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Intravenous Immunoglobulin Treatment of Optic Neuritis Secondary to Guillain Barré Syndrome

Lüke C., Vobig M. A., Lüke M., Widder R. A., Walter P., Brunner R., Krieglstein G. K.,
Universität zu Köln, Zentrum für Augenheilkunde (Köln)

Purpose: The Guillain-Barré-syndrome (GBS) is an acute autoimmune disease of the peripheral nerves which leads to discontinuous demyelination of nerve roots and peripheral nerves. Treatment strategies include administration of systemic steroids, immunoabsorption, plasma exchange, and the intravenous application of immunoglobulins. Optic neuritis in GBS is a very rare entity even when cranial nerve involvement is present.
Method and results: A 55-year-old female patient with bilateral cranial nerve affection secondary to GBS was reffered to our outpatient department with complaints of reduced vision in her left eye (LE). Visual acuity was 20/16, RE and 5/125, LE. Visual field testing revealed a large centrocecal scotoma in the patient`s LE. Ophthalmoscopy showed edema of the left optic disc. The fundus of the right eye was unremarkable. A high dose systemic steroid treatment on the basis of a presumptive diagnosis of secondary optic neuritis proved ineffective intravenous 7S immunoglobulin treatment as initiated. The patient underwent three treatment cycles with an interval of two weeks between each cycle. One cycle consisted of daily intravenous 7S immunoglobulin infusions of 0.4g per kg over a period of 5 days. Visual acuity and central visual field of the LE improved stepwise after the initiation of the immunoglobulin treatment. At the end of the last treatment cycle, 7 weeks after the beginning of ocular symptoms, visual acuity had recovered to 20/25, LE. Ophthalmoscopy of the LE disclosed no signs of optic disc edema. Visual field testing revealed a small residual paracentral scotoma which resolved completely within the following 4 weeks. Further follow-up examinations revealed a complete recovery of visual acuity to 20/20, LE. Side effects due to the immunoglobulin infusions were not observed throughout the treatment period.
Conclusions: Our observation suggests that intravenous 7S immunoglobulin treatment may provide a safe and effective therapeutic alternative for optic neuritis secondary to Guillain-Barré-syndrome.