Abstract
OBJECTIVES—To determine the incidence, treatment, and outcome of Guillain-Barré syndrome in south east England. METHODS—Patients presenting with confirmed Guillain-Barré syndrome between 1 July 1993 and 30 June 1994 were recruited via a voluntary reporting scheme coordinated by the British Neurological Surveillance Unit, hospital activity data collected from acute admitting hospitals within the South East and South West Thames Regional Health Authorities, death certificates, and a contemporary research study of Guillain-Barré syndrome and Campylobacter jejuni infection. All patients were followed up for one year to determine outcome. RESULTS—Seventy nine patients were recruited, 35 (44%) male, 44 (56%) female, including three children (two boys, one girl). The crude (95% confidence interval (95% CI)) annual incidence was 1.2 (0.9-1.4) cases/100 000 population and 1.5 (1.3-1.8)/100 000 when adjusted for undetected cases. Twenty (25%) patients required ventilation for an average (SD) of 42 (64) days. Thirty six (46%) patients received intravenous human immunoglobulin, five (6%) received plasma exchange, 11 (14%) both treatments, three (4%) steroids, and 25 (32%) no immunomodulatory treatment. One year later, six patients (8%) had died, all of whom were older than 60, three (4%) remained bedbound or ventilator dependent, seven (9%) were unable to walk unaided, 14 (17%) were unable to run, and 49 (62%) had made a complete or almost complete recovery. Increasing age was significantly associated with a poorer outcome at one year. CONCLUSIONS—Despite the frequent use of modern immunomodulatory treatments Guillain-Barré syndrome still carries considerable morbidity and mortality.
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- Alter M. The epidemiology of Guillain-Barré syndrome. Ann Neurol. 1990;27 (Suppl):S7–12. doi: 10.1002/ana.410270704. [DOI] [PubMed] [Google Scholar]
- 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]
- Beghi E., Kurland L. T., Mulder D. W., Wiederholt W. C. Guillain-Barré syndrome. Clinicoepidemiologic features and effect of influenza vaccine. Arch Neurol. 1985 Nov;42(11):1053–1057. doi: 10.1001/archneur.1985.04060100035016. [DOI] [PubMed] [Google Scholar]
- FISHER M. An unusual variant of acute idiopathic polyneuritis (syndrome of ophthalmoplegia, ataxia and areflexia). N Engl J Med. 1956 Jul 12;255(2):57–65. doi: 10.1056/NEJM195607122550201. [DOI] [PubMed] [Google Scholar]
- Färkkilä M., Kinnunen E., Weckström P. Survey of Guillain-Barré syndrome in southern Finland. Neuroepidemiology. 1991;10(5-6):236–241. doi: 10.1159/000110278. [DOI] [PubMed] [Google Scholar]
- Hart D. E., Rojas L. A., Rosário J. A., Recalde H., Román G. C. Childhood Guillain-Barré syndrome in Paraguay, 1990 to 1991. Ann Neurol. 1994 Dec;36(6):859–863. doi: 10.1002/ana.410360609. [DOI] [PubMed] [Google Scholar]
- Jiang G. X., de Pedro-Cuesta J., Fredrikson S. Guillain-Barré syndrome in south-west Stockholm, 1973-1991, 1. Quality of registered hospital diagnoses and incidence. Acta Neurol Scand. 1995 Feb;91(2):109–117. doi: 10.1111/j.1600-0404.1995.tb00416.x. [DOI] [PubMed] [Google Scholar]
- Kaplan J. E., Poduska P. J., McIntosh G. C., Hopkins R. S., Ferguson S. W., Schonberger L. B. Guillain-Barré syndrome in Larimer County, Colorado: a high-incidence area. Neurology. 1985 Apr;35(4):581–584. doi: 10.1212/wnl.35.4.581. [DOI] [PubMed] [Google Scholar]
- Koobatian T. J., Birkhead G. S., Schramm M. M., Vogt R. L. The use of hospital discharge data for public health surveillance of Guillain-Barré syndrome. Ann Neurol. 1991 Oct;30(4):618–621. doi: 10.1002/ana.410300418. [DOI] [PubMed] [Google Scholar]
- McLean M., Duclos P., Jacob P., Humphreys P. Incidence of Guillain-Barré syndrome in Ontario and Quebec, 1983-1989, using hospital service databases. Epidemiology. 1994 Jul;5(4):443–448. doi: 10.1097/00001648-199407000-00011. [DOI] [PubMed] [Google Scholar]
- 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]
- Regal R. R., Hook E. B. Goodness-of-fit based confidence intervals for estimates of the size of a closed population. Stat Med. 1984 Jul-Sep;3(3):287–291. doi: 10.1002/sim.4780030310. [DOI] [PubMed] [Google Scholar]
- Sedano M. J., Calleja J., Canga E., Berciano J. Guillain-Barré syndrome in Cantabria, Spain. An epidemiological and clinical study. Acta Neurol Scand. 1994 Apr;89(4):287–292. doi: 10.1111/j.1600-0404.1994.tb01682.x. [DOI] [PubMed] [Google Scholar]
- Tharakan J., Ferner R. E., Hughes R. A., Winer J., Barnett M., Brown E. R., Smith G. Plasma exchange for Guillain-Barré syndrome. J R Soc Med. 1989 Aug;82(8):458–461. doi: 10.1177/014107688908200805. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- Winner S. J., Evans J. G. Age-specific incidence of Guillain-Barré syndrome in Oxfordshire. Q J Med. 1990 Dec;77(284):1297–1304. doi: 10.1093/qjmed/77.3.1297. [DOI] [PubMed] [Google Scholar]
- van der Meché F. G., Schmitz P. I. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. N Engl J Med. 1992 Apr 23;326(17):1123–1129. doi: 10.1056/NEJM199204233261705. [DOI] [PubMed] [Google Scholar]