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The recurrent Guillain-Barre syndrome: a long-term population-based study

Journal article
Authors Natalia Mossberg
Magnus Nordin
Charlotta Movitz
Staffan Nilsson
Kristoffer Hellstrand
Tomas Bergström
B. Andersson
Oluf Andersen
Published in Acta Neurologica Scandinavica
Volume 126
Issue 3
Pages 154-161
ISSN 0001-6314
Publication year 2012
Published at Institute of Neuroscience and Physiology
Department of Mathematical Sciences, Mathematical Statistics
Institute of Biomedicine, Department of Infectious Medicine
Pages 154-161
Language en
Links dx.doi.org/10.1111/j.1600-0404.2012...
Keywords Guillain-Barre syndrome, recurrence, prognosis, neurophysiology, immunology, viral infections, inflammatory demyelinating polyradiculoneuropathy, oxygen radical, production, cidp, polyneuropathy, infections, experience, severity, criteria, spine, assay
Subject categories Virology, Infectious Medicine

Abstract

Objectives To describe a population-based material of patients with recurrent GuillainBarre syndrome (RGBS), examine the long time course, and search for factors predisposing to recurrence. Materials and methods We performed a follow-up study of the neurology and neurophysiology and a systematic study of the acute microbial serology of patients with RGBS. These parameters were compared with the results of a previous study of monophasic GBS. Results The patients with RGBS (n = 15) were retrieved from admissions of 229 patients with GBS during a 17-year period. They had 27 (median 3) episodes occurring at irregular intervals over decades. Of the 11 patients who accepted a follow-up examination, six were in full remission, and five had moderate sequelae. Nine had a demyelinating subtype, one had an axonal motor variant, and one patient with incomplete Miller Fisher syndrome had associated arachnoiditis. Two patients showed ultimate transition to a course similar to chronic inflammatory demyelinating polyneuropathy. Episodes were generally shorter in RGBS than in GBS, and an initial episode duration <45 days was predictive of recurrence and related to a younger onset age (univariate P = 0.0050.009). Triggering infections occurred in all patients, in 32 of 41 episodes (78%) with few examples of etiological promiscuity. Serological findings did not differ from those in GBS. Conclusions Episodes in RGBS were shorter than in monophasic GBS. We were unable to identify further immunological predisposing factors for recurrence beyond the previously demonstrated relationship to a weaker respiratory burst. We observed no obvious tendency for the recurrence frequency to wane.

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