New concepts of Guillain-Barre syndrome

Guillain-Barre syndrome is an acute autoimmune polyradiculoneuropathy with a clinical presentation of flaccid paralysis with areflexia, variable senso ry disturbance, and elevated cerebrospinal fluid protein without pleocytosi s. Although Guillain-Barre syndrome previously had been viewed as a unitary disorder with variations, it currently is viewed as a group of syndromes w ith several distinctive subtypes. These include the principal subtype preva lent in the Western world (acute inflammatory demyelinating polyradiculoneu ropathy, and others, each with distinctive electrodiagnostic and pathologic features, including acute motor axonal neuropathy), acute motor-sensory ax onal neuropathy, Miller Fisher syndrome, and perhaps others. The clinical a nd pathologic features of these Guillain-Barre syndrome subtypes are review ed, and the role of antecedent infections, particularly Campylobacter jejun i gastroenteritis, and the role of antiganglioside antibody responses are r eviewed with respect to pathogenesis. Treatment of Guillain-Barre syndrome includes both important supportive measures and immunotherapies, specifical ly high-dose intravenous immunoglobulin and plasma exchange.