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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2005 May;76(5):719–722. doi: 10.1136/jnnp.2004.051136

Recovery patterns and long term prognosis for axonal Guillain–Barré syndrome

A Hiraga 1, M Mori 1, K Ogawara 1, S Kojima 1, T Kanesaka 1, S Misawa 1, T Hattori 1, S Kuwabara 1
PMCID: PMC1739613  PMID: 15834034

Abstract

Background: Little is known about the long term prognosis for patients the severe acute motor axonal neuropathy (AMAN) form of Guillain–Barré syndrome (GBS), unlike those with acute inflammatory demyelinating neuropathy (AIDP).

Objective: To clarify the long term prognosis for patients with AMAN.

Methods: Clinical recovery and outcome in 97 consecutive GBS patients were reviewed.

Results: Electrodiagnostic criteria showed that 44 patients (45%) had AMAN, 33 (34%) had AIDP, and 20 (21%) were unclassified. Most of the severely affected patients had received plasmapheresis or immunoglobulin therapy. Slow recovery (inability to walk independently at six months after onset) was found in six of the AMAN patients (14%) and in two of the AIDP patients (6%). Of the six AMAN patients, four could walk independently one year after the onset, and the other two could walk independently at 28 and 57 months after onset. Of the two AIDP patients, one could walk at nine months after the onset while the other died of pneumonia seven months after onset.

Conclusions: AMAN electrodiagnosis is not always a marker of poor recovery. Almost all the severe AMAN patients who had slow recoveries over the first six months could eventually walk independently, although some required several years.

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Selected References

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  1. Asbury A. K., Cornblath D. R. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27 (Suppl):S21–S24. doi: 10.1002/ana.410270707. [DOI] [PubMed] [Google Scholar]
  2. Bernsen Robert A. J. A. M., de Jager Aeiko E. J., Schmitz Paul I. M., van der Meché Frans G. A. Long-term impact on work and private life after Guillain-Barré syndrome. J Neurol Sci. 2002 Sep 15;201(1-2):13–17. doi: 10.1016/s0022-510x(02)00158-2. [DOI] [PubMed] [Google Scholar]
  3. Chiò A., Cocito D., Leone M., Giordana M. T., Mora G., Mutani R., Piemonte and Valle d'Aosta Register for Guillain-Barré Syndrome Guillain-Barré syndrome: a prospective, population-based incidence and outcome survey. Neurology. 2003 Apr 8;60(7):1146–1150. doi: 10.1212/01.wnl.0000055091.96905.d0. [DOI] [PubMed] [Google Scholar]
  4. Cornblath D. R., Mellits E. D., Griffin J. W., McKhann G. M., Albers J. W., Miller R. G., Feasby T. E., Quaskey S. A. Motor conduction studies in Guillain-Barré syndrome: description and prognostic value. Ann Neurol. 1988 Apr;23(4):354–359. doi: 10.1002/ana.410230407. [DOI] [PubMed] [Google Scholar]
  5. Dourado M. E., Duarte R. C., Ferreira L. C., Queiroz J. W., Illa I., Perez-Perez G., Guerrant R. L., Jerônimo S. M. B. Anti-ganglioside antibodies and clinical outcome of patients with Guillain-Barré Syndrome in northeast Brazil. Acta Neurol Scand. 2003 Aug;108(2):102–108. doi: 10.1034/j.1600-0404.2003.00103.x. [DOI] [PubMed] [Google Scholar]
  6. Feasby T. E., Gilbert J. J., Brown W. F., Bolton C. F., Hahn A. F., Koopman W. F., Zochodne D. W. An acute axonal form of Guillain-Barré polyneuropathy. Brain. 1986 Dec;109(Pt 6):1115–1126. doi: 10.1093/brain/109.6.1115. [DOI] [PubMed] [Google Scholar]
  7. Fletcher D. D., Lawn N. D., Wolter T. D., Wijdicks E. F. Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurology. 2000 Jun 27;54(12):2311–2315. doi: 10.1212/wnl.54.12.2311. [DOI] [PubMed] [Google Scholar]
  8. Griffin J. W., Li C. Y., Ho T. W., Xue P., Macko C., Gao C. Y., Yang C., Tian M., Mishu B., Cornblath D. R. Guillain-Barré syndrome in northern China. The spectrum of neuropathological changes in clinically defined cases. Brain. 1995 Jun;118(Pt 3):577–595. doi: 10.1093/brain/118.3.577. [DOI] [PubMed] [Google Scholar]
  9. Hadden R. D., Cornblath D. R., Hughes R. A., Zielasek J., Hartung H. P., Toyka K. V., Swan A. V. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol. 1998 Nov;44(5):780–788. doi: 10.1002/ana.410440512. [DOI] [PubMed] [Google Scholar]
  10. Hadden R. D., Karch H., Hartung H. P., Zielasek J., Weissbrich B., Schubert J., Weishaupt A., Cornblath D. R., Swan A. V., Hughes R. A. Preceding infections, immune factors, and outcome in Guillain-Barré syndrome. Neurology. 2001 Mar 27;56(6):758–765. doi: 10.1212/wnl.56.6.758. [DOI] [PubMed] [Google Scholar]
  11. Ho T. W., Hsieh S. T., Nachamkin I., Willison H. J., Sheikh K., Kiehlbauch J., Flanigan K., McArthur J. C., Cornblath D. R., McKhann G. M. Motor nerve terminal degeneration provides a potential mechanism for rapid recovery in acute motor axonal neuropathy after Campylobacter infection. Neurology. 1997 Mar;48(3):717–724. doi: 10.1212/wnl.48.3.717. [DOI] [PubMed] [Google Scholar]
  12. Ho T. W., Li C. Y., Cornblath D. R., Gao C. Y., Asbury A. K., Griffin J. W., McKhann G. M. Patterns of recovery in the Guillain-Barre syndromes. Neurology. 1997 Mar;48(3):695–700. doi: 10.1212/wnl.48.3.695. [DOI] [PubMed] [Google Scholar]
  13. Ho T. W., Mishu B., Li C. Y., Gao C. Y., Cornblath D. R., Griffin J. W., Asbury A. K., Blaser M. J., McKhann G. M. Guillain-Barré syndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. 1995 Jun;118(Pt 3):597–605. doi: 10.1093/brain/118.3.597. [DOI] [PubMed] [Google Scholar]
  14. Kuwabara S., Asahina M., Koga M., Mori M., Yuki N., Hattori T. Two patterns of clinical recovery in Guillain-Barré syndrome with IgG anti-GM1 antibody. Neurology. 1998 Dec;51(6):1656–1660. doi: 10.1212/wnl.51.6.1656. [DOI] [PubMed] [Google Scholar]
  15. Kuwabara S., Mori M., Ogawara K., Hattori T., Yuki N. Indicators of rapid clinical recovery in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 2001 Apr;70(4):560–562. doi: 10.1136/jnnp.70.4.560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kuwabara S., Ogawara K., Mizobuchi K., Mori M., Hattori T. Mechanisms of early and late recovery in acute motor axonal neuropathy. Muscle Nerve. 2001 Feb;24(2):288–291. doi: 10.1002/1097-4598(200102)24:2<288::aid-mus150>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  17. Kuwabara S., Yuki N., Koga M., Hattori T., Matsuura D., Miyake M., Noda M. IgG anti-GM1 antibody is associated with reversible conduction failure and axonal degeneration in Guillain-Barré syndrome. Ann Neurol. 1998 Aug;44(2):202–208. doi: 10.1002/ana.410440210. [DOI] [PubMed] [Google Scholar]
  18. Lyu R. K., Tang L. M., Cheng S. Y., Hsu W. C., Chen S. T. Guillain-Barré syndrome in Taiwan: a clinical study of 167 patients. J Neurol Neurosurg Psychiatry. 1997 Oct;63(4):494–500. doi: 10.1136/jnnp.63.4.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. McKhann G. M., Cornblath D. R., Griffin J. W., Ho T. W., Li C. Y., Jiang Z., Wu H. S., Zhaori G., Liu Y., Jou L. P. Acute motor axonal neuropathy: a frequent cause of acute flaccid paralysis in China. Ann Neurol. 1993 Apr;33(4):333–342. doi: 10.1002/ana.410330402. [DOI] [PubMed] [Google Scholar]
  20. McKhann G. M., Griffin J. W., Cornblath D. R., Mellits E. D., Fisher R. S., Quaskey S. A. Plasmapheresis and Guillain-Barré syndrome: analysis of prognostic factors and the effect of plasmapheresis. Ann Neurol. 1988 Apr;23(4):347–353. doi: 10.1002/ana.410230406. [DOI] [PubMed] [Google Scholar]
  21. 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 Oct;48(4):624–631. [PubMed] [Google Scholar]
  22. Rees J. H., Gregson N. A., Hughes R. A. Anti-ganglioside GM1 antibodies in Guillain-Barré syndrome and their relationship to Campylobacter jejuni infection. Ann Neurol. 1995 Nov;38(5):809–816. doi: 10.1002/ana.410380516. [DOI] [PubMed] [Google Scholar]
  23. Rees J. H., Soudain S. E., Gregson N. A., Hughes R. A. Campylobacter jejuni infection and Guillain-Barré syndrome. N Engl J Med. 1995 Nov 23;333(21):1374–1379. doi: 10.1056/NEJM199511233332102. [DOI] [PubMed] [Google Scholar]
  24. Rees J. H., Thompson R. D., Smeeton N. C., Hughes R. A. Epidemiological study of Guillain-Barré syndrome in south east England. J Neurol Neurosurg Psychiatry. 1998 Jan;64(1):74–77. doi: 10.1136/jnnp.64.1.74. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Ropper A. H. Severe acute Guillain-Barré syndrome. Neurology. 1986 Mar;36(3):429–432. doi: 10.1212/wnl.36.3.429. [DOI] [PubMed] [Google Scholar]
  26. Visser L. H., Schmitz P. I., Meulstee J., van Doorn P. A., van der Meché F. G. Prognostic factors of Guillain-Barré syndrome after intravenous immunoglobulin or plasma exchange. Dutch Guillain-Barré Study Group. Neurology. 1999 Aug 11;53(3):598–604. doi: 10.1212/wnl.53.3.598. [DOI] [PubMed] [Google Scholar]
  27. Visser L. H., Van der Meché F. G., Van Doorn P. A., Meulstee J., Jacobs B. C., Oomes P. G., Kleyweg R. P., Meulstee J. Guillain-Barré syndrome without sensory loss (acute motor neuropathy). A subgroup with specific clinical, electrodiagnostic and laboratory features. Dutch Guillain-Barré Study Group. Brain. 1995 Aug;118(Pt 4):841–847. doi: 10.1093/brain/118.4.841. [DOI] [PubMed] [Google Scholar]
  28. Winer J. B., Hughes R. A., Osmond C. A prospective study of acute idiopathic neuropathy. I. Clinical features and their prognostic value. J Neurol Neurosurg Psychiatry. 1988 May;51(5):605–612. doi: 10.1136/jnnp.51.5.605. [DOI] [PMC free article] [PubMed] [Google Scholar]

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