The idiopathic polyradiculoneuropathies: a historical guide to an understanding of the clinical syndromes

Muscle strength recovery in treated Guillain-Barré syndrome: a prospective study for the first 18 months after onset

OBJECTIVE

To assess the recovery in muscle strength and functional capacities in subjects with Guillain-Barré syndrome (GBS) for 18 months after onset.

DESIGN

Six GBS patients were treated and transferred to our rehabilitation center within the first week of recovery.

RESULTS

Isometric and isokinetic strength increased significantly during the first 6 months (P < 0.01). Between 6 and 18 months, muscle strength increased less rapidly (P < 0.05). We showed a significant negative correlation between plateau period duration and knee extensors, elbow flexors muscles strength recovery (rho = -0.82; P = 0.05). At 6 months, manual muscle testing and functional independence motor total scores were close to normal levels. At 18 months, all patients satisfied the criteria for a full recovery. However, they felt difficulties after prolonged exercise.

CONCLUSIONS

Until 18 months of recovery, dynamometric measures still showed significant strength improvement. This underscores the need for a minimal 24 months of clinical follow-up with an individualized rehabilitation management program.

Guillain-Barré syndrome. An uncommon but severe illness

It is important for primary care physicians to be familiar with Guillain-Barré syndrome, a relatively rare disorder that may occur after another illness or after stress such as surgery. Although most patients recover fully, respiratory failure and cardiovascular failure are possible complications. Rapid diagnosis and referral to specialists experienced in plasmapheresis therapy can significantly benefit patients.

The epidemiology of inflammatory polyradiculoneuropathy. A critical review of the distribution, characteristics and outcome of the disease. Plasmapheresis Study Group

An outline of the principal reports dealing with the definition, distribution, course and treatment of the inflammatory polyradiculoneuropathies, including the Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP), is given. Current diagnostic criteria for GBS are reaffirmed while the diagnosis of CIDP lacks proper standardization. Then, the boundaries between the two disorders are ill-defined. While GBS is rare and homogeneously distributed across developed and developing countries, the prevalence rate of CIDP is unknown. Several antecedent events have been implicated in the pathogenesis of GBS; yet, except for the swine-flu vaccine, the relation between infectious or toxic agents and the occurrence of the disease is purely anecdotal. The only factors known to influence the outcome of GBS are age, severity of opening symptoms, abnormal electrophysiologic characteristics of peripheral nerve function, and plasmapheresis. However, responders and non-responders to current treatment are far from defined. Although similarities have been found between experimental allergic neuritis and experimental allergic encephalomyelitis, the degree of CNS impairment in patients with inflammatory polyradiculoneuropathies needs further refinement. To provide a tentative answer to some of the unsolved questions on inflammatory polyradiculoneuropathies, a multicenter cohort study on newly diagnosed patients submitted to standard clinical and laboratory evaluation, and given common therapeutic regimes, is awaited.