Diagnostic criteria for the Guillain-Barré syndrome

Abstract

The clinical features of 50 cases of Guillain-Barré Syndrome (GBS) are described and compared to previous series in an attempt to further refine the definition of the syndrome.

Nineteen of 50 patients (38%) were Negro. This was not significantly different from the 45.6% of Negroes seen among 3100 neurology patients admitted over this period. There would then seem to be little evidence for any selection by race.

Ten of 20 patients with a history of antecedent illness developed cranial neuropathies and only 3 of the 13 with cranial neuropathy had no history of preceding illness.

Mode of spread was most commonly ascending. Spread within the limbs initially affected with no ascending spread to other body parts was the next most common variety. Descending spread was uncommon. In about 20% of cases no spread occurred outside muscle groups initially affected.

Combined involvement of the proximal and distal muscles was the predominant type of muscle weakness and in most of these patients the proximal and distal muscles were about equally involved.

The occurrence of the GBS in the form of a pure motor polyneuropathy is emphasized. The presence of trunk muscle involvement or selective muscle involvement is also considered to represent a valuable clue to diagnosis.

Absent abdominal and cremasteric reflexes were found to be a common manifestation of the syndrome.

Sensory disturbances lasted longer than 2 months in 11 cases and in 4 of the 11 persisted longer than 6 months. Proprioceptive deficits were the more severe and persisted longer.

In 2 cases in the study elevations of the CSF protein first occurred 6 and 8 weeks respectively after the onset of the illness. No single pattern of protein elevation is characteristic of GBS; varying patterns of protein rise, fall, or plateau over time can occur.

Since 1962 there have been only 3 cases with respiratory involvement and none since 1967 as compared to 8 prior to 1962. Between the years 1952 and 1961, 9 out of 18 cases had cranial nerve involvement as compared to only 4 of 32 between 1962 and 1970 and 1 out of 19 since 1967. There has thus been a decreasing incidence over time of both cranial neuropathy and of the overall severity of the illness in this series.

Using respiratory insufficiency as a criterion for severe involvement, the severity of the illness was significantly correlated with the presence of cranial nerve involvement.

Diagnostic criteria for the GBS favoring a more comprehensive definition than any previously suggested are proposed.