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Semin Neurol 2008; 28(2): 152-167
DOI: 10.1055/s-2008-1062261
© Thieme Medical Publishers

Guillain-Barré Syndrome

Ted M. Burns1
  • 1Department of Neurology, University of Virginia, Charlottesville, Virginia
Further Information

Publication History

Publication Date:
19 March 2008 (online)

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ABSTRACT

Guillain-Barré syndrome (GBS) is an acute-onset, monophasic, immune-mediated polyneuropathy that often follows an antecedent infection. The diagnosis relies heavily on the clinical impression obtained from the history and examination, although cerebrospinal fluid analysis and electrodiagnostic testing usually provide evidence supportive of the diagnosis. The clinician must also be familiar with mimics and variants to promptly and efficiently reach an accurate diagnosis. Intravenous immunoglobulin and plasma exchange are efficacious treatments. Supportive care during and following hospitalization is also crucial.

KEYWORDS

Guillain-Barré syndrome - inflammatory neuropathy - demyelinating neuropathy - acquired demyelinating neuropathy - Miller Fisher syndrome - acute inflammatory demyelinating polyradiculoneuropathy (AIDP) - acute motor axonal neuropathy

REFERENCES

  • 1 Levin K H. Variants and mimics of Guillain Barré syndrome.  Neurologist. 2004;  10 61-74
    CrossrefPubMedGoogle Scholar
  • 2 Fisher M. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia).  N Engl J Med. 1956;  255 57-65
    CrossrefPubMedGoogle Scholar
  • 3 Prineas J W. Pathology of the Guillain-Barré syndrome.  Ann Neurol. 1981;  9(suppl) 6-19
    CrossrefPubMedGoogle Scholar
  • 4 Haymaker W E, Kernohan J W. The Landry-Guillain-Barré syndrome: clinicopathologic report of 50 fatal cases and a critique of the literature.  Medicine (Baltimore). 1949;  28 59-141
    PubMedGoogle Scholar
  • 5 Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome.  Ann Neurol. 1987;  22 753-761
    CrossrefPubMedGoogle Scholar
  • 6 Plasmapheresis and acute Guillain-Barré syndrome. The Guillain-Barré Syndrome Study Group.  Neurology. 1985;  35 1096-1104
    PubMedGoogle Scholar
  • 7 van der Meché F G, Schmitz P I. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group.  N Engl J Med. 1992;  326 1123-1129
    PubMedGoogle Scholar
  • 8 Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group.  Lancet. 1997;  349 225-230
    CrossrefPubMedGoogle Scholar
  • 9 Chio A, Cocito D, Leone M et al.. Guillain-Barré syndrome: a prospective, population-based incidence and outcome survey.  Neurology. 2003;  60 1146-1150
    PubMedGoogle Scholar
  • 10 Hughes R A, Rees J H. Clinical and epidemiologic features of Guillain-Barré syndrome.  J Infect Dis. 1997;  176(S2) S92-S98
    CrossrefPubMedGoogle Scholar
  • 11 Alter M. The epidemiology of Guillain-Barré syndrome.  Ann Neurol. 1990;  27(Suppl) S7-S12
    CrossrefPubMedGoogle Scholar
  • 12 Willison H J. The immunobiology of Guillain-Barré syndromes.  J Peripher Nerv Syst. 2005;  10 94-112
    CrossrefPubMedGoogle Scholar
  • 13 Jacobs B C, Rothbarth P H, van der Meché F G et al.. The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study.  Neurology. 1998;  51 1110-1115
    CrossrefPubMedGoogle Scholar
  • 14 Visser L H, van der Meché F G, Meulstee J et al.. Cytomegalovirus infection and Guillain-Barré syndrome: the clinical, electrophysiologic, and prognostic features.  Dutch Guillain-Barré Study Group.  Neurology. 1996;  47 668-673
    PubMedGoogle Scholar
  • 15 Asbury A K, Cornblath D R. Assessment of current diagnostic criteria for Guillain-Barré syndrome.  Ann Neurol. 1990;  27(suppl) S21-S24
    CrossrefPubMedGoogle Scholar
  • 16 Green D M, Ropper A H. Mild Guillain-Barré syndrome.  Arch Neurol. 2001;  58 1098-1101
    CrossrefPubMedGoogle Scholar
  • 17 Winer J B, Hughes R A, Osmond C. A prospective study of acute idiopathic neuropathy. I. clinical features and their prognostic value.  J Neurol Neurosurg Psychiatry. 1988;  51 605-612
    CrossrefPubMedGoogle Scholar
  • 18 Hughes R A, Cornblath D R. Guillain-Barré syndrome.  Lancet. 2005;  366 1653-1666
    CrossrefPubMedGoogle Scholar
  • 19 Moulin D E, Hagen N, Feasby T E, Amireh R, Hahn A. Pain in Guillain-Barré syndrome.  Neurology. 1997;  48 328-331
    CrossrefPubMedGoogle Scholar
  • 20 Ravn H. The Landry-Guillain-Barré syndrome. A survey and a clinical report of 127 cases.  Acta Neurol Scand. 1967;  43(suppl 30) 1-64
    PubMedGoogle Scholar
  • 21 Ropper A H. The Guillain-Barré syndrome.  N Engl J Med. 1992;  326 1130-1136
    CrossrefPubMedGoogle Scholar
  • 22 Asbury A K. Diagnostic considerations in Guillain-Barré syndrome.  Ann Neurol. 1981;  9(Suppl) 1-5
    PubMedGoogle Scholar
  • 23 Hughes R A, Wijdicks E F, Benson E et al.. Supportive care for patients with Guillain-Barré syndrome.  Arch Neurol. 2005;  62 1194-1198
    CrossrefPubMedGoogle Scholar
  • 24 Gracey D R, McMichan J C, Divertie M B, Howard Jr F M. Respiratory failure in Guillain-Barré syndrome: a 6-year experience.  Mayo Clin Proc. 1982;  57 742-746
    PubMedGoogle Scholar
  • 25 Lawn N D, Fletcher D D, Henderson R D, Wolter T D, Wijdicks E F. Anticipating mechanical ventilation in Guillain-Barré syndrome.  Arch Neurol. 2001;  58 893-898
    CrossrefPubMedGoogle Scholar
  • 26 Massam M, Jones R S. Ventilatory failure in the Guillain-Barré syndrome.  Thorax. 1980;  35 557-558
    PubMedGoogle Scholar
  • 27 Newton-John H. Prevention of pulmonary complications in severe Guillain-Barré syndrome by early assisted ventilation.  Med J Aust. 1985;  142 444-445
    PubMedGoogle Scholar
  • 28 Chevrolet J C, Deleamont P. Repeated vital capacity measurements as predictive parameters for mechanical ventilation need and weaning success in the Guillain-Barré syndrome.  Am Rev Respir Dis. 1991;  144 814-818
    PubMedGoogle Scholar
  • 29 Ropper A H, Kehne S M. Guillain-Barré syndrome: management of respiratory failure.  Neurology. 1985;  35 1662-1665
    CrossrefPubMedGoogle Scholar
  • 30 Flachenecker P, Hartung H P, Reiners K. Power spectrum analysis of heart rate variability in Guillain-Barré syndrome. A longitudinal study.  Brain. 1997;  120(Pt 10) 1885-1894
    CrossrefPubMedGoogle Scholar
  • 31 Flachenecker P, Wermuth P, Hartung H P, Reiners K. Quantitative assessment of cardiovascular autonomic function in Guillain-Barré syndrome.  Ann Neurol. 1997;  42 171-179
    CrossrefPubMedGoogle Scholar
  • 32 Lichtenfeld P. Autonomic dysfunction in the Guillain-Barré syndrome.  Am J Med. 1971;  50 772-780
    CrossrefPubMedGoogle Scholar
  • 33 Zochodne D W. Autonomic involvement in Guillain-Barré syndrome: a review.  Muscle Nerve. 1994;  17 1145-1155
    CrossrefPubMedGoogle Scholar
  • 34 Truax B T. Autonomic disturbances in the Guillain-Barré syndrome.  Semin Neurol. 1984;  4 462-468
    PubMedGoogle Scholar
  • 35 Tuck R R, McLeod J G. Autonomic dysfunction in Guillain-Barré syndrome.  J Neurol Neurosurg Psychiatry. 1981;  44 983-990
    CrossrefPubMedGoogle Scholar
  • 36 Burns T M, Lawn N D, Low P A, Camilleri M, Wijdicks E F. Adynamic ileus in severe Guillain-Barré syndrome.  Muscle Nerve. 2001;  24 963-965
    CrossrefPubMedGoogle Scholar
  • 37 Albers J W, Kelly Jr J J. Acquired inflammatory demyelinating polyneuropathies: clinical and electrodiagnostic features.  Muscle Nerve. 1989;  12 435-451
    CrossrefPubMedGoogle Scholar
  • 38 Albers J W, Donofrio P D, McGonagle T K. Sequential electrodiagnostic abnormalities in acute inflammatory demyelinating polyradiculoneuropathy.  Muscle Nerve. 1985;  8 528-539
    CrossrefPubMedGoogle Scholar
  • 39 Ropper A H, Wijdicks E F, Shahani B T. Electrodiagnostic abnormalities in 113 consecutive patients with Guillain-Barré syndrome.  Arch Neurol. 1990;  47 881-887
    PubMedGoogle Scholar
  • 40 Gordon P H, Wilbourn A J. Early electrodiagnostic findings in Guillain-Barré syndrome.  Arch Neurol. 2001;  58 913-917
    CrossrefPubMedGoogle Scholar
  • 41 Cleland J C, Malik K, Thaisetthawatkul P, Herrmann D N, Logigian E L. Acute inflammatory demyelinating polyneuropathy: contribution of a dispersed distal compound muscle action potential to electrodiagnosis.  Muscle Nerve. 2006;  33 771-777
    CrossrefPubMedGoogle Scholar
  • 42 Cornblath D R, Mellits E D, Griffin J W et al.. Motor conduction studies in Guillain-Barré syndrome: description and prognostic value.  Ann Neurol. 1988;  23 354-359
    CrossrefPubMedGoogle Scholar
  • 43 McKhann G M, Griffin J W, Cornblath D R, Mellits E D, Fisher R S, Quaskey S A. Plasmapheresis and Guillain-Barré syndrome: analysis of prognostic factors and the effect of plasmapheresis.  Ann Neurol. 1988;  23 347-353
    CrossrefPubMedGoogle Scholar
  • 44 Crino P B, Zimmerman R, Laskowitz D, Raps E C, Rostami A M. Magnetic resonance imaging of the cauda equina in Guillain-Barré syndrome.  Neurology. 1994;  44 1334-1336
    PubMedGoogle Scholar
  • 45 Gorson K C, Ropper A H, Muriello M A, Blair R. Prospective evaluation of MRI lumbosacral nerve root enhancement in acute Guillain-Barré syndrome.  Neurology. 1996;  47 813-817
    PubMedGoogle Scholar
  • 46 Weiss M D. Root enhancement in GBS.  Neurology. 1997;  48 1477
    PubMedGoogle Scholar
  • 47 Hughes R, Sanders E, Hall S, Atkinson P, Colchester A, Payan P. Subacute idiopathic demyelinating polyradiculoneuropathy.  Arch Neurol. 1992;  49 612-616
    CrossrefPubMedGoogle Scholar
  • 48 Oh S J, Kurokawa K, de Almeida D F, Ryan Jr H F, Claussen G C. Subacute inflammatory demyelinating polyneuropathy.  Neurology. 2003;  61 1507-1512
    PubMedGoogle Scholar
  • 49 Asbury A K, Arnason B G, Adams R D. The inflammatory lesion in idiopathic polyneuritis. Its role in pathogenesis.  Medicine (Baltimore). 1969;  48 173-215
    CrossrefPubMedGoogle Scholar
  • 50 Berciano J, Coria F, Monton F, Calleja J, Figols J, LaFarga M. Axonal form of Guillain-Barré syndrome: evidence for macrophage-associated demyelination.  Muscle Nerve. 1993;  16 744-751
    CrossrefPubMedGoogle Scholar
  • 51 Feasby T E, Gilbert J J, Brown W F et al.. An acute axonal form of Guillain-Barré polyneuropathy.  Brain. 1986;  109(Pt 6) 1115-1126
    CrossrefPubMedGoogle Scholar
  • 52 Feasby T E, Gilbert J J, Brown W F et al.. Acute “axonal” Guillain-Barré polyneuropathy.  Neurology. 1987;  37 357
    PubMedGoogle Scholar
  • 53 Feasby T E, Hahn A F, Brown W F, Bolton C F, Gilbert J J, Koopman W J. Severe axonal degeneration in acute Guillain-Barré syndrome: evidence of two different mechanisms?.  J Neurol Sci. 1993;  116 185-192
    CrossrefPubMedGoogle Scholar
  • 54 Ropper A H. Severe acute Guillain-Barré syndrome.  Neurology. 1986;  36 429-432
    PubMedGoogle Scholar
  • 55 Griffin J W, Li C Y, Ho T W et al.. Pathology of the motor-sensory axonal Guillain-Barré syndrome.  Ann Neurol. 1996;  39 17-28
    CrossrefPubMedGoogle Scholar
  • 56 Griffin J W, Li C Y, Macko C et al.. Early nodal changes in the acute motor axonal neuropathy pattern of the Guillain-Barré syndrome.  J Neurocytol. 1996;  25 33-51
    CrossrefPubMedGoogle Scholar
  • 57 Sobue G, Li M, Terao S et al.. Axonal pathology in Japanese Guillain-Barré syndrome: a study of 15 autopsied cases.  Neurology. 1997;  48 1694-1700
    PubMedGoogle Scholar
  • 58 Hafer-Macko C, Hsieh S T, Li C Y et al.. Acute motor axonal neuropathy: an antibody-mediated attack on axolemma.  Ann Neurol. 1996;  40 635-644
    CrossrefPubMedGoogle Scholar
  • 59 McKhann G M, Cornblath D R, Griffin J W et al.. Acute motor axonal neuropathy: a frequent cause of acute flaccid paralysis in China.  Ann Neurol. 1993;  33 333-342
    CrossrefPubMedGoogle Scholar
  • 60 Hiraga A, Mori M, Ogawara K, Hattori T, Kuwabara S. Differences in patterns of progression in demyelinating and axonal Guillain-Barré syndromes.  Neurology. 2003;  61 471-474
    CrossrefPubMedGoogle Scholar
  • 61 Hiraga A, Mori M, Ogawara K et al.. Recovery patterns and long term prognosis for axonal Guillain-Barré syndrome.  J Neurol Neurosurg Psychiatry. 2005;  76 719-722
    CrossrefPubMedGoogle Scholar
  • 62 Overell J R, Willison H J. Recent developments in Miller Fisher syndrome and related disorders.  Curr Opin Neurol. 2005;  18 562-566
    PubMedGoogle Scholar
  • 63 Yuki N, Taki T, Takahashi M et al.. Molecular mimicry between GQ1b ganglioside and lipopolysaccharides of Campylobacter jejuni isolated from patients with Fisher's syndrome.  Ann Neurol. 1994;  36 791-793
    CrossrefPubMedGoogle Scholar
  • 64 Ogawara K, Kuwabara S, Yuki N. Fisher syndrome or Bickerstaff brainstem encephalitis? Anti-GQ1b IgG antibody syndrome involving both the peripheral and central nervous systems.  Muscle Nerve. 2002;  26 845-849
    CrossrefPubMedGoogle Scholar
  • 65 Chaudhry F, Gee K E, Vaphiades M S, Biller J, Jay W. GQ1b antibody testing in Guillain-Barré syndrome and variants.  Semin Ophthalmol. 2006;  21 223-227
    CrossrefPubMedGoogle Scholar
  • 66 Radziwill A J, Steck A J, Borruat F X, Bogousslavsky J. Isolated internal ophthalmoplegia associated with IgG anti-GQ1b antibody.  Neurology. 1998;  50 307
    PubMedGoogle Scholar
  • 67 Odaka M, Yuki N, Yamada M et al.. Bickerstaff's brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain-Barré syndrome.  Brain. 2003;  126 2279-2290
    CrossrefPubMedGoogle Scholar
  • 68 Chiba A, Kusunoki S, Shimizu T, Kanazawa I. Serum IgG antibody to ganglioside GQ1b is a possible marker of Miller Fisher syndrome.  Ann Neurol. 1992;  31 677-679
    CrossrefPubMedGoogle Scholar
  • 69 Chiba A, Kusunoki S, Obata H, Machinami R, Kanazawa I. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barré syndrome: clinical and immunohistochemical studies.  Neurology. 1993;  43 1911-1917
    CrossrefPubMedGoogle Scholar
  • 70 Onodera M, Mori M, Koga M et al.. Acute isolated bulbar palsy with anti-GT1a IgG antibody subsequent to Campylobacter jejuni enteritis.  J Neurol Sci. 2002;  205 83-84
    CrossrefPubMedGoogle Scholar
  • 71 Kashihara K, Shiro Y, Koga M, Yuki N. IgG anti-GT1a antibodies which do not cross react with GQ1b ganglioside in a pharyngeal-cervical-brachial variant of Guillain-Barré syndrome.  J Neurol Neurosurg Psychiatry. 1998;  65 799
    CrossrefPubMedGoogle Scholar
  • 72 Nagashima T, Koga M, Odaka M, Hirata K, Yuki N. Clinical correlates of serum anti-GT1a IgG antibodies.  J Neurol Sci. 2004;  219 139-145
    CrossrefPubMedGoogle Scholar
  • 73 Nishimoto Y, Odaka M, Hirata K, Yuki N. Usefulness of anti-GQ1b IgG antibody testing in Fisher syndrome compared with cerebrospinal fluid examination.  J Neuroimmunol. 2004;  148 200-205
    CrossrefPubMedGoogle Scholar
  • 74 Fross R D, Daube J R. Neuropathy in the Miller Fisher syndrome: clinical and electrophysiologic findings.  Neurology. 1987;  37 1493-1498
    CrossrefPubMedGoogle Scholar
  • 75 Nagaoka U, Kato T, Kurita K et al.. Cranial nerve enhancement on three-dimensional MRI in Miller Fisher syndrome.  Neurology. 1996;  47 1601-1602
    PubMedGoogle Scholar
  • 76 Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T. Clinical features and prognosis of Miller Fisher syndrome.  Neurology. 2001;  56 1104-1106
    CrossrefPubMedGoogle Scholar
  • 77 Willison H J. Ganglioside complexes as targets for antibodies in Miller Fisher syndrome.  J Neurol Neurosurg Psychiatry. 2006;  77 1002-1003
    CrossrefPubMedGoogle Scholar
  • 78 Schaublin G A, Michet Jr C J, Dyck P J, Burns T M. An update on the classification and treatment of vasculitic neuropathy.  Lancet Neurol. 2005;  4 853-865
    CrossrefPubMedGoogle Scholar
  • 79 Mori K, Hattori N, Sugiura M et al.. Chronic inflammatory demyelinating polyneuropathy presenting with features of GBS.  Neurology. 2002;  58 979-982
    PubMedGoogle Scholar
  • 80 Keesey J C. Clinical evaluation and management of myasthenia gravis.  Muscle Nerve. 2004;  29 484-505
    CrossrefPubMedGoogle Scholar
  • 81 Cherington M. Clinical spectrum of botulism.  Muscle Nerve. 1998;  21 701-710
    PubMedGoogle Scholar
  • 82 Li J, Loeb J A, Shy M E et al.. Asymmetric flaccid paralysis: a neuromuscular presentation of West Nile virus infection.  Ann Neurol. 2003;  53 703-710
    CrossrefPubMedGoogle Scholar
  • 83 Jeha L E, Sila C A, Lederman R J, Prayson R A, Isada C M, Gordon S M. West Nile virus infection: a new acute paralytic illness.  Neurology. 2003;  61 55-59
    PubMedGoogle Scholar
  • 84 Halperin J J. Lyme disease and the peripheral nervous system.  Muscle Nerve. 2003;  28 133-143
    PubMedGoogle Scholar
  • 85 Steere A C. Lyme disease.  N Engl J Med. 2001;  345 115-125
    CrossrefPubMedGoogle Scholar
  • 86 Donofrio P D, Wilbourn A J, Albers J W, Rogers L, Salanga V, Greenberg H S. Acute arsenic intoxication presenting as Guillain-Barré-like syndrome.  Muscle Nerve. 1987;  10 114-120
    CrossrefPubMedGoogle Scholar
  • 87 Grattan-Smith P J, Morris J G, Johnston H M et al.. Clinical and neurophysiological features of tick paralysis.  Brain. 1997;  120(Pt 11) 1975-1987
    CrossrefPubMedGoogle Scholar
  • 88 Vedanarayanan V V, Evans O B, Subramony S H. Tick paralysis in children: electrophysiology and possibility of misdiagnosis.  Neurology. 2002;  59 1088-1090
    CrossrefPubMedGoogle Scholar
  • 89 Albers J W, Fink J K. Porphyric neuropathy.  Muscle Nerve. 2004;  30 410-422
    CrossrefPubMedGoogle Scholar
  • 90 Calderon-Gonzalez R, Rizzi-Hernandez H. Buckthorn polyneuropathy.  N Engl J Med. 1967;  277 69-71
    CrossrefPubMedGoogle Scholar
  • 91 Piradov M A, Pirogov V N, Popova L M, Avdunina I A. Diphtheritic polyneuropathy: clinical analysis of severe forms.  Arch Neurol. 2001;  58 1438-1442
    CrossrefPubMedGoogle Scholar
  • 92 Snider W D, Simpson D M, Nielsen S, Gold J W, Metroka C E, Posner J B. Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients.  Ann Neurol. 1983;  14 403-418
    CrossrefPubMedGoogle Scholar
  • 93 Roullet E, Assuerus V, Gozlan J et al.. Cytomegalovirus multifocal neuropathy in AIDS: analysis of 15 consecutive cases.  Neurology. 1994;  44 2174-2182
    CrossrefPubMedGoogle Scholar
  • 94 Hafer-Macko C E, Sheikh K A, Li C Y et al.. Immune attack on the Schwann cell surface in acute inflammatory demyelinating polyneuropathy.  Ann Neurol. 1996;  39 625-635
    CrossrefPubMedGoogle Scholar
  • 95 Ilyas A A, Willison H J, Quarles R H et al.. Serum antibodies to gangliosides in Guillain-Barré syndrome.  Ann Neurol. 1988;  23 440-447
    CrossrefPubMedGoogle Scholar
  • 96 Oomes P G, Jacobs B C, Hazenberg M P, Bänffer J R, van der Meché F G. Anti-GM1 IgG antibodies and Campylobacter bacteria in Guillain-Barré syndrome: evidence of molecular mimicry.  Ann Neurol. 1995;  38 170-175
    CrossrefPubMedGoogle Scholar
  • 97 Sheikh K A, Nachamkin I, Ho T W et al.. Campylobacter jejuni lipopolysaccharides in Guillain-Barré syndrome: molecular mimicry and host susceptibility.  Neurology. 1998;  51 371-378
    PubMedGoogle Scholar
  • 98 Vriesendorp F J, Mishu B, Blaser M J, Koski C L. Serum antibodies to GM1, GD1b, peripheral nerve myelin, and Campylobacter jejuni in patients with Guillain-Barré syndrome and controls: correlation and prognosis.  Ann Neurol. 1993;  34 130-135
    CrossrefPubMedGoogle Scholar
  • 99 Willison H J. Ganglioside complexes: new autoantibody targets in Guillain-Barré syndromes.  Nat Clin Pract Neurol. 2005;  1 2-3
    PubMedGoogle Scholar
  • 100 Olsson Y. Topographical differences in the vascular permeability of the peripheral nervous system.  Acta Neuropathol. 1968;  10 26-33
    CrossrefPubMedGoogle Scholar
  • 101 Ho T W, Mishu B, Li C Y et al.. Guillain-Barré syndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies.  Brain. 1995;  118(Pt 3) 597-605
    CrossrefPubMedGoogle Scholar
  • 102 Yuki N, Taki T, Inagaki F et al.. A bacterium lipopolysaccharide that elicits Guillain-Barré syndrome has a GM1 ganglioside-like structure.  J Exp Med. 1993;  178 1771-1775
    CrossrefPubMedGoogle Scholar
  • 103 Ho T W, Li C Y, Cornblath D R et al.. Patterns of recovery in the Guillain-Barré syndromes.  Neurology. 1997;  48 695-700
    PubMedGoogle Scholar
  • 104 Chiba A, Kusunoki S, Obata H, Machinami R, Kanazawa I. Ganglioside composition of the human cranial nerves, with special reference to pathophysiology of Miller Fisher syndrome.  Brain Res. 1997;  745 32-36
    CrossrefPubMedGoogle Scholar
  • 105 Bril V, Ilse W K, Pearce R, Dhanani A, Sutton D, Kong K. Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain-Barré syndrome.  Neurology. 1996;  46 100-103
    PubMedGoogle Scholar
  • 106 Donofrio P D. Immunotherapy of idiopathic inflammatory neuropathies.  Muscle Nerve. 2003;  28 273-292
    CrossrefPubMedGoogle Scholar
  • 107 Hughes R A, Wijdicks E F, Barohn R et al.. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2003;  61 736-740
    CrossrefPubMedGoogle Scholar
  • 108 Plasma exchange in Guillain-Barré syndrome: one-year follow-up. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome.  Ann Neurol. 1992;  32 94-97
    CrossrefPubMedGoogle Scholar
  • 109 McKhann G M, Griffin J W, Cornblath D R, Mellits E D, Fisher R S, Quaskey S A. Plasmapheresis and Guillain-Barré syndrome: analysis of prognostic factors and the effect of plasmapheresis.  Ann Neurol. 1988;  23 347-353
    CrossrefPubMedGoogle Scholar
  • 110 McKhann G M, Griffin J W, Cornblath D R, Quaskey S A, Mellits E D. Role of therapeutic plasmapheresis in the acute Guillain-Barré syndrome.  J Neuroimmunol. 1988;  20 297-300
    CrossrefPubMedGoogle Scholar
  • 111 The French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome . Appropriate number of plasma exchanges in Guillain-Barré syndrome.  Ann Neurol. 1997;  41 298-306
    CrossrefPubMedGoogle Scholar
  • 112 Abd-Allah S A, Jansen P W, Ashwal S, Perkin R M. Intravenous immunoglobulin as therapy for pediatric Guillain-Barré syndrome.  J Child Neurol. 1997;  12 376-380
    PubMedGoogle Scholar
  • 113 Jansen P W, Perkin R M, Ashwal S. Guillain-Barré syndrome in childhood: natural course and efficacy of plasmapheresis.  Pediatr Neurol. 1993;  9 16-20
    CrossrefPubMedGoogle Scholar
  • 114 Jones H R. Childhood Guillain-Barré syndrome: clinical presentation, diagnosis, and therapy.  J Child Neurol. 1996;  11 4-12
    PubMedGoogle Scholar
  • 115 Vallee L, Dulac O, Nuyts J P, Leclerc F, Vamecq J. Intravenous immune globulin is also an efficient therapy of acute Guillain-Barré syndrome in affected children.  Neuropediatrics. 1993;  24 235-236
    Article in Thieme ConnectPubMedGoogle Scholar
  • 116 Epstein M A, Sladky J T. The role of plasmapheresis in childhood Guillain-Barré syndrome.  Ann Neurol. 1990;  28 65-69
    CrossrefPubMedGoogle Scholar
  • 117 Raphaël J C, Chevret S, Hughes R A, Annane D. Plasma exchange for Guillain-Barré syndrome.  Cochrane Database Syst Rev. 2001;  (2) CD001798
    PubMedGoogle Scholar
  • 118 Esperou H, Jars-Guincestre M C, Bolgert F, Raphael J C, Durand-Zaleski I. Cost analysis of plasma-exchange therapy for the treatment of Guillain-Barré syndrome. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome.  Intensive Care Med. 2000;  26 1094-1100
    CrossrefPubMedGoogle Scholar
  • 119 Osterman P O, Fagius J, Lundemo G et al.. Beneficial effects of plasma exchange in acute inflammatory polyradiculoneuropathy.  Lancet. 1984;  2 1296-1299
    PubMedGoogle Scholar
  • 120 Yuki N, Tagawa Y, Hirata K. Minimal number of plasma exchanges needed to reduce immunoglobulin in Guillain-Barré syndrome.  Neurology. 1998;  51 875-877
    PubMedGoogle Scholar
  • 121 Lehmann H C, Hartung H P, Hetzel G R, Stuve O, Kieseier B C. Plasma exchange in neuroimmunological disorders: part 2. Treatment of neuromuscular disorders.  Arch Neurol. 2006;  63 1066-1071
    CrossrefPubMedGoogle Scholar
  • 122 Dalakas M C. The use of intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: evidence-based indications and safety profile.  Pharmacol Ther. 2004;  102 177-193
    CrossrefPubMedGoogle Scholar
  • 123 Dalakas M C. Intravenous immunoglobulin in autoimmune neuromuscular diseases.  JAMA. 2004;  291 2367-2375
    CrossrefPubMedGoogle Scholar
  • 124 Thornton C A, Ballow M. Safety of intravenous immunoglobulin.  Arch Neurol. 1993;  50 135-136
    CrossrefPubMedGoogle Scholar
  • 125 Hughes R A, Newsom-Davis J M, Perkin G D, Pierce J M. Controlled trial prednisolone in acute polyneuropathy.  Lancet. 1978;  2 750-753
    PubMedGoogle Scholar
  • 126 Hughes R A, van Der Meché F G. Corticosteroids for treating Guillain-Barré syndrome.  Cochrane Database Syst Rev. 2000;  (3) CD001446
    PubMedGoogle Scholar
  • 127 Hughes R A, Swan A V, van Koningsveld R, van Doorn P A. Corticosteroids for Guillain-Barré syndrome.  Cochrane Database Syst Rev. 2006;  (2) CD001446
    PubMedGoogle Scholar
  • 128 van Koningsveld R, Schmitz P I, Meché F G et al.. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial.  Lancet. 2004;  363 192-196
    CrossrefPubMedGoogle Scholar
  • 129 Okamiya S, Ogino M, Ogino Y et al.. Tryptophan-immobilized column-based immunoadsorption as the choice method for plasmapheresis in Guillain-Barré syndrome.  Ther Apher Dial. 2004;  8 248-253
    CrossrefPubMedGoogle Scholar
  • 130 Haupt W F, Rosenow F, van der Ven C, Birkmann C. Immunoadsorption in Guillain-Barré syndrome and myasthenia gravis.  Ther Apher. 2000;  4 195-197
    PubMedGoogle Scholar
  • 131 Haupt W F, Rosenow F, van der Ven C, Borberg H, Pawlik G. Sequential treatment of Guillain-Barré syndrome with extracorporeal elimination and intravenous immunoglobulin.  J Neurol Sci. 1996;  137 145-149
    CrossrefPubMedGoogle Scholar
  • 132 Romano J G, Rotta F T, Potter P et al.. Relapses in the Guillain-Barré syndrome after treatment with intravenous immune globulin or plasma exchange.  Muscle Nerve. 1998;  21 1327-1330
    CrossrefPubMedGoogle Scholar
  • 133 Visser L H, van der Meché F G, Meulstee J, van Doorn P A. Risk factors for treatment related clinical fluctuations in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group.  J Neurol Neurosurg Psychiatry. 1998;  64 242-244
    CrossrefPubMedGoogle Scholar
  • 134 Mori M, Kuwabara S, Fukutake T, Hattori T. Intravenous immunoglobulin therapy for Miller Fisher syndrome.  Neurology. 2007;  68 1144-1146
    CrossrefPubMedGoogle Scholar
  • 135 Mori M, Kuwabara S, Fukutake T, Hattori T. Plasmapheresis and Miller Fisher syndrome: analysis of 50 consecutive cases.  J Neurol Neurosurg Psychiatry. 2002;  72 680
    CrossrefPubMedGoogle Scholar
  • 136 Overell J R, Hsieh S, Odaka M, Yuki N, Willison H J. Treatment for Fisher syndrome, Bickerstaff's brainstem encephalitis and related disorders.  Cochrane Database Syst Rev. 2007;  1 CD004761
    PubMedGoogle Scholar
  • 137 Fletcher D D, Lawn N D, Wolter T D, Wijdicks E F. Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation.  Neurology. 2000;  54 2311-2315
    PubMedGoogle Scholar
  • 138 Gold R, Bayas A, Toyka K V. Autoimmune neuropathies-current aspects of immunopathologic diagnostics and therapy.  Nervenarzt. 2005;  76 1009-1021 quiz 1022-1023
    CrossrefPubMedGoogle Scholar
  • 139 Sunderrajan E V, Davenport J. The Guillain-Barré syndrome: pulmonary-neurologic correlations.  Medicine (Baltimore). 1985;  64 333-341
    PubMedGoogle Scholar
  • 140 Pontoppidan H, Geffin B, Lowenstein E. Acute respiratory failure in the adult. 2.  N Engl J Med. 1972;  287 743-752
    PubMedGoogle Scholar
  • 141 Lawn N D, Wijdicks E F. Post-intubation pulmonary function test in Guillain-Barré syndrome.  Muscle Nerve. 2000;  23 613-616
    CrossrefPubMedGoogle Scholar
  • 142 Durand M C, Porcher R, Orlikowski D et al.. Clinical and electrophysiological predictors of respiratory failure in Guillain-Barré syndrome: a prospective study.  Lancet Neurol. 2006;  5 1021-1028
    PubMedGoogle Scholar
  • 143 Sharshar T, Chevret S, Bourdain F, Raphael J C. French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome . Early predictors of mechanical ventilation in Guillain-Barré syndrome.  Crit Care Med. 2003;  31 278-283
    CrossrefPubMedGoogle Scholar
  • 144 Durand M C, Lofaso F, Lefaucheur J P et al.. Electrophysiology to predict mechanical ventilation in Guillain-Barré syndrome.  Eur J Neurol. 2003;  10 39-44
    CrossrefPubMedGoogle Scholar
  • 145 Henderson R D, Lawn N D, Fletcher D D, McClelland R L, Wijdicks E F. The morbidity of Guillain-Barré syndrome admitted to the intensive care unit.  Neurology. 2003;  60 17-21
    Google Scholar
  • 146 Holdgaard H O, Pedersen J, Jensen R H et al.. Percutaneous dilatational tracheostomy versus conventional surgical tracheostomy. A clinical randomised study.  Acta Anaesthesiol Scand. 1998;  42 545-550
    CrossrefPubMedGoogle Scholar
  • 147 Emmons P R, Blume W T, DuShane J W. Cardiac monitoring and demand pacemaker in Guillain-Barré syndrome.  Arch Neurol. 1975;  32 59-61
    PubMedGoogle Scholar
  • 148 Favre H, Foex P, Guggisberg M. Use of demand pacemaker in a case of Guillain-Barré syndrome.  Lancet. 1970;  1 1062-1063
    PubMedGoogle Scholar
  • 149 Singh N K, Jaiswal A K, Misra S, Srivastava P K. Assessment of autonomic dysfunction in Guillain-Barré syndrome and its prognostic implications.  Acta Neurol Scand. 1987;  75 101-105
    PubMedGoogle Scholar
  • 150 McLeod J G. Invited review: autonomic dysfunction in peripheral nerve disease.  Muscle Nerve. 1992;  15 3-13
    PubMedGoogle Scholar
  • 151 Clarke E, Bayliss R IS, Cooper R. Landry-Guillain-Barré syndrome: cardiovascular complications; treatment with A.C.T.H. and cortisone.  BMJ. 1954;  2(4903) 1504-1507
    PubMedGoogle Scholar
  • 152 Kogan B A, Solomon M H, Diokno A C. Urinary retention secondary to Landry-Guillain-Barré syndrome.  J Urol. 1981;  126 643-644
    PubMedGoogle Scholar
  • 153 Samama M M, Cohen A T, Darmon J Y et al.. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in medical patients with enoxaparin study group.  N Engl J Med. 1999;  341 793-800
    CrossrefPubMedGoogle Scholar
  • 154 Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery.  N Engl J Med. 1988;  318 1162-1173
    CrossrefPubMedGoogle Scholar
  • 155 Clagett G P, Reisch J S. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis.  Ann Surg. 1988;  208 227-240
    CrossrefPubMedGoogle Scholar
  • 156 Pandey C K, Bose N, Garg G et al.. Gabapentin for the treatment of pain in Guillain-Barré syndrome: a double-blinded, placebo-controlled, crossover study.  Anesth Analg. 2002;  95 1719-1723
    CrossrefPubMedGoogle Scholar
  • 157 Tripathi M, Kaushik S. Carbamezapine for pain management in Guillain-Barré syndrome patients in the intensive care unit.  Crit Care Med. 2000;  28 655-658
    PubMedGoogle Scholar
  • 158 Meythaler J M. Rehabilitation of Guillain-Barré syndrome.  Arch Phys Med Rehabil. 1997;  78 872-879
    CrossrefPubMedGoogle Scholar
  • 159 Herbison G J, Jaweed M M, Ditunno Jr J F. Exercise therapies in peripheral neuropathies.  Arch Phys Med Rehabil. 1983;  64 201-205
    PubMedGoogle Scholar
  • 160 Pitetti K H, Barrett P J, Abbas D. Endurance exercise training in Guillain-Barré syndrome.  Arch Phys Med Rehabil. 1993;  74 761-765
    CrossrefPubMedGoogle Scholar
  • 161 Cooke J F, Orb A. The recovery phase in Guillain-Barré syndrome: moving from dependency to independence.  Rehabil Nurs. 2003;  28 105-108, 130
    PubMedGoogle Scholar
  • 162 Bernsen R A, de Jager A E, Schmitz P I, van der Meché F G. Long-term impact on work and private life after Guillain-Barré syndrome.  J Neurol Sci. 2002;  201 13-17
    CrossrefPubMedGoogle Scholar
  • 163 Bernsen R A, de Jager A E, van der Meché F G, Suurmeijer T P. How Guillain-Barré patients experience their functioning after 1 year.  Acta Neurol Scand. 2005;  112 51-56
    CrossrefPubMedGoogle Scholar
  • 164 Rees J H, Thompson R D, Smeeton N C, Hughes R A. Epidemiological study of Guillain-Barré syndrome in south east England.  J Neurol Neurosurg Psychiatry. 1998;  64 74-77
    CrossrefPubMedGoogle Scholar
  • 165 The prognosis and main prognostic indicators of Guillain-Barré syndrome. A multicentre prospective study of 297 patients. The Italian Guillain-Barré Study Group.  Brain. 1996;  119(Pt 6) 2053-2061
    CrossrefPubMedGoogle Scholar
  • 166 Bernsen R A, de Jager A E, Schmitz P I, van der Meché F G. Residual physical outcome and daily living 3 to 6 years after Guillain-Barré syndrome.  Neurology. 1999;  53 409-410
    PubMedGoogle Scholar
  • 167 Prevots D R, Sutter R W. Assessment of Guillain-Barré syndrome mortality and morbidity in the United States: implications for acute flaccid paralysis surveillance.  J Infect Dis. 1997;  175(Sl) S151-S155
    PubMedGoogle Scholar
  • 168 van Koningsveld R, Steyerberg E W, Hughes R A, Swan A V, van Doorn P A, Jacobs B C. A clinical prognostic scoring system for Guillain-Barré syndrome.  Lancet Neurol. 2007;  6 589-594
    CrossrefPubMedGoogle Scholar
  • 169 Bradshaw D Y, Jones Jr H R. Guillain-Barré syndrome in children: clinical course, electrodiagnosis, and prognosis.  Muscle Nerve. 1992;  15 500-506
    PubMedGoogle Scholar
  • 170 Vajsar J, Fehlings D, Stephens D. Long-term outcome in children with Guillain-Barré syndrome.  J Pediatr. 2003;  142 305-309
    CrossrefPubMedGoogle Scholar
  • 171 de Jager A E, Minderhoud J M. Residual signs in severe Guillain-Barré syndrome: analysis of 57 patients.  J Neurol Sci. 1991;  104 151-156
    CrossrefPubMedGoogle Scholar
  • 172 Garssen M P, Van Koningsveld R, Van Doorn P A. Residual fatigue is independent of antecedent events and disease severity in Guillain-Barré syndrome.  J Neurol. 2006;  253 1143-1146
    PubMedGoogle Scholar
  • 173 Merkies I S, Schmitz P I, Samijn J P, van der Meché F G, van Doorn P A. Fatigue in immune-mediated polyneuropathies. European Inflammatory Neuropathy Cause and Treatment (INCAT) Group.  Neurology. 1999;  53 1648-1654
    PubMedGoogle Scholar
  • 174 Garssen M P, van Doorn P A, Visser G H. Nerve conduction studies in relation to residual fatigue in Guillain-Barré syndrome.  J Neurol. 2006;  253 851-856
    PubMedGoogle Scholar
  • 175 Garssen M P, Schmitz P I, Merkies I S, Jacobs B C, van der Meché F G, van Doorn P A. Amantadine for treatment of fatigue in Guillain-Barré syndrome: a randomised, double blind, placebo controlled, crossover trial.  J Neurol Neurosurg Psychiatry. 2006;  77 61-65
    CrossrefPubMedGoogle Scholar
  • 176 Garssen M P, Bussmann J B, Schmitz P I et al.. Physical training and fatigue, fitness, and quality of life in Guillain-Barré syndrome and CIDP.  Neurology. 2004;  63 2393-2395
    PubMedGoogle Scholar
  • 177 Hughes R A, Charlton J, Latinovic R, Gulliford M C. No association between immunization and Guillain-Barré syndrome in the United Kingdom, 1992 to 2000.  Arch Intern Med. 2006;  166 1301-1304
    CrossrefPubMedGoogle Scholar
  • 178 Juurlink D N, Stukel T A, Kwong J et al.. Guillain-Barré syndrome after influenza vaccination in adults: a population-based study.  Arch Intern Med. 2006;  166 2217-2221
    CrossrefPubMedGoogle Scholar
  • 179 Lasky T, Terracciano G J, Magder L et al.. The Guillain-Barré syndrome and the 1992-1993 and 1993-1994 influenza vaccines.  N Engl J Med. 1998;  339 1797-1802
    CrossrefPubMedGoogle Scholar
  • 180 Fenichel G M. Assessment: neurologic risk of immunization: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology.  Neurology. 1999;  52 1546-1552
    PubMedGoogle Scholar
  • 181 Wijdicks E F, Fletcher D D, Lawn N D. Influenza vaccine and the risk of relapse of Guillain-Barré syndrome.  Neurology. 2000;  55 452-453
    PubMedGoogle Scholar
  • 182 Pritchard J, Mukherjee R, Hughes R A. Risk of relapse of Guillain-Barré syndrome or chronic inflammatory demyelinating polyradiculoneuropathy following immunisation.  J Neurol Neurosurg Psychiatry. 2002;  73 348-349
    CrossrefPubMedGoogle Scholar

Ted M BurnsM.D. 

Department of Neurology, University of Virginia

PO Box 800394, Charlottesville, VA 22908

Email: tmb8r@virginia.edu

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