctuation — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularGBS – Treatment-Related FluctuationSCE Neurology

A 50-year-old man with GBS treated with a full course of IVIg shows initial improvement at day 10 but then deteriorates again at day 21 with increasing limb weakness and declining FVC. What is this pattern called, and what is the appropriate management?

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Correct answer: D — Treatment-related fluctuation (TRF) — administer a second course of IVIg

A treatment-related fluctuation (TRF) in GBS occurs when a patient initially improves after IVIg or PLEX but then worsens within 8 weeks, usually due to the catabolism of administered immunoglobulins before the immune attack has fully resolved. A second course of IVIg is appropriate. If deterioration occurs after 8 weeks or there are >2 fluctuations, CIDP should be considered. A: PLEX is an alternative first-line but a second IVIg course is appropriate for TRF. C: CIDP is diagnosed if symptoms progress beyond 8 weeks. D: Secondary axonal degeneration causes a failure to recover, not acute worsening. E: MG has a different clinical picture.

Reference: EAN/PNS guideline on diagnosis and treatment of Guillain–Barré syndrome: https://pubmed.ncbi.nlm.nih.gov/37814552/