Eighty three years of the Guillain-Barré syndrome: clinical and immunopathologic aspects, current and future treatments.
It is now 83 years that Guillain, Barré and Strohl described the first two cases of an acute paralytic illness with the typical "dissociation albumino-cytologique" in the cerebrospinal fluid. Since then, the full spectrum of GBS has been documented in hundreds of cases ranging from acute inflammatory demyelinating polyneuropathy to the pure motor variants and the Miller Fisher syndrome. During the last 10 years, detailed immunopathologic features have been described and new triggering and possibly causative agents identified, the most prominent being the enteritic bacterium Campylobacter jejuni. Besides the pathogenic role of cell-mediated immunity, IgG antibodies have now been discovered which block neuromuscular transmission. Established treatments include plasma exchange therapy and intravenous immunoglobulin G. Together with sophisticated intensive care measures, mortality has now been reduced to below 5p. 100 with these treatment modalities. Several treatment strategies that proved effective in the animal model of GBS need to be studied in future clinical trials.
Toyka
K V
KV
Neurologische Universitätsklinik, Würzburg, Germany. k.toyka@mail-uni-wuerzburg.de
D000818:Animals; D000917:Antibody Formation; D001327:Autoimmune Diseases / Q000266:history* / Q000276:immunology / Q000473:pathology / Q000628:therapy; D002986:Clinical Trials as Topic; D005544:Forecasting; D005602:France; D006017:Glycolipids / Q000276:immunology; D020275:Guillain-Barre Syndrome / Q000266:history* / Q000276:immunology / Q000473:pathology / Q000628:therapy; D049673:History, 20th Century; D006801:Humans; D007111:Immunity, Cellular; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D018448:Models, Immunological; D008959:Models, Neurological; D009444:Neuritis, Autoimmune, Experimental / Q000276:immunology / Q000628:therapy; D010951:Plasma Exchange; D051381:Rats; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
D006017:Glycolipids; D016756:Immunoglobulins, Intravenous