Residual neuropathy in long-term population-based follow-up of Guillain-Barré syndrome.
OBJECTIVE
To estimate the occurrence of residual neuropathy and its self-reported health consequences in a population-based group of patients with Guillain-Barré syndrome (GBS) and to characterize quantitatively the concomitant motor, sensory, and autonomic impairments.


METHODS
Forty patients (mean age 46 years) with a confirmed diagnosis of GBS were studied a mean of 7 years (range 1 to 13 years) after the acute attack together with 40 healthy control subjects. The Dyck minimal criteria of neuropathy, the Neuropathy Symptom Score, the Neuropathy Disability Score, the Short Form-36 (SF-36) generic health questionnaire, isokinetic dynamometry at ankle and wrist, quantitative sensory testing of thresholds for vibration, cold, and pain, autonomic function tests, nerve conduction studies, and a summed Neuropathy Rank Sum Score (NRSS) were applied.


RESULTS
Nineteen patients (48%) had residual neuropathy, which was independent of follow-up time. The patients with GBS reported lower health status than control subjects on the SF-36 Physical Component Summary Scale (PCS; p = 0.01), and the PCS scores correlated with the NRSS (r = -0.41, p = 0.009). In patients with GBS, muscle strength at ankle dorsal flexion was reduced by 13.9% (p = 0.001), sensory thresholds for vibration were increased in the foot (p < 0.05), and sensory thresholds for cold were increased in the hand and foot (p < 0.05), whereas autonomic functions and pain thresholds were unaffected.


CONCLUSIONS
Residual neuropathy affecting large- and medium-sized myelinated fibers endures long after the acute attack of Guillain-Barré syndrome in approximately half of all patients, leads to motor and sensory dysfunction, and shows a trend toward impairing self-reported physical health status.
Dornonville de la Cour
Charlotte
C
Department of Neurology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark. lacour@akhphd.au.dk
Jakobsen
Johannes
J
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003289:Convalescence; D003718:Denmark / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D006304:Health Status; D006801:Humans; D008297:Male; D008393:Marriage; D008475:Median Nerve / Q000503:physiopathology; D008875:Middle Aged; D009069:Movement Disorders / Q000453:epidemiology / Q000209:etiology; D018908:Muscle Weakness / Q000209:etiology; D009413:Nerve Fibers, Myelinated / Q000502:physiology; D009431:Neural Conduction; D009460:Neurologic Examination; D009790:Occupations; D012021:Reflex, Abnormal; D012647:Self-Assessment; D012678:Sensation Disorders / Q000453:epidemiology / Q000209:etiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires