European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain–Barré syndrome

Guillain–Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal–paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2–4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12–15 L in four to five exchanges over 1–2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.</p

Theory of Light Hydrogenlike Atoms

The present status and recent developments in the theory of light hydrogenic atoms, electronic and muonic, are extensively reviewed. The discussion is based on the quantum field theoretical approach to loosely bound composite systems. The basics of the quantum field theoretical approach, which provide the framework needed for a systematic derivation of all higher order corrections to the energy levels, are briefly discussed. The main physical ideas behind the derivation of all binding, recoil, radiative, radiative-recoil, and nonelectromagnetic spin-dependent and spin-independent corrections to energy levels of hydrogenic atoms are discussed and, wherever possible, the fundamental elements of the derivations of these corrections are provided. The emphasis is on new theoretical results which were not available in earlier reviews. An up-to-date set of all theoretical contributions to the energy levels is contained in the paper. The status of modern theory is tested by comparing the theoretical results for the energy levels with the most precise experimental results for the Lamb shifts and gross structure intervals in hydrogen, deuterium, and helium ion $He^+$, and with the experimental data on the hyperfine splitting in muonium, hydrogen and deuterium.Comment: 230 pages, 106 figures, 24 tables. Discussion of muonic hydrogen is added, list of references expanded, some minor corrections and amendment

European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain–Barré syndrome

Guillain–Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal–paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2–4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12–15 L in four to five exchanges over 1–2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.</p

230th ENMC International Workshop:: Improving future assessment and research in IgM anti-MAG peripheral neuropathy: A consensus collaborative effort, Naarden, The Netherlands, 24–26 February 2017

The 230th European Neuromuscular Center (ENMC) international workshop occurred in Naarden, the Netherlands, from February 24th to 26th, 2017. The aims of the workshop were: 1) to create an IgM associated peripheral neuropathy study group and achieve consensus regarding the registration of patients with IgM associated peripheral neuropathy in a patient-based registry, 2) to improve future assessment of patients with IgM associated peripheral neuropathy from hematological markers to clinical trials, and 3) to discuss promising therapies for future clinical trials. Seventeen clinicians and researchers (sixteen neurologists and one hematologist) from nine countries (Belgium, Curaçao, France, Italy, the Netherlands, Spain, Switzerland, the United Kingdom, and the United States of America) were present. A patient with IgM associated peripheral neuropathy, a representative of the GBS/CIDP Foundation International, and a PhD student, who received support from the ENMC Young Scientist Program, also attended

Serendipity and Digital Media Entrepreneurship Teams in Remote Work Ecosystems

The COVID-19 pandemic has drastically altered and upended the way we learn, work and interact with each other. Human interaction in virtual spaces, specifically video conferencing platforms, has become the “new normal,” and the pandemic will most likely impact how we continue to interact with each other in the future. Serendipity, the notion of accidental information discovery, which often occurs during water cooler moments between team members that fuel some of the greatest advancements in business, technology and medicine, is a phenomenon that is almost non-existent in Digital Media Entrepreneurship remote work ecosystems. This paper aims to explore how social connectivity may help nurture serendipitous interactions in Digital Media Entrepreneurship teams working remotely. I conducted the study using a qualitative questionnaire and a complementary focus group. In addition, I analyzed data using thematic analysis that allowed me to understand the experiences of Digital Media Entrepreneurship teams working remotely.</p

Recurrences, vaccinations and long-term symptoms in GBS and CIDP

We determined the frequency of recurrent Guillain-Barre syndrome (GBS), whether vaccinations led to recurrences of GBS or an increase of disability in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and we assessed the prevalence of pain, fatigue and the impact on quality of life after GBS and CIDP. Additionally, we assessed the presence of common auto-immune disorders. Four hundred and sixty-one members of the Dutch society of neuromuscular disorders received a questionnaire. Two hundred and forty-five GBS and seventy-six CIDP patients were included (response rate 70%). Nine patients had a confirmed recurrent GBS, and two patients had experienced both GBS and CIDP. Common auto-immune diseases were reported in 9% of GBS and 5% of CIDP patients. None of the 106 GBS patients who received a flu vaccination (range 1-37 times, total 775 vaccinations) reported a recurrence thereafter. Five out of twenty-four CIDP patients who received a flu vaccination (range 1-17 times) reported an increase in symptoms. Pain or severe fatigue was reported in about 70% of patients after the diagnosis of GBS (median 10 years) or after onset of CIDP (median 6 years), and quality of life was significantly reduced. Flu vaccinations seem relatively safe. GBS and CIDP patients often experience pain, fatigue and a reduced quality of life for many years after the diagnosis