{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:53:20Z","timestamp":1777312400990,"version":"3.51.4"},"reference-count":114,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>\n                    <jats:bold>Background and Aim:<\/jats:bold>\n                    Guillain\u2013Barr\u00e9 Syndrome (GBS) is a severe neurological disorder in which the immune system attacks the peripheral nervous system, leading to acute flaccid paralysis. The conventional treatment involves intravenous immunoglobulin (IVIG), yet the efficacy of a second IVIG dose remains uncertain. This systematic review aims to evaluate the clinical outcomes of administering a second dose of IVIG in GBS patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    The review was registered in the PROSPERO database (CRD42024557465) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Databases including EBSCO, MEDLINE, CINAHL, and SCOPUS were searched from database inception until June 2024, using a combination of relevant keywords. Only English-language studies were included. Quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools. In total, 89 abstracts were initially screened, 20 full-text articles were reviewed, and 10 studies met the inclusion criteria for final evaluation.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    The review included 10 studies with 94 patients across all included studies (31 female, 63 male). This review includes two clinical trials, six case studies, and two case report series, conducted across Europe and Asia. The studies evaluated the clinical outcomes of a second IVIG dose in GBS patients in various healthcare settings, such as emergency rooms, medical departments, and intensive care units. Most of these studies reported significant clinical improvements in motor symptoms and successful weaning from mechanical ventilation following the administration of a second IVIG dose. Eighty percent of the studies included patients on mechanical ventilation, with a standard IVIG dose of 0.4 g\/kg reported in 60% of studies. Half of the studies administered the second IVIG dose 2 weeks after the first. Seventy percent of the studies reported clinical motor improvement following the second IVIG dose, with half indicating successful weaning from mechanical ventilation. Evaluation methods varied, with cerebrospinal fluid protein testing (60%) and nerve conduction studies (50%) being the most common. A smaller proportion of studies assessed GMI\/GDIA antibodies, immunoglobulin G (IgG) levels, or conducted electrophysiological studies. The findings demonstrate the potential effectiveness of a second IVIG dose in improving motor outcomes and reducing ventilator dependency in GBS patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    The findings suggest that a second dose of IVIG may enhance clinical outcomes in GBS patients, particularly in improving motor functions and facilitating weaning from mechanical ventilation. However, further prospective randomized trials are essential to validate these results and improve treatment protocols.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2025.88","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T08:31:26Z","timestamp":1761640286000},"source":"Crossref","is-referenced-by-count":2,"title":["Assessing the impact of a second IVIG dose on patients with Guillain\u2013Barr\u00e9 Syndrome: A synthesis without meta-analysis (SWiM)"],"prefix":"10.5339","volume":"2025","author":[{"given":"Mohammad Minwer","family":"Alnaeem","sequence":"first","affiliation":[{"name":"AI-Zaytoonah University of Jordan, School of Nursing, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad R.","family":"Al-Qudimat","sequence":"additional","affiliation":[{"name":"Surgical Research Section, Surgery Department, Hamad Medical Corporation, Doha, Qatar"},{"name":"Public Health Department, Health Sciences College, Qatar University, Doha, Qatar*Correspondence: Ahmad R. Al-Qudimat aalqudimat@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doaa","family":"Talafha","sequence":"additional","affiliation":[{"name":"AI-Zaytoonah University of Jordan, School of Nursing, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Alqaisi","sequence":"additional","affiliation":[{"name":"AI-Zaytoonah University of Jordan, School of Nursing, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"key":"CIT0001","series-title":"Guillain\u2013Barr\u00e9 syndrome;","author":"World Health Organization: WHO","year":"2016"},{"issue":"(4):","key":"CIT0002","series-title":"Lancet Neurol","first-page":"275\u201383","article-title":"Second intravenous immunoglobulin dose in patients with Guillain\u2013Barr\u00e9 syndrome with poor prognosis (SID-GBS): A double-blind, randomised, placebo-controlled trial","volume":"20","author":"Walgaard\n \nC","year":"2021;"},{"key":"CIT0003","series-title":"Guillain\u2013Barr\u00e9 syndrome;","author":"World Health Organization: WHO","year":"2023"},{"issue":"(1):","key":"CIT0004","series-title":"J Clin Neurol","first-page":"48\u201358","article-title":"Incidence, disability, and mortality in patients with Guillain\u2013Barr\u00e9 syndrome in Korea: A nationwide population-based study","volume":"18","author":"Yi\n \nS-W","year":"2022"},{"issue":"(1):","key":"CIT0005","series-title":"Neurocrit Care","first-page":"113\u201320","article-title":"Dysautonomia in Guillain\u2013Barr\u00e9 syndrome: Prevalence, clinical spectrum, and outcomes","volume":"32","author":"Chakraborty\n \nT","year":"2020"},{"issue":"(1):","key":"CIT0006","series-title":"Sci Rep","first-page":"15520","article-title":"A retrospective analysis of the clinical profile and factors associated with mortality and poor hospital outcomes in adult Guillain\u2013Barre syndrome patients","volume":"14","author":"Tewedaj\n \nZD","year":"2024"},{"issue":"(4):","key":"CIT0007","series-title":"Biochim Biophys Acta","first-page":"658\u201366","article-title":"Pathogenesis of immune-mediated neuropathies","volume":"1852","author":"Dalakas M\n \nC","year":"2015"},{"issue":"(5):","key":"CIT0008","series-title":"Neurol Neuroimmunol Neuroinflamm","first-page":"e781","article-title":"Guillain\u2013Barr\u00e9 syndrome: The first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing","volume":"7","author":"Dalakas\n \nMC","year":"2020"},{"key":"CIT0009","series-title":"J Clin Neurosci","first-page":"448","article-title":"Does COVID-19 cause axonal GBS?","volume":"78","author":"Umapathi\n \nT","year":"2020"},{"issue":"(22):","key":"CIT0010","series-title":"Int J Mol Sci","first-page":"14222","article-title":"Triggers of Guillain\u2013Barr\u00e9 syndrome: Campylobacter jejuni predominates","volume":"23","author":"Finsterer\n \nJ","year":"2022"},{"key":"CIT0011","series-title":"Front Neurol","first-page":"588290","article-title":"Trauma-related Guillain\u2013Barr\u00e9 syndrome: Systematic review of an emerging concept","volume":"11","author":"Huang\n \nC","year":"2020"},{"issue":"(8):","key":"CIT0012","series-title":"Int J Mol Sci","first-page":"7288","article-title":"Immune-mediated neuropathies: Pathophysiology and management","volume":"24","author":"Shastri\n \nA","year":"2023"},{"issue":"(1):","key":"CIT0013","series-title":"Neurology","first-page":"e59\u201376","article-title":"Current treatment practice of Guillain\u2013Barr\u00e9 syndrome","volume":"93","author":"Verboon\n \nC","year":"2019"},{"key":"CIT0014","series-title":"Bmj","first-page":"368","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline","author":"Campbell\n, \nM.","year":"2020"},{"issue":"(1):","key":"CIT0015","series-title":"BMC Neurol","first-page":"321","article-title":"Guillain\u2013Barr\u00e9 syndrome as the first presentation of human immunodeficiency virus infection","volume":"21","author":"Lopes\n \nM","year":"2021"},{"issue":"(4):","key":"CIT0016","series-title":"Med Princ Pract","first-page":"272\u20135","article-title":"Guillain\u2013Barre syndrome in a case of acute lymphoblastic leukaemia: A case report","volume":"12","author":"Vembu\n \nP","year":"2003"},{"issue":"(2)","key":"CIT0017","series-title":"Experimental and Therapeutic Medicine","first-page":"1091\u20131094","article-title":"Successful treatment of a 12yearold boy with GuillainBarr\u00e9 syndrome requiring tracheostomy due to respiratory muscle paralysis: A case report","volume":"19","author":"Miyamoto\n, \nM.","year":"2020;"},{"key":"CIT0018","series-title":"J Clin Neurosci","first-page":"247\u20139","article-title":"Albumin levels as a biomarker for second Intravenous Immunoglobulin (IVIG) treatment in Guillain\u2013Barre syndrome (GBS)","volume":"74","author":"Shalman\n \nA","year":"2020"},{"key":"CIT0019","series-title":"Case Rep Rheumatol","first-page":"528026","article-title":"A case of systemic lupus erythematosus presenting as Guillain\u2013Barr\u00e9 syndrome","volume":"2015","author":"Okoh\n \nHC","year":"2015;"},{"issue":"(10):","key":"CIT0020","series-title":"Arq Neuropsiquiatr","first-page":"848\u201351","article-title":"Is a second cycle of immunoglobulin justified in axonal forms of Guillain\u2013Barr\u00e9 syndrome?","volume":"73","author":"Godoy\n \nDA","year":"2015"},{"issue":"(9093):","key":"CIT0021","series-title":"Lancet","first-page":"1747","article-title":"Efficacy of repeated intravenous immunoglobulin in severe unresponsive Guillain\u2013Barr\u00e9 syndrome","volume":"350","author":"Farcas\n \nP","year":"1997"},{"issue":"(2):","key":"CIT0022","series-title":"J Neurol Neurosurg Psychiatry","first-page":"113\u201321","article-title":"Second IVIg course in Guillain\u2013Barr\u00e9 syndrome with poor prognosis: The non-randomised ISID study","volume":"91","author":"Verboon\n \nC","year":"2020"},{"issue":"(9):","key":"CIT0023","series-title":"Rinsho Shinkeigaku","first-page":"600\u20133","article-title":"An elderly case of Guillain\u2013Barr\u00e9 syndrome with anti-GT1b antibodies","volume":"59","author":"Kinboshi\n \nM","year":"2019"},{"issue":"(9093)","key":"CIT0024","series-title":"The Lancet","first-page":"1747","article-title":"Efficacy of repeated intravenous immunoglobulin in severe unresponsive Guillain-Barr\u00e9 syndrome","volume":"350","author":"Farcas\n, \nP.","year":"1997"},{"issue":"(4)","key":"CIT0025","series-title":"Lancet Neurol","first-page":"275\u2013283","article-title":"Second intravenous immunoglobulin dose in patients with Guillain-Barr\u00e9 syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial","volume":"20","author":"Walgaard\n, \nC.","year":"2021"},{"issue":"(1)","key":"CIT0026","series-title":"Annals of Clinical and Translational Neurology","first-page":"129\u2013143","article-title":"IVI g-induced plasmablasts in patients with Guillain-Barr\u00e9 syndrome","volume":"6","author":"Brem\n, \nM. D.","year":"2019"},{"issue":"(10280)","key":"CIT0027","series-title":"The lancet","first-page":"1214\u20131228","article-title":"Guillain-barr\u00e9 syndrome","volume":"397","author":"Shahrizaila\n, \nN.","year":"(2021)"},{"issue":"(11):","key":"CIT0028","series-title":"Expert Rev Clin Immunol","first-page":"1053\u201364","article-title":"Mechanical ventilation in Guillain\u2013Barr\u00e9 syndrome","volume":"16","author":"Shang\n \nP","year":"2020"},{"issue":"(1):","key":"CIT0029","series-title":"Ann Intensive Care","first-page":"128","article-title":"Early mechanical ventilation in patients with Guillain\u2013Barr\u00e9 syndrome at high risk of respiratory failure: A randomized trial","volume":"10","author":"Melone\n \nMA","year":"2020"},{"issue":"(9):","key":"CIT0030","series-title":"J Neurol Neurosurg Psychiatry","first-page":"949\u201354","article-title":"Clinical outcome of Guillain\u2013Barr\u00e9 syndrome after prolonged mechanical ventilation","volume":"89","author":"van den Berg\n \nB","year":"2018"},{"issue":"(1):","key":"CIT0031","series-title":"Crit Care","first-page":"310","article-title":"Predictors for mechanical ventilation and short-term prognosis in patients with Guillain\u2013Barr\u00e9 syndrome","volume":"19","author":"Wu\n \nX","year":"2015"},{"issue":"(10045)","key":"CIT0032","series-title":"The Lancet","first-page":"717\u2013727","article-title":"Guillain-barre syndrome","volume":"388","author":"Willison\n, \nH. 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A.","year":"2015"},{"key":"CIT0040","series-title":"Front Pharmacol","first-page":"608130","article-title":"Intensive care and treatment of severe Guillain\u2013Barr\u00e9 syndrome","volume":"12","author":"Shang\n \nP","year":"2021"},{"issue":"(2)","key":"CIT0041","series-title":"Neurocritical Care","first-page":"371\u2013374","article-title":"Should We Assess Diaphragmatic Function During Mechanical Ventilation Weaning in Guillain\u2013Barr\u00e9 Syndrome and Myasthenia Gravis Patients?","volume":"34","author":"Weiss\n, \nN.","year":"2021"},{"issue":"(4)","key":"CIT0042","series-title":"Respir Care","first-page":"e68\u201372","article-title":"Neurally adjusted ventilatory assist during weaning from respiratory support in a case of Guillain\u2013Barre syndrome","volume":"60","author":"Dugernier\n \nJ","year":"2015"},{"issue":"(2):","key":"CIT0043","series-title":"PLoS One","first-page":"e0318824","article-title":"HLA-class II genes association with multiple sclerosis: An immunogenetic prediction among multiple sclerosis Jordanian patients","volume":"20","author":"Khdair\n \nSI","year":"2025"},{"issue":"(10):","key":"CIT0044","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1145\u20138","article-title":"Pharmacokinetics of intravenous immunoglobulin in multifocal motor neuropathy","volume":"85","author":"Vlam\n \nL","year":"2014"},{"issue":"(4)","key":"CIT0045","series-title":"Drug Metabolism and Personalized Therapy","first-page":"331\u2013338","article-title":"CRHR1 polymorphism at rs242941, rs242940, and rs72834580: association of symptoms improvement with intranasal corticosteroids in allergic rhinitis Jordanian patients","volume":"38","author":"Zihlif\n, \nM.","year":"2024"},{"issue":"(5):","key":"CIT0046","series-title":"J Pers Med","first-page":"329","article-title":"The association of IgE levels with ADAM33 genetic polymorphisms among asthmatic patients","volume":"11","author":"Zihlif\n \nM","year":"2021"},{"issue":"(8):","key":"CIT0047","series-title":"J Neurol Neurosurg Psychiatry","first-page":"876\u201385","article-title":"IVIg-exposure and thromboembolic event risk: Findings from the UK Biobank","volume":"93","author":"Kapoor\n \nM","year":"2022"},{"issue":"(5):","key":"CIT0048","series-title":"Ann Clin Transl Neurol","first-page":"966\u201375","article-title":"If it does not help, it might hurt: Pharmacodynamics of a second IVIg course in Guillain\u2013Barr\u00e9 syndrome","volume":"12","author":"van Tilburg\n \nSJ","year":"2025"},{"issue":"(11):","key":"CIT0049","series-title":"Nat Rev Neurol","first-page":"671\u201383","article-title":"Diagnosis and management of Guillain\u2013Barr\u00e9 syndrome in ten steps","volume":"15","author":"Leonhard\n \nSE","year":"2019"},{"issue":"(2):","key":"CIT0050","series-title":"Bangladesh J Neurosci","first-page":"79\u201384","article-title":"Cerebrospinal fluid protein level and nerve conduction study as short-term 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\nS-W","year":"2022"},{"issue":"(1):","key":"CIT0005","series-title":"Neurocrit Care","first-page":"113\u201320","article-title":"Dysautonomia in Guillain\u2013Barr\u00e9 syndrome: Prevalence, clinical spectrum, and outcomes","volume":"32","author":"Chakraborty\n \nT","year":"2020"},{"issue":"(1):","key":"CIT0006","series-title":"Sci Rep","first-page":"15520","article-title":"A retrospective analysis of the clinical profile and factors associated with mortality and poor hospital outcomes in adult Guillain\u2013Barre syndrome patients","volume":"14","author":"Tewedaj\n \nZD","year":"2024"},{"issue":"(4):","key":"CIT0007","series-title":"Biochim Biophys Acta","first-page":"658\u201366","article-title":"Pathogenesis of immune-mediated neuropathies","volume":"1852","author":"Dalakas M\n \nC","year":"2015"},{"issue":"(5):","key":"CIT0008","series-title":"Neurol Neuroimmunol Neuroinflamm","first-page":"e781","article-title":"Guillain\u2013Barr\u00e9 syndrome: The first documented 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\nA","year":"2023"},{"issue":"(1):","key":"CIT0013","series-title":"Neurology","first-page":"e59\u201376","article-title":"Current treatment practice of Guillain\u2013Barr\u00e9 syndrome","volume":"93","author":"Verboon\n \nC","year":"2019"},{"key":"CIT0014","series-title":"Bmj","first-page":"368","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline","author":"Campbell\n, \nM.","year":"2020"},{"issue":"(1):","key":"CIT0015","series-title":"BMC Neurol","first-page":"321","article-title":"Guillain\u2013Barr\u00e9 syndrome as the first presentation of human immunodeficiency virus infection","volume":"21","author":"Lopes\n \nM","year":"2021"},{"issue":"(4):","key":"CIT0016","series-title":"Med Princ Pract","first-page":"272\u20135","article-title":"Guillain\u2013Barre syndrome in a case of acute lymphoblastic leukaemia: A case report","volume":"12","author":"Vembu\n \nP","year":"2003"},{"issue":"(2)","key":"CIT0017","series-title":"Experimental and Therapeutic Medicine","first-page":"1091\u20131094","article-title":"Successful treatment of a 12yearold boy with GuillainBarr\u00e9 syndrome requiring tracheostomy due to respiratory muscle paralysis: A case report","volume":"19","author":"Miyamoto\n, \nM.","year":"2020;"},{"key":"CIT0018","series-title":"J Clin Neurosci","first-page":"247\u20139","article-title":"Albumin levels as a biomarker for second Intravenous Immunoglobulin (IVIG) treatment in Guillain\u2013Barre syndrome (GBS)","volume":"74","author":"Shalman\n \nA","year":"2020"},{"key":"CIT0019","series-title":"Case Rep Rheumatol","first-page":"528026","article-title":"A case of systemic lupus erythematosus presenting as Guillain\u2013Barr\u00e9 syndrome","volume":"2015","author":"Okoh\n \nHC","year":"2015;"},{"issue":"(10):","key":"CIT0020","series-title":"Arq Neuropsiquiatr","first-page":"848\u201351","article-title":"Is a second cycle of immunoglobulin justified in axonal forms of Guillain\u2013Barr\u00e9 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