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Colegio de Medicina Interna de México.

2005, Number 6

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Med Int Mex 2005; 21 (6)

Guillain-Barré syndrome. Diagnostic-therapeutic approach

Duarte MJ, Díaz MS, Rubio GJ, Vargas GRB, Lee Eng CVE, Fernández PLY

Language: Spanish
References: 100
Page: 440-452
PDF size: 102.57 Kb.


ABSTRACT

Guillain-Barré syndrome is an eponym for a heterogeneous group of immune-mediated peripheral neuropathies. A feature common in all variants of this syndrome is a rapidly evolving polyradiculoneuropathy preceded by a triggering event, most often an infection. Guillain-Barré syndrome generally manifests as a symmetric motor paralysis with or without sensory and autonomic disturbances. The diagnosis of Guillain-Barré syndrome is based on typical clinical features electro-diagnostic examination, examination of the cerebrospinal fluid can aid in the diagnosis. The treatment has two components: supportive care and specific therapy. Supportive care remains the cornerstone of therapy. If patients overcome the acute phase of illness, most will recover function. However, the neuropathy can advance so rapidly that endotracheal intubation and mechanical ventilation may be necessary within 24 hours of symptom onset. The specific treatments are plasma exchange and intravenous immunoglobulin.


REFERENCES

  1. Newswanger DL. Guillain-Barré syndrome. Am Fam Physician 2004;69(10):2405-10.

  2. Lindenbaum Y, Kissel JT, Mendell JR. Treatment approaches for Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Neurol Clin 2001;19:187-204

  3. Koga M. Anti-GM1 antibody IgG subclass: a clinical recovery predictor in Guillain-Barré syndrome. Neurology 2003;60(9):1514-8.

  4. Hahn AF. Guillain-Barré syndrome. Lancet 1998;352:635-41.

  5. The Italian Guillain-Barré Study Group. The prognosis and main prognostic indicators of Guillain-Barré syndrome: a multicentre prospective study of 297 patients. Brain 1996;119(6):2053-61.

  6. Hung PL. A clinical and electrophysiologic survey of childhood Guillain-Barré syndrome. Pediatr Neurol 2004;30(2):86-91.

  7. Geleijns K. The occurrence of Guillain-Barré syndrome within families. Neurology 2004;63(9):1747-50.

  8. Jiang GX, de Pedro-Cuesta J, Strigard K, Olsson T, Link H. Pregnancy and Guillain-Barré syndrome: a nationwide register cohort study. Neuroepidemiology 1996;15:192-200.

  9. Luijckx GJ, Vles J, de Baets M, Buchwald B, Troost J. Guillain-Barré syndrome in mother and newborn child. Lancet 1997;4;349(9044):27.

  10. Rees JH, Thompson RD, Smeeton NC, Hughes RA, Epidemiological study of Guillain-Barré syndrome in south east England. J Neurol Neurosurg Psychiatry 1998;64:74-77.

  11. Beghi E, Kurland LT, Mulder DW, Wiederholt WC. Guillain-Barré syndrome. Clinicoepidemiologic features and effect of influenza vaccine. Arch Neurol 1985;42:1053-7.

  12. Sanders G. A case of Guillain-Barré syndrome presenting as ataxia. Am J Emerg Med 2004;22(2):137-8.

  13. Hughes R. Campylobacter jejuni in Guillain-Barré syndrome. Lancet Neurol 2004;3(11):644.

  14. Hirano M. A family with Campylobacter enteritis: anti-GD1a antibody with/without Guillain-Barré syndrome. Neurology 2003;60(10):1719-20.

  15. 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;178:1771-5.

  16. Sheikh KA, Deerinck TJ, Ellisman MH, Griffin JW. The distribution of ganglioside-like moieties in peripheral nerves. Brain 1999;122:449-60.

  17. Mishu B, Ilyas AA, Koski CL, et al. Serologic evidence of previous Campylobacter jejuni infection in patients with the Guillain-Barré syndrome. Ann Intern Med 1993;118:947-53.

  18. Hughes R, Hadden RG, Gregson NA, et al. Pathogenesis of Guillain-Barré syndrome. J Neuroimmunol 1999;100:74-97.

  19. Lunn MP, Johnson LA, Fromholt SE, et al. High-affinity anti-ganglioside IgG antibodies raised in complex ganglioside knockout mice: reexamination of GD1a immunolocalization. J Neurochem 2000;75:404-12.

  20. Ogawara K, Kuwabara S, Mori M, Hattori T, Koga M, Yuki N. Axonal Guillain-Barré syndrome: relation to anti-ganglioside antibodies and Campylobacter jejuni infection in Japan. Ann Neurol 2000;48:624–31.

  21. Susuki K. Acute motor axonal neuropathy after Mycoplasma infection: evidence of molecular mimicry. Neurology 2004;62(6):949-56.

  22. Ang CW, Tio-Gillen AP, Groen J, et al. Cross-reactive anti-galactocerebroside antibodies and Mycoplasma pneumoniae infections in Guillain-Barré syndrome. J Neuroimmunol 2002;130:179-83.

  23. Yuki N, Tagawa Y. Acute cytomegalovirus infection and IgM anti-GM2 antibody. J Neurol Sci 1998;154:14-7.

  24. Yuki N, Yoshino H, Sato S, Miyatake T. Acute axonal polyneuropathy associated with anti-GM1 antibodies following Campylobacter enteritis. Neurology 1990;40:1900-2.

  25. Rees JH, Gregson NA, Hughes RA. Anti-ganglioside antibodies in patients with Guillain-Barré syndrome and Campylobacter jejuni infection. J Infect Dis 1995;172:605-6.

  26. Mori M, Kuwabara S, Miyake M, et al. Haemophilus influenzae has a GM1 ganglioside-like structure and elicits Guillain-Barré syndrome. Neurology 1999;52:1282-4.

  27. Jacobs BC, van Doorn PA, Groeneveld JHM, Tio-Gillen AP, van der Meché FGA. Cytomegalovirus infections and anti-GM2 antibodies in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 1997;62:641-3.

  28. Ang CW, Jacobs BC, Brandenburg AH, et al. Cross-reactive antibodies against GM2 and CMV-infected fibroblasts in Guillain-Barré syndrome. Neurology 2000;54:1453-8.

  29. Kusunoki S, Shiina M, Kanazawa I. Anti-Gal-C antibodies in GBS subsequent to Mycoplasma infection: evidence of molecular mimicry. Neurology 2001;57:736-8.

  30. Jacobs BC, Rothbarth PH, van der Meché FGA, et al. The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study. Neurology 1998;51:1110-5.

  31. Saida T, Saida K, Dorfman SH, et al. Experimental allergic neuritis induced by sensitization with galactocerebroside. Science 1979;204:1103-6.

  32. Kusunoki S, Chiba A, Hitoshi S, Takizawa H, Kanazawa I. Anti-Gal-C antibody in autoimmune neuropathies subsequent to Mycoplasma infection. Muscle Nerve 1995;18:409-13.

  33. Ogino M, Orazio N, Latov N. IgG anti-GM1 antibodies from patients with acute motor neuropathy are predominantly of the IgG1 and IgG3 subclasses. J Neuroimmunol 1995;58:77-80.

  34. Ilyas AA, Chen ZW, Cook SD, Mithen FA, Singhal BS. Immunoglobulin G subclass distribution of autoantibodies to gangliosides in patients with Guillain-Barré syndrome. Res Commun Chem Pathol Pharmacol 2001;109:115-23.

  35. Mishu B, Ilyas AA, Koski CL, et al. Serologic evidence of previous Campylobacter jejuni infection in patients with the Guillain-Barré syndrome. Ann Intern Med 1993;118:947-53.

  36. Kuroki S, Saida T, Nukina M, et al. Campylobacter jejuni strains from patients with Guillain-Barré syndrome belong mostly to Penner serogroup 19 and contain b-N-acetylglucosamine residues. Ann Neurol 1993;33:243-7.

  37. Alter M. The epidemiology of Guillain-Barré syndrome. Ann Neurol 1990;27(suppl):7-12.

  38. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27(suppl):21-4.

  39. Kuwabara S, Mori M, Ogawara K, Hattori T, Yuki N. Indicators of rapid clinical recovery in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 2001;70:560-2.

  40. Schwerer B, Neisser A, Bernheimer H. Distinct immunoglobulin class and immunoglobulin G subclass patterns against ganglioside GQ1b in Miller Fisher syndrome following different types of infection. Infect Immun 1999;67:2414-20.

  41. Hafer-Macko C, Hsieh ST, Li CY, et al. Acute motor axonal neuropathy: an antibody-mediated attack on axolemma. Ann Neurol 1996;40:635-44.

  42. Griffin JW, Li CY, Macko C, et al. Early nodal change in the acute motor axonal neuropathy pattern of the Guillain-Barré syndrome. J Neurocytol 1996;25:33-51.

  43. Berciano J, García A, Figols J, Muñoz R, Berciano MT, Lafarga M. Perineurium contributes to axonal damage in acute inflammatory demyelinating polyneuropathy. Neurology 2000;55:552-9.

  44. Van Rhijn I. Gammadelta T cell non-responsiveness in Campylobacter jejuni-associated Guillain-Barré syndrome patients. Neurology 2003;61(7):994-6.

  45. Kuwabara S. Does Campylobacter jejuni infection elicit “demyelinating” Guillain-Barré syndrome? Neurology 2004;63(3):529-33.

  46. Nishino S. CSF hypocretin levels in Guillain-Barré syndrome and other inflammatory neuropathies. Neurology 2003;61(6):823-5.

  47. Hu W. Cyclo-oxygenases and prostaglandins in acute inflammatory demyelination of the peripheral nerve. Neurology 2003;61(12):1774-9.

  48. Gonovi V. Exogenous gangliosides and Guillain-Barré syndrome, an observational study in the local health district of Ferrara, Italy. Brain 1997;120:1123-30.

  49. 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;43:1911-7.

  50. Kusunoki S, Chiba A, Kanazawa I. Anti-GQ1b IgG antibody is associated with ataxia as well as ophthalmoplegia. Muscle Nerve 1999;22:1071-4.

  51. Van Koningsveld R. Infections and course of disease in mild forms of Guillain-Barré syndrome. Neurology 2002;58(4):610-4.

  52. Jacobs BC, van Doorn PA, Groeneveld JHM, et al. Cytomegalovirus infections and anti-GM2 antibodies in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 1997;62:641-3.

  53. Pritchard J, Hughes R. Guillain-Barré syndrome. Lancet 2004;363:2186-8.

  54. Lunn MP, Johnson LA, Fromholt SE, et al. High-affinity anti-ganglioside IgG antibodies raised in complex ganglioside knockout mice: reexamination of GD1a immunolocalization. J Neurochem 2000;75:404-12.

  55. Brown WF, Feasby TE, Hahn AF. Electrophysiological changes in the acute “axonal” form of Guillain-Barré syndrome. Muscle Nerve 1993;16:200-5.

  56. Pritchard J, Hughes R. Guillain-Barré syndrome. Lancet 2004;363:218-8.

  57. Ho TW, Hsieh ST, Nachamkim I, et al. Motor nerve terminal degeneration provides a potential mechanism for rapid recovery in acute motor axonal neuropathy after Campylobacter infection. Neurology 1997;48:717-24.

  58. Willison HJ, Veitch J, Paterson G, Kennedy PGE. Miller Fisher syndrome is associated with serum antibodies to GB1b ganglioside. J Neurol Neurosurg Psychiatry 1993;56:204-6.

  59. Faloona J, Walsh-Kelly CM. Upper airway dysfunction: a unusual presentation of Guillain-Barré syndrome. Ann Emerg Med 1992;21:437-9.

  60. Keller S, Vasu RI. A unusual presentation of Guillain-Barré syndrome. Tenn Med 2000;93:23-5.

  61. Vargas F, Hilbert G, Gruson D, et al. Fulminant Guillain-Barré syndrome mimicking cerebral death. Intensive Care Med 2000;26:623-7.

  62. Koga M, Yoshino H, Morimatsu M, Auki N. Anti-GT1a IgG in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 2002;72:767-71.

  63. Hadden M, Karch H. Preceding infections, immune factors, and outcome in Guillain-Barré syndrome. Neurology 2001;56(6):758-65.

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

  65. Hughes RA. Sensory form of Guillain-Barré syndrome. Lancet 2001;357:1465.

  66. Oh SJ, LaGanke C, Claussen GC. Sensory Guillain-Barré syndrome. Neurology 2001;56:82-6.

  67. Yuki N. Axonal Guillain-Barré syndrome subtypes: do we need more splitting? Neurology 2003;61(5):598-9.

  68. Hiraga A. Differences in patterns of progression in demyelinating and axonal Guillain-Barré syndromes. Neurology 2003;61(4):471-4.

  69. Visser LH, van der Meché FGA, van Doorn PA, et al. Guillain-Barré syndrome without sensory loss (acute motor neuropathy): a subgroup with specific clinical, electrodiagnostic and laboratory features. Brain 1995;118:841-7.

  70. 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 1993;33:333-42.

  71. Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T. Clinical features and prognosis of Miller Fisher syndrome. Neurology 2001;56:1104-6.

  72. Ho TW, Li CY, Cornblath DR, Gao CY, Asbury AK, Griffin JW, et al. Patterns of recovery in the Guillain-Barré syndromes. Neurology 1997;48:695-700.

  73. Griffin JW, Li CY, Ho TW, Tian M, Gao CY, Xue P, et al. Pathology of the motor-sensory axonal Guillain-Barré syndrome. Ann Neurol 1996;39:17-28.

  74. Gordon PH, Wilbourn AJ. Early electrodiagnostic findings in Guillain-Barré syndrome. Arch Neurol 2001;58:913-7.

  75. Ropper AH. The Guillain-Barré syndrome. N Engl J Med 1992;326:1130-6.

  76. Jozefowicz RF. Neurologic diagnostic procedures. In: Goldman L, Bennett C, editors. Cecil textbook of medicine. 21st ed. Philadelphia: WB Saunders, 2000;pp:2010-6.

  77. Pritchard J. A randomized controlled trial of recombinant interferon-beta 1a in Guillain-Barré syndrome. Neurology 2003;61(9):1282-4.

  78. Turner B, Wills AJ. Cerebral infarction complicating intravenous immunoglobulin therapy in a patient with Miller Fisher syndrome. J Neurol Neurosurg Psychiatry 2000;68(6):790-1.

  79. Sewell WA, Brennan VM, Donaghy M, Chapel HM. The use of self infused intravenous immunoglobulin home therapy in the treatment of acquired chronic demyelinating neuropathies. J Neurol Neurosurg Psychiatry 1997;63:106-9.

  80. Raphael JC, Chevret S. Rational therapy of Guillain-Barré syndrome. Lancet 1998:351(9104):753.

  81. Visser LH. Prognostic factors of Guillain-Barré syndrome after intravenous immunoglobulin or plasma exchange. Neurology 1999;53(3):598-604.

  82. Van Koningsveld R, Schmitz PI, Meche FG, Visser LH, Mulstee J, van Doorn PA; Dutch GBS study group. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial. Lancet 2004;363(9404):192-6.

  83. Smith M, Appleton R. Letters to the editor. Dev Med Child Neurol 2001;43:69-72.

  84. Plasmapheresis and acute Guillain-Barré syndrome. The Guillain-Barre syndrome study group. Neurology 1985;35:1096-104.

  85. Kleyweg RP, van der Meche FGA, Meultee J. Treatment of Guillain-Barré syndrome with high dose gammaglobulin. Neurology 1988;38:1639-41.

  86. Guillain-Barré syndrome steroid trial group. Double blind trial of intravenous methylprednisolone in Guillain-Barré syndrome. Lancet 1993;341:586-90.

  87. Raphael JC, Chevret S, Harboun M, Jars-Guincestre MC. French Guillain-Barré Syndrome Cooperative Group. Intravenous immune globulins in patients with Guillain-Barré syndrome and contraindications to plasma exchange: 3 days versus 6 days. Neurol Neurosurg Psychiatry 2001;71:235-38.

  88. Tekgul H. Outcome of axonal and demyelinating forms of Guillain-Barré syndrome in children. Pediatr Neurol 2003;28(4):295-9.

  89. Vajsar J. Long-term outcome in children with Guillain-Barré syndrome. J Pediatr 2003;142(3):305-9

  90. Seneviratne U. Guillain-Barré syndrome. Postgrad Med J 2000;76:774-82.

  91. Mori M, Kuwabara S, H. Influenza infection and Guillain-Barré syndrome. Brain 2000;123:2171-8.

  92. Van Koningsveld R, Schmitz PIM, Ang CW, et al. Infections and course of disease in mild forms of Guillain-Barré syndrome. Neurology 2002;58:610-4.

  93. Sharshar T. Early predictors of mechanical ventilation in Guillain-Barré syndrome. Crit Care Med 2003;31(1):278-83.

  94. Visser LH. Prognostic factors of Guillain-Barré syndrome after intravenous immunoglobulin or plasma exchange. Dutch Guillain-Barré study group. Neurology 1999;53(3):598-604.

  95. Markland LD, Riley HD. The Guillain-Barré syndrome in childhood. Clin Pediatr 1967;6:162-70.

  96. McKhann GM, Griffin JW, Cornblath DR, Mellits ED, Fisher RS, Quaskey SA. Plasmapheresis and Guillain-Barré syndrome: analysis of prognostic factors and the effect of plasmapheresis. Ann Neurol 1988;23:347-53.

  97. Cornblath DR, Mellits ED, Griffin JW, et al. Motor conduction studies in Guillain-Barré syndrome: description and prognostic value. Ann Neurol 1988;23:354-9.

  98. Miller RG, Peterson GW, Daube JR, Albers JW. Prognostic value of electrodiagnosis in Guillain-Barré syndrome. Muscle Nerve 1988;11:769-74.

  99. Gruener G, Bosch EP, Strauss RG, Klugman M, Kimura J. Prediction of early beneficial response to plasma exchange in Guillain-Barré syndrome. Arch Neurol 1987;44:295-8.

  100. Cuadernos de Neurología Universidad Autónoma de Chile, volumen XXVI, 2002.




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