Electrodiagnostic studies in Guillain-Barre syndrome

Abstract

The Guillain-Barre syndrome (GBS) is a monophasic (sub)acute inflammatory demyelinating predominantly motor polyradiculo-neuropathy. Clinical criteria have been proposed by Asbury (Asbury et aI., 1978; Asbury and Cornblath, 1990). GBS is a selflimiting disease, however, up to 30% of the patients may need temporary artificial ventilation; about 15% remain disabled and mortality is estimated to be up to 5%. Therefore, GBS must be regarded as a serious disease. Plasma exchange (PE) and more recently high dose immune globulins ([vIg) have been proved to be succesful in shortening the duration of the disease, the duration of artificial ventilation and to improve outcome at 6 months (GBS study group, 19- 85; van del' Meche et aI., 1992; French cooperative group, 1992). In contrast to immune globulin therapy, plasma exchange is not always possible for haemodynamic reasons. In addition it is generally not feasible in children, not in all hospitals available, and is in general rather cumbersome. Therefore in the multicentre Dutch Guillain-Barn: Study the effectiveness of immune globulins versus plasma exchange was evaluated in 150 patients, with a main aim to demonstrate at least equal efficacy. This study revealed therapeutic effectiveness of both therapies with a limited but significant superiority of immune globulins over plasma exchange (van del' Meche et aI., 1992). [n the Dutch Guillain-Barre trial each patient was tested electrodiagnostically three times in an early stage of the disease according to a rigid protocol. The results of these electro diagnostic studies are the subject of this thesis