The Guillain-Barré syndrome: clinical and electroneuromyographic studies

Electrophysiological, clinical and epidemiological study of Guillain–Barré Syndrome in Hong Kong Chinese

The authors reviewed the clinical and electrophysiological features in 20 consecutive adult patients with Guillain-Barre Syndrome (GBS) admitted to a regional hospital in Hong Kong from 1993 to 1998. The majority of cases in this locality consists of the demyelinating form of GBS; epidemic, acute motor axonal neuropathy is not the predominant form. The incidence of GBS in this region of China was 0.44 per 100,000.

Clinical signs in severe Guillain-Barré syndrome: analysis of 63 patients

Clinical data are presented of 63 artificially ventilated Guillain-Barré patients. About half of them had an antecedent event. In 57% the disease was heralded by sensory symptoms. The mean progressive phase lasted 12 days, the plateau 12 days and the recovery phase 568 days. In all patients one or more cranial nerves were involved, most often leading to facial palsy or difficulties in swallowing. Three-quarters of the patients had sensory signs, proprioceptive more often than superficial. Autonomic disturbances were common, especially hypertension and tachycardia. Twenty-two percent of the patients were severely confused in the first weeks of the disease. Laboratory examination showed atypical lymphocytes in the blood of 37% of patients and disturbed hepatic function tests in 79%. CSF protein level was elevated in all patients, with a mean value of 1.5 g/l.

A prospective study of acute idiopathic neuropathy. I. Clinical features and their prognostic value

A prospective study in South-East England during 15 months in 1983-1984 recruited 100 patients with acute idiopathic neuropathy. After 12 months 67% had recovered completely, 20% were still significantly disabled and 13% had died. Ten of the 13 deaths were attributable to the neuropathy. The major features in the initial assessment which were associated with persistent disability were the time taken to become bedbound, requirement for ventilation, age greater than 40 years, and small or absent compound abductor pollicis brevis muscle action potentials elicited by stimulation of the median nerve at the wrist. These four variables have been combined in a statistical model to predict outcome for individual patients with acute idiopathic neuropathy.

Guillain-Barré syndrome. A clinical electrophysiological and biochemical study

Fifty-six consecutive patients with Guillain-Barré syndrome representing 49% of all cases of peripheral neuropathy (except those due to diabetes mellitus and leprosy) admitted to the Postgraduate Institute of Medical Education and Research, Chandigarh over a period of three years were studied. All patients developed weakness of limbs within one day to three weeks. Attenuation of deep tendon jerks (98%) paresthesia (66%), cranial nerve involvement (41%) and antecedent infection (32%) were the common clinical features. The common patterns of motor weakness were predominantly proximal in all the four limbs (45%) or predominantly proximal in lower limbs along with distal muscles in upper limbs (29%). Electrodiagnostic studies revealed prolonged distal (motor) latency (82%), reduced motor nerve conduction velocity (74%), sensory nerve conduction abnormality (85%) and evidence of denervation (41%). Evoked motor response of median, ulnar, common peroneal and tibial nerves exhibited significant increase in duration and reduction in amplitude. The maximum incidence of electrophysiological abnormality occurred between four to 12 weeks after the onset of neurological symptoms. Four patients died and 11 showed poor recovery. Long intervals (greater than 3 weeks) between peak deficit and onset of recovery and coexistence of reduced motor nerve conduction velocity with evidence of denervation on EMG were found to be associated with poor recovery.