NEUROLOGY 1997;48:695-700
© 1997 American Academy of Neurology
Patterns of recovery in the Guillain-Barre syndromes
T. W. Ho, MD,
C. Y. Li, MD,
D. R. Cornblath, MD,
C. Y. Gao, MD,
A. K. Asbury, MD,
J. W. Griffin, MD and
G. M. McKhann, MD
From the Departments of Neurology (Drs. Ho, Cornblath, Griffin, and McKhann) and Neuroscience (Dr. Griffin), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (Drs. Li and Gao), Second Teaching Hospital, Hebei University School of Medicine, Shijiazhuang, Hebei Province, People's Republic of China; Department of Neurology (Dr. Asbury), the University of Pennsylvania School of Medicine, Philadelphia, PA; and the Zanvyl Krieger Mind-Brain Institute (Dr. McKhann) of Johns Hopkins University, Baltimore, MD.
Supported in part by USPHS grants RO1-NS34846 and RO1-NS31528. Dr. Ho was supported by USPHS Special Fellowship NS09286.
Received June 13, 1996. Accepted in final form August 29, 1996.
Address correspondence and reprint requests to Dr Ho, Department of Neurology, Johns Hopkins Hospital, Pathology Building 509, 600 N. Wolfe St., Baltimore, MD 21287.
Article abstract-Clinical, electrodiagnostic, and pathologic studies indicate that the Guillain-Barre syndromes (GBSs) include both primary demyelinating and primary axonal forms. The axonal forms are usually thought to have a poorer prognosis, with less chance for rapid or complete recovery. In northern China, epidemics of one axonal form, acute motor axonal neuropathy (AMAN), occur annually in the summer. Autopsy studies in some fatal cases have demonstrated wallerian-like degeneration of motor roots and motor fibers in the peripheral nerves. Recovery of such patients would require axonal regeneration along the entire length of the nerve fiber. In a 2-year prospective study of GBS at a single hospital in northern China, 42 patients were classified as having either AMAN (32 patients), acute inflammatory demyelinating polyneuropathy (AIDP) (8 patients), or as undetermined (2 patients) by electrodiagnostic criteria. Their recoveries were monitored clinically. The recovery times of AMAN and AIDP patients were similar: the median time to regain the ability to walk 5 meters with assistance was 31 days for patients classified as having AMAN and 32 days for those classified as having AIDP. These rapid recovery times are incompatible with severe wallerian degeneration of the ventral roots and motor nerve fibers. The rapid recoveries observed in AMAN patients could be explained by relatively quickly reversible immune-mediated changes at nodes of Ranvier in motor fibers, by degeneration and regeneration of intramuscular motor nerve terminals, or both.
NEUROLOGY 1997;48: 695-700
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