Treatment related fluctuations (TRFs) in Guillain-Barré Syndrome (GBS) are described as one or more episodes of deterioration manifesting within two months after disease onset and following an initial improvement or stabilisation after treatment. They may be encountered in 8% to 16% of patients, but currently predictive factors of TRF occurrence and severity are poorly known. To this end, we evaluated the frequency and clinical features of TRFs in a cohort of GBS patients admitted to the Neurological unit of Sant'Andrea Hospital (La Spezia, Italy) from January 1st, 2003 to December 31st, 2017.

Among the 98 GBS collected patients, five (5.1%) developed a TRF during disease course. Consistently with the literature, the majority of our GBS patients who developed a TRF did not report a preceding diarrhoea, had a predominant proximal weakness and all of them had sensory disturbances at the clinical onset. Interestingly, 80% of our TRF patients manifested since GBS onset an autonomic dysfunction with abnormal sweating and a peculiar ‘skin flushing’ in face, neck and chest. Two patients developed respiratory insufficiency at the TRF time, and they both died.

We would advise to pay attention to GBS patients with particular ‘skin flushing’ in face, neck and chest and abnormal sweating, because these findings could be a red flag for TRF.

格林-巴利综合征 (GBS) 中的治疗相关波动 (TRF) 被描述为在疾病发作后两个月内以及治疗后初步改善或稳定后出现的一次或多次恶化发作。它们可能在 8% 至 16% 的患者中遇到，但目前对 TRF 发生和严重程度的预测因素知之甚少。为此，我们评估了 2003 年 1 月 1 日至 2017 年 12 月 31 日期间在圣安德烈亚医院（意大利拉斯佩齐亚）神经科收治的 GBS 患者队列中 TRF 的频率和临床特征。

在收集的 98 名 GBS 患者中，有 5 名（5.1%）在病程中出现了 TRF。与文献一致，我们大多数发生 TRF 的 GBS 患者没有报告先前的腹泻，主要有近端无力，并且所有患者在临床发病时都有感觉障碍。有趣的是，自 GBS 发病以来，我们 80% 的 TRF 患者表现出自主神经功能障碍，伴有异常出汗和面部、颈部和胸部特殊的“皮肤潮红”。两名患者在 TRF 时出现呼吸功能不全，两人均死亡。

我们建议注意面部、颈部和胸部特别“皮肤潮红”和异常出汗的 GBS 患者，因为这些发现可能是 TRF 的危险信号。