Guillain-Barré Syndrome Otr
Guillain-Barré Syndrome Otr
Guillain-Barré Syndrome Otr
a, b
Vibhuti Ansar, MD *, Nojan Valadi, MD
KEYWORDS
Guillain-Barré syndrome Demyelinating syndrome
Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
Acute motor axonal neuropathy Miller Fisher syndrome
KEY POINTS
Guillain-Barré syndrome (GBS) has several clinical variants, including acute inflammatory
demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy, acute
motor and sensory axonal neuropathy, acute pandysautonomia, sensory GBS, GBS
with ophthalmoplegia, and Miller Fisher syndrome.
The incidence typically is 1 to 2 per 100,000, with a higher prevalence in men and the
elderly.
GBS is often preceded by an acute viral infection and has been linked to vaccine
administration.
Treatment may consist of several cycles of plasma exchange (PE) or intravenous
immunoglobulin (IVIG). Both treatments are effective. Corticosteroids have not been
shown to help in GBS.
Approximately 80% to 90% of patients recover with no sequelae at 1 year.
INTRODUCTION
a
Department of Medical Education, Midtown Medical Center, Columbus Regional Healthcare,
1900 10th Avenue, Suite 100, Columbus, GA 31901, USA; b 2300-A Manchester Expressway,
Suite 201, Columbus, GA 31903, USA
* Corresponding author.
E-mail address: [email protected]
including acute motor axonal neuropathy, acute motor and sensory axonal neuropa-
thy, and Miller Fisher syndrome.1 The subtypes differ in pathologic and electrodiag-
nostic features. Some clinical distinctions are also present, especially with Miller
Fisher variant.2
EPIDEMIOLOGY
With the decline of acute poliomyelitis, GBS has become the most common acute para-
lytic disease in Western countries. Incidence of GBS is approximately 1 to 2 per 100,000
and afflicts men and the elderly more commonly than women or younger patients.3
RISK FACTORS
CLINICAL FEATURES
GBS and variants typically present with progressively ascending fairly symmetric
paralysis and areflexia over the course of hours to several days. Motor paralysis af-
fects the lower extremities more frequently than the upper extremeties.5 Sensory dis-
turbances may or may not occur. Respiratory failure due to neuromuscular
compromise is not uncommon, often requiring supportive ventilation.6 Autonomic
symptoms have been reported in as many as 65% of patients admitted to hospitals
for GBS and may include orthostatic hypotension, anhidrosis, urinary retention,
gastrointestinal atony, or iridoplegia.7 Miller Fisher syndrome, which accounts for
5% of GBS cases, is characterized by ophthalmoplegia, ataxia, and areflexia. Patients
present with diplopia followed by discoordination of the limbs and gait. Tables 1 and 2
indicate various physical signs and symptoms in patients with GBS.
DIAGNOSIS
Several consensus statements have been made about the required diagnostic criteria
for GBS and variants. Required criteria for the diagnosis include progressive weak-
ness of more than 2 limbs, areflexia, and progression for no more than 4 weeks.3 Sup-
portive criteria include mild sensory signs, relative symmetry of symptoms, absence of
fever, facial diplegia, and a cerebrospinal fluid (CSF) profile of albuminocytologic
dissociation with elevated protein concentration without CSF pleocytosis, with the
exception of the setting of HIV, where pleocytosis is the norm and not the exception.8
Laboratory testing could show an elevated erythrocyte sedimentation rate, mildly
abnormal renal and liver laboratory results, and electrolyte disturbances, such as
hyponatremia (from the syndrome of inappropriate secretion of antidiuretic hormone).
Nerve conduction studies may be abnormal and show slowed motor conduction
velocities, partial conduction block, and dispersed motor responses. Demyelination
at the nerve roots may cause absent or delayed F-wave responses or H-reflexes on
the studies. MRI of the lumbosacral spine typically shows enhancement of the nerve
Guillain-Barré Syndrome 191
Table 1
Percentage of patients with these physical signs in GBS
Data from Bahemuka M. Guillain-Barre syndrome in Kenya: a clinical review of 54 patients. J Neurol
1988;235:418–21.
roots.9 This inflammatory response at the nerve roots helps explain certain features,
including the CSF findings, some neurophysiologic findings, and autonomic dysfunc-
tion that may be seen in these patients. In Miller Fisher syndrome, serum IgG anti-
bodies to ganglioside GQ1b are found in most patients.
THERAPEUTIC OPTIONS
PE and IVIG are common treatments for GBS. Combination therapy is not superior to
either alone. Both are expensive but decrease the time to recovery.3 Both treatment
modalities are superior to supportive therapy alone. No significant differences have
been found between the two treatment options for disability scores at 4 weeks or
the time to wean ventilatory support or recover unassisted walking.10 Patients
receiving IVIG, however, have fewer side effects, have fewer complications, and are
less likely to quit therapy compared with those receiving PE.11
PE involves taking the autoantibodies out of the blood. It cannot be performed in
pregnant patients or hemodynamically unstable patients. Practice guidelines set by
Table 2
Presenting symptoms
Data from Bahemuka M. Guillain-Barre syndrome in Kenya: a clinical review of 54 patients. J Neurol
1988;235:418–21.
192 Ansar & Valadi
CLINICAL OUTCOMES
Overall, patients afflicted with GBS have a good prognosis. Improvements in critical
care have vastly changed outcomes from GBS, decreasing mortality from 33% to
Guillain-Barré Syndrome 193
SUMMARY
In conclusion, GBS and its clinical variants are a group of rapidly progressing, poten-
tially debilitating neurologic disorders that may have significant morbidity/mortality if
left unrecognized or untreated. The most common symptoms include ascending
limb weakness and paralysis, which may progress to respiratory failure. Diagnosis is
made clinically with laboratory testing. Several treatment options exist, including PE
and IVIG administration. Most cases may resolve without sequelae, but those that
do not may leave behind significant persistent debility.
REFERENCES