Good point Molly. And how about hospital induced polymyopathy (i.e ICU,
prolonged immobility, etc). I think this distinction is especially important
since cancer is quite catabolic, when it comes to regaining muscle mass, this
can be really challenging. As opposed to a true ICU polymyopathy, which while
still challenging to gain muscle, may be a bit easier to regain muscle (this is
purely a hypothesis). I’ve had quite a few patients after transplant go to the
ICU, develop severe weakness within a couple weeks, and then be diagnosed with
GBS, which we forget has a diagnosis criteria, not just sudden onset of
weakness.
Again, while it is somewhat just semantics since both cause sudden onset of
weakness, the recovery of the two may look very different and may have very
different outcomes in the short, and long run. Like Heidi said, it can take
years to recover with symptoms like this. She may have some input on what she’s
seen in people who have ICU induced polymyopathy and length of recovery, vs GBS
and length of recovery.
This distinction will primarily give the family some insight on the road to
recovery, rather than change your plan of care, but that may be just as
important to give some realistic short and long term goals, as well as
equipment recommendations.
Shai
On Feb 23, 2022, at 00:13, Virginia Callais <virginialynn.pt@xxxxxxxxx> wrote:
So where do we draw the distinction between GBS/MG and CIPN?
Sent from my iPhone
On Feb 21, 2022, at 10:32 PM, heidi engel <dmarc-noreply@xxxxxxxxxxxxx>
wrote:
Hi Molly,
This is a rare but known potential side effect of immunotherapy. I have seen
great variation in recovery and in symptoms with patients who are diagnosed
with cancer treatment related GBS. In my mind, it is a minimum 2 years ahead
of intensive therapeutic management for recovery- PT, OT, nutrition,
psychological and financial. If only folks who are not incredibly wealthy
had access to all of that. My advice to your patient is keep working at it
for years ahead. I have witnessed patients continuing to make gains in
nerologic recovery 5 years or more after diagnosis with non-stop working at
it.
-Heidi
On Monday, February 21, 2022, 08:50:56 AM PST, Reynolds Molly
<dmarc-noreply@xxxxxxxxxxxxx> wrote:
Hello,
Has anyone had a patient that was on immunotherapy develop Guillain-Barre? I
have a patient that is on Nivolumab for recurrent esophageal cancer and
began developing stocking-glove distribution neuropathy with progressive
weakness. Eventually he was diagnosed with GB and underwent IVIg infusions.
I am now working with him to learn to walk and do normal ADL’s again. He did
not have any known virus prior to his symptoms. He did receive vaccines in
December with the onset of his symptoms being approximately 4 weeks later.
Unfortunately his immunotherapy was discontinued. Has anyone witnessed this
before and if so, did your patient return to baseline function?
Cheers,
Molly
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