title: Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis.
abstract: Guillain-Barré syndrome (GBS) is a potentially life-threatening postinfectious disease characterized by rapidly progressive, symmetrical weakness of the extremities. About 25% of patients develop respiratory insufficiency and many show signs of autonomic dysfunction. Diagnosis can usually be made on clinical grounds, but lumbar puncture and electrophysiological studies can help to substantiate the diagnosis and to differentiate demyelinating from axonal subtypes of GBS. Molecular mimicry of pathogen-borne antigens, leading to generation of crossreactive antibodies that also target gangliosides, is part of the pathogenesis of GBS; the subtype and severity of the syndrome are partly determined by the nature of the antecedent infection and specificity of such antibodies. Intravenous immunoglobulin and plasma exchange are proven effective treatments but many patients have considerable residual deficits. Discrimination of patients with treatment-related fluctuations from those with acute-onset chronic inflammatory demyelinating polyneuropathy is important, as these conditions may require different treatments. Novel prognostic models can accurately predict outcome and the need for artificial ventilation, which could aid the selection of patients with a poor prognosis for more-individualized care. This Review summarizes the clinical features of and diagnostic criteria for GBS, and discusses its pathogenesis, treatment and prognosis.
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Bianca
authors.initials: B
authors.lastname: van den Berg
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Christa
authors.initials: C
authors.lastname: Walgaard
authors.affiliation: Department of Clinical Neurophysiology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Drenthen
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Gelre ziekenhuis lokatie Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, Netherlands.
authors.forename: Christiaan
authors.initials: C
authors.lastname: Fokke
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Bart C
authors.initials: BC
authors.lastname: Jacobs
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: van Doorn
mesh_terms: D020275:Guillain-Barre Syndrome / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D006801:Humans; D011379:Prognosis