Quiz Form

Question Date: 28/06/2023

Question: Which of these statements is true regarding treatment related fluctuations (TRF) in Guillain Barre syndrome?

Options:

• A patient not recovering from initial treatment should be considered to have TRF
• TRF can be easily differentiated from Chronic inflammatory demyelinating neuropathy
• TRF is seen in 50% of GBS
• TRF can be treated successfully with another course of the same initial treatment

Correct Answer: TRF can be treated successfully with another course of the same initial treatment

Explaination: Treatment related fluctuation (TRF) is defined as worsening of weakness after initial improvement or stabilization following treatment with IVIG or plasma exchange. It is seen in approximately 10% of GBS and occurs within 2 months of treatment initiation. It is thought to be due to continuation of an active immune attack on the nerves. Approximately 5-15% of CIDP patients present acutely and it is difficult to differentiate CIDP from TRF. Recurrent worsening or attack beyond two weeks may suggest CIDP. TRF is usually treated with another course of IVIg or plasma exchange and is often beneficial.

Reference: Donofrio P. Guillain-Barre Syndrome. Continuum 2017;23(5):1295-1309.