Neurological diseases Guillain-Barre syndrome

Neurological diseases myasthenia gravis, multiple sklerosis, Guillain-Barre-syndrom... 

Neurologic symptoms Motor weakness has been reported rarely. Most of these cases occurred in the setting of lactic acidosis. The evolution of motor weakness may mimic the clinical presentation of Guillain-Barre syndrome (including respiratory failure). Symptoms may continue or worsen following discontinuation of therapy. Stavudine therapy has been associated with peripheral neuropathy, which can be severe and is dose-related. Peripheral neuropathy has occurred more frequently in patients with advanced HIV disease, a history of neuropathy, or concurrent neurotoxic drug therapy, including didanosine (see Adverse Reactions). 

Severe complications connected with cholera (or combined) immunization are extremely rare and the causal relation is always doubtful. However, when they do occur they constitute a contraindication to further administration. There are occasional reports of neurological and psychiatric reactions (SED-8, 706) (SEDA-1, 246), Guillain-Barre syndrome (SEDA-1, 246), myocarditis (154,155), myocardial infarction (SEDA-3, 261), a syndrome similar to immune complex disease (156), acute renal insufficiency accompanied by hepatitis (157), and pancreatitis (158). 

By 1988 it was possible to summarize the adverse effects reported after the distribution of over 1.8 million doses of plasma-derived hepatitis B vaccine (Table 1) (2). From 1982 onwards, the Centers for Disease Control, the Food and Drug Administration, and the manufacturers, Merck Sharp Dohme, had supported a special surveillance system to monitor spontaneous reports of reactions to plasma-derived hepatitis vaccine. During the first 3 years, about 850 000 persons were immunized. In all, 41 reports were received for one of the following neurological adverse events convulsion (n = 5), Bell s palsy (n — 10), Guillain-Barre syndrome (n = 9), lumbar radiculopathy (n — 5), brachial plexus neuropathy (n = 3), optic neuritis (n — 5), and transverse myelitis (n = 4). Half of these events occurred after the first vaccine dose. However, no conclusive causal association could be made between any neurological adverse event and the vaccine (3). 

Preparations for intravenous administration are mainly used in patients with general immune deficiency states (primary or secondary) or diseases like idiopathic thrombo-cjhopenic purpura (ITP) and autoimmune diseases (5,6). Neurological disorders (for example Guillain-Barre syndrome and chronic demyelinating polyneuropathy) have been treated with intravenous immunoglobulin (7-9). 

Based on studies demonstrating increased levels of MMP-9 in the spinal fluid of patients with inflammatory processes involving the nervous system, considerable interest evolved in the measurement of plasma MMPs in various neurologic diseases. Mean plasma levels of MMP-9 in patients with Guillain-Barre syndrome were reported to be five times higher than in healthy subjects or patients with other neurologic diseases. The percentage of plasma MMP-9 in these patients decreased approximately 60% after... 

Following observations of the critical role of MMP-9 in animal models resembling multiple sclerosis and Guillain-Barre s syndrome, MMPs have been implicated in several different types of neurologic diseases (C9, R4, V2). Treatment with synthetic inhibitors of MMPs has reversed some of the pathology in animal models of brain injury (R4). TIMPs and MMPs have also been implicated in Alzheimer s disease (P3). 

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