Guillain-Barre Syndrome Workup

  • Author: Michael T Andary, MD, MS; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Aug 26, 2011
 

Approach Considerations

Guillain-Barré syndrome (GBS) is generally diagnosed on clinical grounds. Basic laboratory studies, such as complete blood counts and metabolic panels, are of limited value in the diagnosis of GBS. They are often ordered, however, to exclude other diagnoses, and to better assess functional status and prognosis. The ordering of specific tests should be guided by the patient's history and presentation.

Abnormalities in nerve conduction studies (NCS) that are consistent with demyelination are sensitive and represent specific findings for classic GBS.[80] Frequent evaluations of these parameters should be performed at bedside to monitor respiratory status and the need for ventilatory assistance.

Lumbar puncture for cerebrospinal fluid (CSF) studies is recommended. During the acute phase of GBS, characteristic findings on CSF analysis include albuminocytologic dissociation, which is an elevation in CSF protein (>0.55 g/L) without an elevation in white blood cells. The increase in CSF protein is thought to reflect the widespread inflammation of the nerve roots.

Imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scanning of the spine, may be more helpful in excluding other diagnoses, such as mechanical causes of myelopathy, than in assisting in the diagnosis of GBS.

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Peripheral Neuropathy Workup

A basic peripheral neuropathy workup is recommended in cases in which the diagnosis is uncertain. These studies may include the following:

  • Thyroid panel
  • Rheumatology profiles
  • Vitamin B-12
  • Folic acid
  • Hemoglobin A1C
  • Erythrocyte sedimentation rate (ESR)
  • Rapid protein reagent
  • Immunoelectrophoresis of serum protein
  • Tests for heavy metals
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Biochemical Screening

Biochemical screening includes the following studies:

  • Electrolyte levels
  • Liver function tests (LFTs)
  • Creatine phosphokinase (CPK) level
  • Erythrocyte sedimentation rate (ESR)

LFT results are elevated in as many as one third of patients. CPK and ESR may be elevated with myopathies or systemic inflammatory conditions. A stool culture for C jejuni and pregnancy test are also indicated.

The syndrome of inappropriate antidiuretic hormone (SIADH) may occur.

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Serologic Studies

Serologic studies are of limited value in the diagnosis of GBS. Assays for antibodies to the following infectious agents may be considered:

  • Campylobacter jejuni
  • Cytomegalovirus
  • Epstein-Barr virus
  • Herpes simplex virus (HSV)
  • HIV
  • Mycoplasma pneumoniae

An increase in titers for infectious agents, such as CMV, EBV, or Mycoplasma, may help in establishing etiology for epidemiologic purposes. HIV has been reported to precede GBS, and serology should be tested in high-risk patients to establish possible infection with this agent.

Serum autoantibodies

Serum autoantibodies are not measured routinely in the workup of GBS, but results may be helpful in patients with a questionable diagnosis or a variant of GBS. Antibodies to glycolipids are observed in the sera of 60-70% of patients with GBS during the acute phase, with gangliosides being the major target antigens.[81]

Antibodies to GM1 frequently are frequently found in the sera of patients with the motor axonal neuropathy or AIDP variants of GBS. Antecedent C jejuni infections are closely associated with elevated titers of anti-GM1 antibodies. Anti-GQ1b antibodies are found in patients with GBS with ophthalmoplegia, including patients with the Miller-Fisher variant. Other antibodies to different major and minor gangliosides also have been found in GBS patients.

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Nerve Conduction Studies

Nerve conduction studies (NCS) can be very helpful in the diagnostic workup of patients with suspected GBS. Abnormalities in NCS that are consistent with demyelination are sensitive and represent specific findings for classic GBS.[80]

A delay in F-waves is present, implying nerve root demyelination.[2, 82] Nerve motor action potentials may be decreased. This is technically difficult to determine until the abnormality is severe. Compound muscle action potential (CMAP) amplitude may be decreased. Although most patients exhibit sensory abnormalities on NCS, these findings are much less marked than they are in motor nerves.

Frequently, patients show evidence of conduction block or dispersion of responses at sites of natural nerve compression. The extent of decreased action potentials correlates with prognosis. Prolonged distal latencies may be present. Abnormal H-reflex may be noted.

Although NCS results classically show a picture of demyelinating neuropathy in most patients, axonal neuropathy and inexcitable results are found in certain subgroups. The inexcitable studies may represent either axonopathy or severe demyelination with distal conduction block.

On NCS, demyelination is characterized by nerve conduction slowing, prolongation of the distal latencies, prolongation of the F-waves, conduction block, and/or temporal dispersion. Changes on NCS should be present in at least 2 nerves in regions that are not typical for those associated with compressive mononeuropathies (preferentially in anatomically distinct areas, such as an arm and a leg or a limb and the face).

The needle examination is of limited value in GBS. Reduced motor unit recruitment and absent denervation help to support the suggestion of a demyelinating mechanism, although the same changes can be observed in early axonal damage with pending wallerian degeneration. In severe cases, denervation changes may be observed later in the disease course.

In the axonal variant of the disease, absent or markedly reduced distal compound muscle action potentials (CMAP) are observed on NCS. On needle examination, profuse and early denervation potentials also support the conclusion that there has been axonal injury.

Rarely neurophysiologic testing is normal in patients with GBS. This is believed to be due to the location of demyelinating lesions in proximal sites not amenable to study.

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Pulmonary Function Tests

Maximal inspiratory pressures and vital capacities are measurements of neuromuscular respiratory function and predict diaphragmatic strength. Maximal expiratory pressures also reflect abdominal muscle strength. Frequent evaluations of these parameters should be performed at bedside to monitor respiratory status and the need for ventilatory assistance.

Forced vital capacity (FVC) is very helpful in guiding disposition and therapy.[60] Patients with an FVC of less than 15-20 mL/kg, maximum inspiratory pressure of less than 30 cm H2 O, or a maximum expiratory pressure of less than 40 cm H2 O generally progress to require prophylactic intubation and mechanical ventilation. Respiratory assistance should also be considered when there is a decrease in oxygen saturation (arterial PO2 < 70 mm Hg).

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Lumbar Puncture

Most, but not all, patients with GBS have an elevated CSF protein level (>400 mg/L), with normal CSF cell counts. Elevated or rising protein levels on serial lumbar punctures and 10 or fewer mononuclear cells/mm3 strongly support the diagnosis.

A normal CSF protein level does not rule out GBS, however, as the level may remain normal in 10% of patients. CSF protein may not rise until 1-2 weeks after the onset of weakness.

Normal CSF cell counts may not be a feature of GBS in HIV-infected patients. CSF pleocytosis is well recognized in HIV-associated GBS.

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Magnetic Resonance Imaging

MRI is sensitive but nonspecific for diagnosis; however, it may be an effective diagnostic adjunct.[83, 84] MRI can reveal nerve root enhancement.

Spinal nerve root enhancement with gadolinium is a nonspecific feature seen in inflammatory conditions and is caused by disruption of the blood-nerve barrier. Selective anterior nerve root enhancement appears to be strongly suggestive of GBS.[85] The cauda equina nerve roots are enhanced in 83% of patients.

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Other Studies

Muscle biopsy may help to distinguish GBS from a primary myopathy in unclear cases. Many different abnormalities may be seen on electrocardiography, including second- and third-degree atrioventricular (AV) block, T-wave abnormalities, ST depression, QRS widening, and various rhythm disturbances.

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Histologic Findings

Lymphocyte and macrophage infiltration is observed on microscopic examination of peripheral nerves. Macrophage influx is believed to be responsible for the multifocal demyelination seen in GBS. A variable degree of wallerian degeneration also can be observed with severe inflammatory changes. Cellular infiltrates are scattered throughout the cranial nerves, nerve roots, dorsal root ganglions, and peripheral nerves.

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Contributor Information and Disclosures
Author

Michael T Andary, MD, MS  Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Coauthor(s)

Joyce L Oleszek, MD  Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center, The Children's Hospital of Denver

Joyce L Oleszek, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Angela Cha-Kim, MD  Assistant Professor, Director of Spinal Cord Injury, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center

Angela Cha-Kim, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Paraplegia Society

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier III, MD  Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Heather Rachel Davids, MD Physician, Department of Anesthesiology, Interventional Pain Medicine, University of Colorado Health Sciences Center

Heather Rachel Davids, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Daniel D Scott, MD, MA Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Attending Physician, Department of Physical Medicine and Rehabilitation, Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System

Daniel D Scott, MD, MA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Seneviratne U. Guillain-Barré syndrome. Postgrad Med J. Dec 2000;76(902):774-82. [Medline]. [Full Text].

  2. Winer JB. Guillain Barré syndrome. Mol Pathol. Dec 2001;54(6):381-5. [Medline]. [Full Text].

  3. Jacobs BC, Koga M, van Rijs W, Geleijns K, van Doorn PA, Willison HJ, et al. Subclass IgG to motor gangliosides related to infection and clinical course in Guillain-Barré syndrome. J Neuroimmunol. Feb 2008;194(1-2):181-90. [Medline].

  4. Jacobs BC, van Doorn PA, Schmitz PI, Tio-Gillen AP, Herbrink P, Visser LH, et al. Campylobacter jejuni infections and anti-GM1 antibodies in Guillain-Barré syndrome. Ann Neurol. Aug 1996;40(2):181-7. [Medline].

  5. Koga M, Takahashi M, Masuda M, Hirata K, Yuki N. Campylobacter gene polymorphism as a determinant of clinical features of Guillain-Barré syndrome. Neurology. Nov 8 2005;65(9):1376-81. [Medline].

  6. Kimoto K, Koga M, Odaka M, Hirata K, Takahashi M, Li J, et al. Relationship of bacterial strains to clinical syndromes of Campylobacter-associated neuropathies. Neurology. Nov 28 2006;67(10):1837-43. [Medline].

  7. Geleijns K, Roos A, Houwing-Duistermaat JJ, van Rijs W, Tio-Gillen AP, Laman JD, et al. Mannose-binding lectin contributes to the severity of Guillain-Barré syndrome. J Immunol. Sep 15 2006;177(6):4211-7. [Medline].

  8. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27 Suppl:S21-4. [Medline].

  9. Ho TW, Mishu B, Li CY, Gao CY, Cornblath DR, Griffin JW, et al. Guillain-Barré syndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. Jun 1995;118 ( Pt 3):597-605. [Medline].

  10. Hiraga A, Mori M, Ogawara K, Kojima S, Kanesaka T, Misawa S, et al. Recovery patterns and long term prognosis for axonal Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. May 2005;76(5):719-22. [Medline]. [Full Text].

  11. Winer JB. Treatment of Guillain-Barré syndrome. QJM. Nov 2002;95(11):717-21. [Medline].

  12. Brown WF, Feasby TE, Hahn AF. Electrophysiological changes in the acute "axonal" form of Guillain-Barre syndrome. Muscle Nerve. Feb 1993;16(2):200-5. [Medline].

  13. Fisher M. An unusual variant of acute immune polyneuritis (syndrome of ophthalmoplegia, ataxia, and areflexia). N Engl J Med. 1956;255:57-65.

  14. Li H, Yuan J. Miller Fisher syndrome: toward a more comprehensive understanding. Chin Med J (Engl). Mar 2001;114(3):235-9. [Medline].

  15. 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. Oct 1993;43(10):1911-7. [Medline].

  16. Baravelli M, Fantoni C, Rossi A, et al. Guillain-Barré syndrome as a neurological complication of infective endocarditis. Is it really so rare and how often do we recognise it?. Int J Cardiol. Jan 10 2008;[Medline].

  17. Jacobs BC, Rothbarth PH, van der Meché FG, Herbrink P, Schmitz PI, de Klerk MA, et al. The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study. Neurology. Oct 1998;51(4):1110-5. [Medline].

  18. Nelson L, Gormley R, Riddle MS, Tribble DR, Porter CK. The epidemiology of Guillain-Barré Syndrome in U.S. military personnel: a case-control study. BMC Res Notes. Aug 26 2009;2:171. [Medline]. [Full Text].

  19. van der Meché FG, Visser LH, Jacobs BC, Endtz HP, Meulstee J, van Doorn PA. Guillain-Barré syndrome: multifactorial mechanisms versus defined subgroups. J Infect Dis. Dec 1997;176 Suppl 2:S99-102. [Medline].

  20. Rees JH, Gregson NA, Hughes RA. Anti-ganglioside GM1 antibodies in Guillain-Barré syndrome and their relationship to Campylobacter jejuni infection. Ann Neurol. Nov 1995;38(5):809-16. [Medline].

  21. Visser LH, van der Meché FG, Meulstee J, Rothbarth PP, Jacobs BC, Schmitz PI, et al. Cytomegalovirus infection and Guillain-Barré syndrome: the clinical, electrophysiologic, and prognostic features. Dutch Guillain-Barré Study Group. Neurology. Sep 1996;47(3):668-73. [Medline].

  22. Kang JH, Sheu JJ, Lin HC. Increased risk of Guillain-Barré Syndrome following recent herpes zoster: a population-based study across Taiwan. Clin Infect Dis. Sep 1 2010;51(5):525-30. [Medline].

  23. Van Koningsveld R, Van Doorn PA. Steroids in the Guillain-Barré syndrome: is there a therapeutic window?. Neurologia. Mar 2005;20(2):53-7. [Medline].

  24. Islam Z, Jacobs BC, van Belkum A, Mohammad QD, Islam MB, Herbrink P, et al. Axonal variant of Guillain-Barre syndrome associated with Campylobacter infection in Bangladesh. Neurology. Feb 16 2010;74(7):581-7. [Medline].

  25. Islam Z, van Belkum A, Cody AJ, Tabor H, Jacobs BC, Talukder KA, et al. Campylobacter jejuni HS:23 and Guillain-Barre syndrome, Bangladesh. Emerg Infect Dis. Aug 2009;15(8):1315-7. [Medline]. [Full Text].

  26. Kalra V, Chaudhry R, Dua T, Dhawan B, Sahu JK, Mridula B. Association of Campylobacter jejuni infection with childhood Guillain-Barré syndrome: a case-control study. J Child Neurol. Jun 2009;24(6):664-8. [Medline].

  27. Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP. A prospective study of acute idiopathic neuropathy. II. Antecedent events. J Neurol Neurosurg Psychiatry. May 1988;51(5):613-8. [Medline]. [Full Text].

  28. Souayah N, Nasar A, Suri MF, Qureshi AI. Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). J Clin Neuromuscul Dis. Sep 2009;11(1):1-6. [Medline].

  29. Kuitwaard K, Bos-Eyssen ME, Blomkwist-Markens PH, van Doorn PA. Recurrences, vaccinations and long-term symptoms in GBS and CIDP. J Peripher Nerv Syst. Dec 2009;14(4):310-5. [Medline].

  30. Lasky T, Terracciano GJ, Magder L, Koski CL, Ballesteros M, Nash D, et al. The Guillain-Barré syndrome and the 1992-1993 and 1993-1994 influenza vaccines. N Engl J Med. Dec 17 1998;339(25):1797-802. [Medline].

  31. Lehmann HC, Hartung HP, Kieseier BC, Hughes RA. Guillain-Barré syndrome after exposure to influenza virus. Lancet Infect Dis. Sep 2010;10(9):643-51. [Medline].

  32. Preliminary results: surveillance for Guillain-Barré syndrome after receipt of influenza A (H1N1) 2009 monovalent vaccine - United States, 2009-2010. MMWR Morb Mortal Wkly Rep. Jun 4 2010;59(21):657-61. [Medline].

  33. Stowe J, Andrews N, Wise L, Miller E. Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. Am J Epidemiol. Feb 1 2009;169(3):382-8. [Medline].

  34. Liang XF, Li L, Liu DW, Li KL, Wu WD, Zhu BP, et al. Safety of influenza A (H1N1) vaccine in postmarketing surveillance in China. N Engl J Med. Feb 17 2011;364(7):638-47. [Medline].

  35. Dieleman J, Romio S, Johansen K, Weibel D, Bonhoeffer J, Sturkenboom M. Guillain-Barre syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccine: multinational case-control study in Europe. BMJ. Jul 12 2011;343:d3908. [Medline].

  36. Kinnunen E, Junttila O, Haukka J, Hovi T. Nationwide oral poliovirus vaccination campaign and the incidence of Guillain-Barré Syndrome. Am J Epidemiol. Jan 1 1998;147(1):69-73. [Medline].

  37. Rantala H, Cherry JD, Shields WD, Uhari M. Epidemiology of Guillain-Barré syndrome in children: relationship of oral polio vaccine administration to occurrence. J Pediatr. Feb 1994;124(2):220-3. [Medline].

  38. Friedrich F. Rare adverse events associated with oral poliovirus vaccine in Brazil. Braz J Med Biol Res. Jun 1997;30(6):695-703. [Medline].

  39. Tuttle J, Chen RT, Rantala H, Cherry JD, Rhodes PH, Hadler S. The risk of Guillain-Barré syndrome after tetanus-toxoid-containing vaccines in adults and children in the United States. Am J Public Health. Dec 1997;87(12):2045-8. [Medline]. [Full Text].

  40. Shaw FE Jr, Graham DJ, Guess HA, Milstien JB, Johnson JM, Schatz GC, et al. Postmarketing surveillance for neurologic adverse events reported after hepatitis B vaccination. Experience of the first three years. Am J Epidemiol. Feb 1988;127(2):337-52. [Medline].

  41. da Silveira CM, Salisbury DM, de Quadros CA. Measles vaccination and Guillain-Barré syndrome. Lancet. Jan 4 1997;349(9044):14-6. [Medline].

  42. Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June-July 2005. MMWR Morb Mortal Wkly Rep. Oct 14 2005;54(40):1023-5. [Medline].

  43. Awong IE, Dandurand KR, Keeys CA, Maung-Gyi FA. Drug-associated Guillain-Barré syndrome: a literature review. Ann Pharmacother. Feb 1996;30(2):173-80. [Medline].

  44. Shin IS, Baer AN, Kwon HJ, Papadopoulos EJ, Siegel JN. Guillain-Barré and Miller Fisher syndromes occurring with tumor necrosis factor alpha antagonist therapy. Arthritis Rheum. May 2006;54(5):1429-34. [Medline].

  45. Silburn S, McIvor E, McEntegart A, Wilson H. Guillain-Barré syndrome in a patient receiving anti-tumour necrosis factor alpha for rheumatoid arthritis: a case report and discussion of literature. Ann Rheum Dis. Apr 2008;67(4):575-6. [Medline].

  46. Kurmann PT, Van Linthoudt D, So AK. Miller-Fisher syndrome in a patient with rheumatoid arthritis treated with adalimumab. Clin Rheumatol. Jan 2009;28(1):93-4. [Medline].

  47. Bouchra A, Benbouazza K, Hajjaj-Hassouni N. Guillain-Barre in a patient with ankylosing spondylitis secondary to ulcerative colitis on infliximab therapy. Clin Rheumatol. Jun 2009;28 Suppl 1:S53-5. [Medline].

  48. Machado FC, Valério BC, Morgulis RN, Nunes KF, Mazzali-Verst S. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery. Arq Neuropsiquiatr. Sep 2006;64(3A):609-12. [Medline].

  49. Prasad KN, Nyati KK, Verma A, Rizwan A, Paliwal VK. Tumor necrosis factor-alpha polymorphisms and expression in Guillain-Barré syndrome. Hum Immunol. Sep 2010;71(9):905-10. [Medline].

  50. Alshekhlee A, Hussain Z, Sultan B, Katirji B. Guillain-Barré syndrome: incidence and mortality rates in US hospitals. Neurology. Apr 29 2008;70(18):1608-13. [Medline].

  51. Prevots DR, Sutter RW. Assessment of Guillain-Barré syndrome mortality and morbidity in the United States: implications for acute flaccid paralysis surveillance. J Infect Dis. Feb 1997;175 Suppl 1:S151-5. [Medline].

  52. Kushnir M, Klein C, Pollak L, Rabey JM. Evolving pattern of Guillain-Barre syndrome in a community hospital in Israel. Acta Neurol Scand. May 2008;117(5):347-50. [Medline].

  53. Landaverde JM, Danovaro-Holliday MC, Trumbo SP, Pacis-Tirso CL, Ruiz-Matus C. Guillain-Barré syndrome in children aged < 15 years in Latin America and the Caribbean: baseline rates in the context of the influenza A (H1N1) pandemic. J Infect Dis. Mar 2010;201(5):746-50. [Medline].

  54. McKhann GM, Cornblath DR, Griffin JW, Ho TW, Li CY, Jiang Z, et al. Acute motor axonal neuropathy: a frequent cause of acute flaccid paralysis in China. Ann Neurol. Apr 1993;33(4):333-42. [Medline].

  55. Jiang GX, de Pedro-Cuesta J, Strigård K, Olsson T, Link H. Pregnancy and Guillain-Barré syndrome: a nationwide register cohort study. Neuroepidemiology. 1996;15(4):192-200. [Medline].

  56. Evans OB, Vedanarayanan V. Guillain-Barré syndrome. Pediatr Rev. Jan 1997;18(1):10-6. [Medline].

  57. Zochodne DW. Autonomic involvement in Guillain-Barré syndrome: a review. Muscle Nerve. Oct 1994;17(10):1145-55. [Medline].

  58. Maher J, Rutledge F, Remtulla H, Parkes A, Bernardi L, Bolton CF. Neuromuscular disorders associated with failure to wean from the ventilator. Intensive Care Med. Sep 1995;21(9):737-43. [Medline].

  59. Hund EF, Borel CO, Cornblath DR, Hanley DF, McKhann GM. Intensive management and treatment of severe Guillain-Barré syndrome. Crit Care Med. Mar 1993;21(3):433-46. [Medline].

  60. Teitelbaum JS, Borel CO. Respiratory dysfunction in Guillain-Barré syndrome. Clin Chest Med. Dec 1994;15(4):705-14. [Medline].

  61. Fletcher DD, Lawn ND, Wolter TD, Wijdicks EF. Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurology. Jun 27 2000;54(12):2311-5. [Medline].

  62. Bersano A, Carpo M, Allaria S, Franciotta D, Citterio A, Nobile-Orazio E. Long term disability and social status change after Guillain-Barré syndrome. J Neurol. Feb 2006;253(2):214-8. [Medline].

  63. Dornonville de la Cour C, Jakobsen J. Residual neuropathy in long-term population-based follow-up of Guillain-Barré syndrome. Neurology. Jan 25 2005;64(2):246-53. [Medline].

  64. Rudolph T, Larsen JP, Farbu E. The long-term functional status in patients with Guillain-Barré syndrome. Eur J Neurol. Dec 2008;15(12):1332-7. [Medline].

  65. Mullings KR, Alleva JT, Hudgins TH. Rehabilitation of Guillain-Barré syndrome. Dis Mon. May 2010;56(5):288-92. [Medline].

  66. Khan F, Pallant JF, Ng L, Bhasker A. Factors associated with long-term functional outcomes and psychological sequelae in Guillain-Barre syndrome. J Neurol. Dec 2010;257(12):2024-31. [Medline].

  67. Winer JB, Hughes RA, Osmond C. A prospective study of acute idiopathic neuropathy. I. Clinical features and their prognostic value. J Neurol Neurosurg Psychiatry. May 1988;51(5):605-12. [Medline]. [Full Text].

  68. Petzold A, Brettschneider J, Jin K, Keir G, Murray NM, Hirsch NP, et al. CSF protein biomarkers for proximal axonal damage improve prognostic accuracy in the acute phase of Guillain-Barré syndrome. Muscle Nerve. Jul 2009;40(1):42-9. [Medline].

  69. Das A, Kalita J, Misra UK. Recurrent Guillain Barre' syndrome. Electromyogr Clin Neurophysiol. Mar 2004;44(2):95-102. [Medline].

  70. Roper TA, Alani SM. Recurrent Guillain-Barré syndrome: lightning does strike twice. Br J Hosp Med. Apr 19-May 2 1995;53(8):403-7. [Medline].

  71. Romano JG, Rotta FT, Potter P, Rosenfeld V, Santibanez R, Rocha B, et al. Relapses in the Guillain-Barré syndrome after treatment with intravenous immune globulin or plasma exchange. Muscle Nerve. Oct 1998;21(10):1327-30. [Medline].

  72. Appropriate number of plasma exchanges in Guillain-Barré syndrome. The French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome. Ann Neurol. Mar 1997;41(3):298-306. [Medline].

  73. Bernsen RA, de Jager AE, Schmitz PI, van der Meché FG. Residual physical outcome and daily living 3 to 6 years after Guillain-Barré syndrome. Neurology. Jul 22 1999;53(2):409-10. [Medline].

  74. Bernsen RA, de Jager AE, van der Meché FG, Suurmeijer TP. How Guillain-Barre patients experience their functioning after 1 year. Acta Neurol Scand. Jul 2005;112(1):51-6. [Medline].

  75. Bernsen RA, Jacobs HM, de Jager AE, van der Meché FG. Residual health status after Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. Jun 1997;62(6):637-40. [Medline]. [Full Text].

  76. Hughes RA, Rees JH. Clinical and epidemiologic features of Guillain-Barré syndrome. J Infect Dis. Dec 1997;176 Suppl 2:S92-8. [Medline].

  77. El Mhandi L, Calmels P, Camdessanché JP, Gautheron V, Féasson L. Muscle strength recovery in treated Guillain-Barré syndrome: a prospective study for the first 18 months after onset. Am J Phys Med Rehabil. Sep 2007;86(9):716-24. [Medline].

  78. Lo YL. Clinical and immunological spectrum of the Miller Fisher syndrome. Muscle Nerve. Nov 2007;36(5):615-27. [Medline].

  79. Diaz JH. A 60-year meta-analysis of tick paralysis in the United States: a predictable, preventable, and often misdiagnosed poisoning. J Med Toxicol. Mar 2010;6(1):15-21. [Medline].

  80. Albers JW, Kelly JJ Jr. Acquired inflammatory demyelinating polyneuropathies: clinical and electrodiagnostic features. Muscle Nerve. Jun 1989;12(6):435-51. [Medline].

  81. Kusunoki S. Antiglycolipid antibodies in Guillain-Barré syndrome and autoimmune neuropathies. Am J Med Sci. Apr 2000;319(4):234-9. [Medline].

  82. Ye Y, Zhu D, Wang K, Wu J, Feng J, Ma D, et al. Clinical and electrophysiological features of the 2007 Guillain-Barré syndrome epidemic in northeast China. Muscle Nerve. Sep 2010;42(3):311-4. [Medline].

  83. Smith N, Pereira J, Grattan-Smith P. Investigation of suspected Guillain-Barre syndrome in childhood: What is the role for gadolinium enhanced magnetic resonance imaging of the spine?. J Paediatr Child Health. Jul 2 2010;[Medline].

  84. Yikilmaz A, Doganay S, Gumus H, Per H, Kumandas S, Coskun A. Magnetic resonance imaging of childhood Guillain-Barre syndrome. Childs Nerv Syst. Aug 2010;26(8):1103-8. [Medline].

  85. Perry JR, Fung A, Poon P, Bayer N. Magnetic resonance imaging of nerve root inflammation in the Guillain-Barré syndrome. Neuroradiology. 1994;36(2):139-40. [Medline].

  86. Visser LH, Schmitz PI, Meulstee J, van Doorn PA, van der Meché FG. Prognostic factors of Guillain-Barré syndrome after intravenous immunoglobulin or plasma exchange. Dutch Guillain-Barré Study Group. Neurology. Aug 11 1999;53(3):598-604. [Medline].

  87. Hughes RA, Wijdicks EF, Benson E, Cornblath DR, Hahn AF, Meythaler JM, et al. Supportive care for patients with Guillain-Barré syndrome. Arch Neurol. Aug 2005;62(8):1194-8. [Medline].

  88. Ilyas M, Tolaymat A. Minimal change nephrotic syndrome with Guillain-Barré syndrome. Pediatr Nephrol. Jan 2004;19(1):105-6. [Medline].

  89. Cochen V, Arnulf I, Demeret S, Neulat ML, Gourlet V, Drouot X, et al. Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome. Brain. Nov 2005;128:2535-45. [Medline].

  90. Gupta A, Taly AB, Srivastava A, Murali T. Guillain-Barre Syndrome – rehabilitation outcome, residual deficits and requirement of lower limb orthosis for locomotion at 1 year follow-up. Disabil Rehabil. 2010;32(23):1897-902. [Medline].

  91. Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol. Nov 1998;44(5):780-8. [Medline].

  92. Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Lancet. Jan 25 1997;349(9047):225-30. [Medline].

  93. van der Meché FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. N Engl J Med. Apr 23 1992;326(17):1123-9. [Medline].

  94. Visser LH, van der Meché FG, Meulstee J, van Doorn PA. Risk factors for treatment related clinical fluctuations in Guillain-Barré syndrome. Dutch Guillain-Barré study group. J Neurol Neurosurg Psychiatry. Feb 1998;64(2):242-4. [Medline]. [Full Text].

  95. Agrawal S, Peake D, Whitehouse WP. Management of children with Guillain-Barré syndrome. Arch Dis Child Educ Pract Ed. Dec 2007;92(6):161-8. [Medline].

  96. Double-blind trial of intravenous methylprednisolone in Guillain-Barré syndrome. Guillain-Barré Syndrome Steroid Trial Group. Lancet. Mar 6 1993;341(8845):586-90. [Medline].

  97. Hughes RA, Pritchard J, Hadden RD. Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain Barré syndrome. Cochrane Database Syst Rev. Mar 16 2011;CD008630. [Medline].

  98. Garssen MP, Blok JH, van Doorn PA, Visser GH. Conduction velocity distribution in neurologically well-recovered but fatigued Guillain-Barré syndrome patients. Muscle Nerve. Feb 2006;33(2):177-82. [Medline].

  99. de Vries JM, Hagemans ML, Bussmann JB, et al. Fatigue in neuromuscular disorders: focus on Guillain-Barré syndrome and Pompe disease. Cell. Mol Life Sci. Nov 16 2009;[Medline].

  100. Garssen MP, Schmitz PI, Merkies IS, Jacobs BC, van der Meché FG, van Doorn PA. Amantadine for treatment of fatigue in Guillain-Barre syndrome: a randomised, double blind, placebo controlled, crossover trial. J Neurol Neurosurg Psychiatry. Jan 2006;77(1):61-5. [Medline]. [Full Text].

  101. Dalakas MC. Intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: present status and practical therapeutic guidelines. Muscle Nerve. Nov 1999;22(11):1479-97. [Medline].

  102. Jayasena YA, Mudalige SP, Manchanayake GS, Dharmapala HL, Kumarasiri RP, Weerasinghe VS, et al. Physiological changes during and outcome following 'filtration' based continuous plasma exchange in Guillain Barre Syndrome. Transfus Apher Sci. Apr 2010;42(2):109-13. [Medline].

  103. Brannagan TH 3rd, Nagle KJ, Lange DJ, Rowland LP. Complications of intravenous immune globulin treatment in neurologic disease. Neurology. Sep 1996;47(3):674-7. [Medline].

  104. Paran D, Herishanu Y, Elkayam O, Shopin L, Ben-Ami R. Venous and arterial thrombosis following administration of intravenous immunoglobulins. Blood Coagul Fibrinolysis. Jul 2005;16(5):313-8. [Medline].

  105. van Doorn PA. What's new in Guillain-Barré syndrome in 2007-2008?. J Peripher Nerv Syst. Jun 2009;14(2):72-4. [Medline].

 
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