HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Massaro, M. E. Articles by Reisin, R. C. Search for Related Content PubMed PubMed Citation Articles by Massaro, M. E. Articles by Reisin, R. C.

Nerve biopsy in children with severe Guillain-Barré syndrome and inexcitable motor nerves

From the Department of Pediatric Neurology and Neuropathology, Instituto de Investigaciones Neurológicas Raúl Carrea (FLENI) (Drs. Massaro, Sacolitti, and Taratuto); the Division of Neurology, Fundación Hospitalaria (Dr. Rodriguez); the Division of Neurology, Hospital de Pediatría J.P. Garrahan (Drs. Pociecha, Arroyo, and Fejerman); and the Neurophysiology Laboratory, Hospital Británico (Dr. Reisin), Buenos Aires, Argentina.

Address correspondence and reprint requests to Dr Reisin, Hospital Británico, Department of Neurology, 74 Perdriel, Buenos Aires (1280), Argentina.

The presence of inexcitable motor nerves early in the course of Guillain-Barré syndrome (GBS) identifies a subgroup of patients with more severe disease and delayed recovery. How frequently these electrodiagnostic findings reflect a primary axonal attack ("axonal" GBS) is controversial. We present two children with severe acute GBS, delayed recovery, and residual disability despite early treatment with human immunoglobulin. They had inexcitable motor nerves at days 6 and 7, and profuse fibrillations and positive waves on subsequent studies. Clinically and electrodiagnostically, both children's disease resembled the acute motor-sensory axonal variant of GBS (AMSAN). Sensory and motor nerve biopsies revealed severe macrophage-associated demyelination with axonal degeneration of variable severity. We conclude that clinical and electrodiagnostic features cannot discriminate between the "axonal" and demyelinating GBS. Early and severe demyelination with secondary axonal damage may mimic clinically and electrophysiologically the AMSAN variant of GBS.

Presented in part at the XVI World Congress of Neurology, September 1997, Buenos Aires, Argentina.

Received May 15, 1997. Accepted in final form March 27, 1998.

This article has been cited by other articles:

				C.-L. Pan, T.-J. Tseng, Y.-H. Lin, M.-C. Chiang, W.-M. Lin, and S.-T. Hsieh Cutaneous innervation in Guillain-Barre syndrome: pathology and clinical correlations Brain, February 1, 2003; 126(2): 386 - 397. [Abstract] [Full Text] [PDF]

				P. H. Gordon and A. J. Wilbourn Early Electrodiagnostic Findings in Guillain-Barre Syndrome Arch Neurol, June 1, 2001; 58(6): 913 - 917. [Abstract] [Full Text] [PDF]

				J. Berciano, A. Garcia, J. Figols, R. Munoz, M. T. Berciano, and M. Lafarga Perineurium contributes to axonal damage in acute inflammatory demyelinating polyneuropathy Neurology, August 22, 2000; 55(4): 552 - 559. [Abstract] [Full Text] [PDF]

				J. L. Lu, K. A. Sheikh, H. S. Wu, J. Zhang, Z. F. Jiang, D. R. Cornblath, G. M. McKhann, A. K. Asbury, J. W. Griffin, and T. W. Ho Physiologic-pathologic correlation in Guillain-Barre syndrome in children Neurology, January 11, 2000; 54(1): 33 - 33. [Abstract] [Full Text] [PDF]

				D. Menkes, M. R. Swenson, R. Reisin, J. Pociecha, and M. Massaro Nerve biopsy in children with severe Guillain-Barre syndrome and inexcitable motor nerves Neurology, April 1, 1999; 52(7): 1517 - 1517. [Full Text]