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Mild Guillain-Barré Syndrome
Deborah M. Green, MD;
Allan H. Ropper, MD
Arch Neurol. 2001;58:1098-1101.
Background The unpredictability of the early course of Guillain-Barré syndrome
(GBS) makes it difficult to determine which patients' conditions will worsen
under observation. Most large randomized treatment trials for GBS have used
an inability to walk as the enrollment criterion. Consequently, little is
known about the treatment of those patients with milder degrees of affection.
Objectives To determine the approximate frequency of mild GBS with the persistent
ability to walk and to see if there were features that predicted that the
illness would remain mild.
Setting A registry of patients with GBS seen on the wards and in the neurology
clinic from January 1,1992, to May 1, 2000, in a 400-bed community teaching
hospital.
Patients Twelve (4.7%) of 254 patients in our case series were able to walk throughout
their illness. Eight had been treated with plasmapheresis or intravenous immunoglobulin;
the others were observed without treatment.
Results There was no age, sex, or seasonal preponderance in comparison with
large case series that included cases of all severities. Nine of 12 patients
had a preceding respiratory tract infection, 10 had paresthesias, 7 had prominent
pain, and 9 had ataxia. Seven of 10 patients who were examined had normal
cerebrospinal fluid protein levels. It took 8 days, on average, to reach the
maximal degree of weakness. One additional treated patient, excluded from
our case series, had mild weakness for the first 3 weeks and subsequently
worsened with a relapsing course more typical of chronic inflammatory demyelinating
polyneuropathy. Eleven patients demonstrated proximal, intermediate, or distal
conduction block, and only 3 had a mild degree of denervation. There were
no distinguishing clinical or electrophysiologic features between treated
and untreated patients with mild GBS and, except for the mild degree of affection
and the absence of substantial electromyographic changes of axonal disruption,
there were no important differences between these mild cases as a group and
patients who developed more severe GBS.
Conclusions Cases of mild GBS reach a clinical nadir in a similar time to those
with more severe disease. Treatment may be unnecessary in patients who are
able to walk during the second week of illness, but observation until approximately
the eighth day seems appropriate to be certain that the illness does not progress.
In all likelihood there are mild cases of GBS that never come to the attention
of a neurologist.
From the Department of Neurology, St Elizabeth's Medical Center, Boston,
Mass. Dr Green is now with the Neuroscience Institute, The Queen's Medical
Center, Honolulu, Hawaii.
Reprints: Deborah M. Green, MD, Neuroscience Institute, The Queen's
Medical Center, 1301 Punchbowl St, Honolulu, HI 96813 (e-mail: dgreen{at}queens.org).
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