Marcel P J Garssen

Jeroen Bosch Ziekenhuis, Hertogenbosch, North Brabant, Netherlands

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Publications (13)48.13 Total impact

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    ABSTRACT: Fatigue is a major disabling complaint in patients with immune-mediated neuropathies (IN). The 9-item fatigue severity scale (FSS) has been used to assess fatigue in these conditions, despite having limitations due to its classic ordinal construct. The aim was to improve fatigue assessment in IN through evaluation of the FSS using a modern clinimetric approach [Rasch unidimensional measurement model (RUMM2020)]. Included were 192 stable patients with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) or polyneuropathy associated with monoclonal gammopathy of undetermined significance (MGUSP). The obtained FSS data were exposed to RUMM2020 model to investigate whether this scale would meet its expectations. Also, reliability and validity studies were performed. The original FSS did not meet the Rasch model expectations, primarily based on two misfitting items, one of these also showing bias towards the factor 'walking independent.' After removing these two items and collapsing the original 7-point Likert options to 4-point response categories for the remaining items, we succeeded in constructing a 7-item Rasch-built scale that fulfilled all requirements of unidimensionality, linearity, and rating scale model. Good reliability and validity were also obtained for the modified FSS scale. In conclusion, a 7-item linearly weighted Rasch-built modified FSS is presented for more proper assessment of fatigue in future studies in patients with immune-mediated neuropathies.
    Journal of the Peripheral Nervous System 12/2009; 14(4):268-78. · 2.57 Impact Factor
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    Journal of neurology, neurosurgery, and psychiatry 10/2007; 78(9):1012-3. · 4.87 Impact Factor
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    ABSTRACT: Many patients with Guillain-Barré syndrome (GBS) suffer from severe residual fatigue that has an uncertain basis. We determined the relative contribution of peripheral and central factors during a 2-min fatiguing sustained maximal voluntary contraction (MVC) in 10 neurologically well-recovered GBS patients and 12 age- and sex-matched healthy controls. Physiological fatigue was defined as the decline of voluntary force during an MVC of the biceps brachii. Relative amounts of peripheral fatigue and central activation failure were determined combining voluntary force and force responses to electrical stimulation. Surface electromyography was used to determine muscle-fiber conduction velocity. During the first minute of sustained MVC, peripheral fatigue developed more slowly in patients than in controls. Central fatigue only occurred in patients. The muscle-fiber conduction velocity was higher in patients. The initial MVC, decrease of MVC, initial force response, and initial central activation failure did not significantly differ between the groups. Although peripheral mechanisms cannot be excluded in the pathogenesis of residual fatigue after GBS, these results suggest that central changes are involved. This study thus provides further insight into the factors contributing to residual fatigue in GBS patients.
    Muscle & Nerve 08/2007; 36(1):93-9. · 2.31 Impact Factor
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    ABSTRACT: To elucidate the effects of physical exercise in severely fatigued patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy, and to clarify the mutual relationships between 5 domains studied in these patients: physical fitness, fatigue, objectively measured actual mobility, perceived physical functioning, and perceived mental functioning. Case series.Subjects/patients: Twenty patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. The patients undertook a 12-week physical exercise program. Relationships between domains were studied in the change scores, and additionally in the baseline data of patients. The percentage of significant relationships between each pair of domains was determined. In the change scores, a small percentage of significant relationships was found between the physical fitness domain and the other 4 domains (2/30, 7%). A higher percentage of significant relationships was found between the domains perceived mental functioning and actual mobility (44%), perceived mental functioning and perceived physical functioning (44%), and between fatigue and perceived physical functioning (33%). Generally, similar patterns were found in the baseline data. Changes in fatigue, actual mobility and perceived functioning seem not to be influenced by changes in physical fitness. This study stresses the presence and importance of additional effects of a physical training program, not directly related to increasing fitness.
    Journal of Rehabilitation Medicine 04/2007; 39(2):121-5. · 2.13 Impact Factor
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    ABSTRACT: The occurrence of severe fatigue after Guillain-Barré syndrome (GBS), and its relation with disease course, clinical characteristics, and antecedent infections was studied in 100 GBS patients. Severe fatigue, expressed as a mean Fatigue Severity Scale (FSS) score of 5.0 or more, was present in 60% of all patients. It was more frequently present in females and in patients over 50 years (p < 0.01). There was no significant relationship between fatigue severity and the level of functional disability at nadir, antecedent events or infections, clinical variables, and time to follow-up after GBS.
    Journal of Neurology 10/2006; 253(9):1143-6. · 3.58 Impact Factor
  • Marcel P J Garssen, P A van Doorn, G H Visser
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    ABSTRACT: Many Guillain-Barré syndrome (GBS) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) patients recover well, but suffer from excessive fatigue, which may persist for years and reduce the quality of life considerably. In order to determine whether residual subclinical peripheral nerve dysfunction is a possible underlying mechanism of fatigue, we performed standardized nerve conduction (NC) studies in 16 fatigued patients, mean 6.5 years after diagnosis. Thirteen were relatively well recovered from GBS and 3 had stable CIDP. In contrast to CIDP, most NC values in GBS patients were remarkably restored and within normal values. No correlations were found between the electrophysiological findings and the fatigue scores,muscle strength, or functional scores. This study demonstrates that fatigue in GBS is not explained by residual nerve dysfunction, using conventional NC measurements.
    Journal of Neurology 08/2006; 253(7):851-6. · 3.58 Impact Factor
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    ABSTRACT: Many patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) suffer from excessive fatigue. To assess whether this fatigue might be related to changes in slow-conducting nerve fibers, we determined the conduction velocity distribution (CVD) in the median nerve. Thirteen fatigued but neurologically well-recovered GBS patients, 2 fatigued and stable CIDP patients, and 19 healthy controls participated in this study. Conventional maximal nerve conduction velocities (NCVs) did not show differences between GBS patients and healthy controls. However, in both GBS and CIDP patients the CVD was altered, showing significant narrowing of the velocity distribution with loss of the fastest- and slowest-conducting fibers. These changes were most pronounced in the subgroup of patients with the lowest fatigue scores. We therefore conclude that the observed CVD changes in patients are not likely to contribute to persisting complaints of fatigue after GBS.
    Muscle & Nerve 03/2006; 33(2):177-82. · 2.31 Impact Factor
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    ABSTRACT: Fatigue is a major complaint in patients with immune mediated polyneuropathies. Despite apparently good physical recovery after Guillain-Barré syndrome (GBS), many patients remain restricted in daily and social activities, and have a decreased quality of life. In this trial, the effect of amantadine on severe fatigue related to GBS was studied. During the pre-treatment phase, all patients were monitored for 2 weeks. Only patients with severe fatigue, defined as a mean fatigue score of > or = 5.0 on the Fatigue Severity Scale (FSS), were randomised for this double blind, placebo controlled, crossover study. Primary outcome measure was improvement of at least 1 point on the FSS. Secondary outcome measures were impact of fatigue, anxiety and depression, handicap, and quality of life. In total, 80 patients with GBS were randomised, of whom 74 were included for analysis. Fatigue appeared to be reduced already during the pre-treatment phase (p = 0.05), probably due to increased attention provided to the patients. No significant differences in any of the primary and secondary outcome measures were found. Amantadine was not superior to placebo. Because fatigue remains a serious complaint, other studies evaluating new treatment options are strongly recommended.
    Journal of Neurology Neurosurgery &amp Psychiatry 02/2006; 77(1):61-5. · 4.92 Impact Factor
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    M. P. J. Garssen
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    ABSTRACT: Chapter 1 is the general introduction of this thesis, in which di.erent aspects of the Guillain-Barré syndrome (GBS) are described. GBS is an acute post-infectious polyneuropathy, in which the immune system plays an important role. Insight in pathogenesis, clinical and electrophysiological features, functional outcome, and residual complaints is increasing. To date, fatigue is considered one of the most disabling residual symptoms, seriously a.ecting quality of life. The considerable percentages of (long-lasting) morbidity and mortality, as well as the residual complaints of severe fatigue, were the most important reasons to initiate this study, entitled; ‘treatment of GBS and causes and treatment of residual fatigue’. Items discussed in the introduction range from diagnosis to pathogenesis and treatment of GBS. Attention is partially focused towards prognosis and outcome, in particular towards residual fatigue. Chapter 2.1 is a review about the peripheral neuropathies GBS, chronic in.ammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN), all potentially treatable immune-mediated disorders. It was postulated that the use of appropriate assessment scales to evaluate the e.ects of treatment is essential. Recent clinical trials and Cochrane reviews on the e.ect of various treatments in patients with GBS, CIDP and MMN are discussed. It is concluded that intravenous immunoglobulin (IVIg) remains the cornerstone of treatment for GBS, but that combinations of treatment may be even more e.ective. Also studies on prognostic factors related to improvement are discussed. Whether patients with Miller Fisher syndrome or those with mild GBS should also be treated remains a matter of debate. IVIg is the best studied therapy for CIDP patients. IVIg is e.ective and is one of the most important treatments in these patients. Whether steroids are able to eradicate the disease besides suppressing disease activity in CIDP remains to be established. Some GBS patients have secondary deterioration or .nally turn out to have CIDP; additional information in this group of patients may lead to more appropriate disease management. Most patients with CIDP and those with MMN need long-term treatment. New treatment strategies should also focus on the e.ect and the costs of treatment during long-term follow up. In chapter 2.2 a multi-center open label study on the additional e.ect of Mycophenolate Mofetil (MM) when added to the combination of IVIg and intravenous methylprednisolone (MP) is described. An important reason for this study was that, despite di.erent treatments, GBS remains associated with considerable co-morbidity, mortality, and long-lasting residual de. cits. The aims of this pilot study were to investigate the safety of this treatment combination and to study the potential additional e.ect of MM on the outcome in patients with GBS. Patients were treated for 6 consecutive weeks with MM in a dosage of 2g daily, and for 5 days with 0.4 g/kg of body weight IVIg and 500 mg MP daily. Because the IVIg-MP treatment group of the Dutch IVIg-MP trial was used as control group, identical outcome measures were used. The primary endpoint was the percentage of patients showing improvement with at least one grade on the GBS-disability scale, 4 weeks after inclusion. Twenty-six patients were included in analysis. Sixty- 189 two percent reached the primary endpoint in the group of patients treated with IVIg-MP-MM, as compared with 68% in the group treated with IVIg-MP (OR 1.3, 95% CI 0.6-3.2, p=0.54). None of the secondary endpoints showed any signi.cant di.erences either. Complications and adverse events were comparable in both groups. It was concluded that although side e.ects were generally mild, there appears to be no signi.cant improved outcome in the group of patients additionally treated with MM. It was concluded that new treatment studies are warranted. In chapter 3.1 a double-blind, placebo controlled, cross-over study is described, aiming to reduce fatigue with amantadine treatment, in 80 severely fatigued GBS patients. Fatigue was assessed using the Fatigue Severity Scale (FSS) and Fatigue Impact Scale (FIS). Patients could participate when they were severely fatigued (de.ned as FSS = 5.0), and other possible confounding factors causing fatigue were excluded. Amantadine was not superior to placebo. However, some reduction of fatigue was observed both during the pre-treatment period and during the consecutive visits, both in the placebo and amantadine treated group, suggesting that increased attention for fatigue provided by this study already had an ameliorating in.uence on fatigue. Also secondary outcome measures including impact of fatigue, anxiety and depression, handicap, and quality of life did not reveal any signi.cant di.erence. Fatigue scores obtained from the FSS (fatigue severity) as well as from the FIS (impact of fatigue on cognitive, physical, and social functioning) showed the same trends and changes during the consecutive follow-up visits. In chapter 3.2 the favourable results are discussed of a 12-week during bicycle exercise training in 20 severely fatigued patients. Sixteen patients were relatively good recovered from GBS and 4 had stable chronic in.ammatory demyelinating polyneuropathy (CIDP). Selfreported fatigue scores as measured with the FSS, as well as aerobic capacity and isokinetic muscle strength improved signi.cantly compared to baseline measurements. Daily physical activity, as measured with the Rotterdam activity monitor (RAM) showed that endurance related physical activities (e.g., duration of standing, walking, cycling and transitions from positions), did not show any signi.cant improvement. It was suggested that changing the level of daily physical activity is not an important adaptation strategy in these fatigued patients. Maybe the maintenance of normal activity patterns contributes to fatigue. Both GBS and CIDP patients showed comparable signi.cant improvements on the FSS and FIS. Patients reported that increased physical activity in the past often resulted in increased neurological complaints, resembling the initial phase of GBS or CIDP, and resulting in threatening and anxious feelings of getting a relapse. This medical supervised training showed the opposite, patients became con.dent, and a negative circle seemed to be broken. It was suggested that the motivational aspect of increased social contacts with fellow-patients, besides promoting exercise adherence, has also lead to better psychological performances. Quality of life improved, mainly on the physically focused domains of the SF-36, suggesting being a result of improved physical .tness and muscle strength. Most patients (80%) were motivated to continue with regular training activities. Marcel BW.indd 189 02-11-2005 16:23:25 In chapter 3.3 the long-term follow-up of fatigue, quality of life, physical .tness and muscle strength in GBS and CIDP patients is described, evaluated 2 years after training intervention. Mean reduction of self-reported fatigue compared to pre-training values was not di.erent from the fatigue reduction observed directly after the training intervention. Also maximal ‘power output’and muscle strength (except elbow .exion), remained signi.cantly improved compared to pre-training values. It seemed that lower fatigue scores and improved functional scores were not a result of natural reduction of fatigue after GBS nor could be explained by ongoing reconditioning activities. Patients became more convinced of their physical capabilities, and were less afraid and more capable to perform rather high level (short-lasting) maximal physical e.ort, as measured by the increased maximal power output and muscle strength measurements. Presumably, training has taught the patients that increased physical activity can be performed without getting new neurological complaints or ‘relapse’feelings, and thus helped them to take the barrier. Although some methodological remarks had to be made, these results favoured a long-term e.ect of a physical training intervention. The results of a cross-sectional study within a prospective nationwide study in the Netherlands, in which the presence of fatigue after GBS was investigated, is described in chapter 4.1. The occurrence of severe fatigue, and its relation with disease course, clinical characteristics, and antecedent infections was studied in 100 GBS patients. Severe fatigue, again expressed as a mean FSS-score of at least 5.0, was present in 60% of all patients; it was more frequently present in females and in patients over 50 years (p
    Stroke 01/2005; · 6.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) experience excessive fatigue, which may persist for years and reduce quality of life. The authors performed a 12-week study of bicycle exercise training in 20 patients with severe fatigue, 16 with relatively good recovery from GBS, and 4 with stable CIDP. Training seemed well tolerated, and self-reported fatigue scores decreased 20% (p = 0.001). Physical fitness, functional outcome, and quality of life were improved.
    Neurology 01/2005; 63(12):2393-5. · 8.25 Impact Factor
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    ABSTRACT: Narcolepsy is a sleep disorder caused by defective hypocretin (orexin) neurotransmission. It is thought to result from an autoimmune destruction of hypocretin producing neurons. Recently, low hypocretin levels were found in patients with Guillain-Barré syndrome, a post-infectious immune-mediated disorder in which a variety of circulating antibodies against neuronal gangliosides are found. We therefore considered gangliosides to be candidate antigens in narcolepsy as well, and screened for the presence of a panel of serum anti-ganglioside antibodies in a group of 28 well-characterized narcoleptic patients. We did not find a correlation between increased titers of anti-ganglioside antibodies and hypocretin-deficient narcolepsy. This study does not support the hypothesis that an autoimmune response is involved in narcolepsy. However, as an autoimmune attack may be selective and/or transient, future studies are needed to ultimately refute or confirm the autoimmune hypothesis.
    Neuroscience Letters 05/2003; 341(1):13-6. · 2.03 Impact Factor
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    Pieter A Van Doorn, Marcel P J Garssen
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    ABSTRACT: Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating poly(radiculo)neuropathy (CIDP) and multifocal motor neuropathy (MMN) are potentially treatable disorders. The use of appropriate assessment scales to evaluate the effects of treatment is essential. Recent therapeutic trials and the question of whether patients with mild disease or other variants of these disorders need to be treated are discussed. Recent clinical trials and Cochrane reviews give new information on the effect of various treatments in patients with GBS, CIDP and MMN. Intravenous immunoglobulin remains the only treatment proven to be effective in MMN. Combinations of treatment may be even more effective in GBS. Studies on prognostic factors related to improvement have been reported. Whether patients with Miller-Fisher syndrome or those with mild GBS should also be treated is still debated. New assessment scales at the disability and handicap level have now been evaluated for GBS and CIDP, and are ready for use. Results of studies in experimental models contribute to our understanding of the mechanism of action of intravenous immunoglobulin. Recent new information on the use of intravenous immunoglobulin and steroids indicates that the former should remain the cornerstone of treatment for GBS and MMN, and probably also for CIDP. Whether steroids not only suppress disease activity in CIDP but also eradicate the disease remains to be established. Some GBS patients have secondary deterioration or finally turn out to have CIDP; additional information in this group of patients may lead to more appropriate disease management. Most patients with CIDP and those with MMN need long-term treatment. New treatment strategies should now focus also on the effect and the costs of treatment over long-term follow up.
    Current Opinion in Neurology 11/2002; 15(5):623-31. · 5.42 Impact Factor
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Publication Stats

177 Citations
48.13 Total Impact Points

Institutions

  • 2009
    • Jeroen Bosch Ziekenhuis
      Hertogenbosch, North Brabant, Netherlands
  • 2006
    • Erasmus Universiteit Rotterdam
      • Department of Neurology
      Rotterdam, South Holland, Netherlands
  • 2002–2006
    • Erasmus MC
      • Department of Neurology
      Rotterdam, South Holland, Netherlands