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From the Departments of Neurology (Drs. Van Koningsveld, Ang, Van der Meché, and Van Doorn), Immunology (Dr. Ang), Medical Microbiology and Infectious Diseases (Dr. Ang), Statistics (Dr. Schmitz), and Institute of Virology (Drs. Groen and Osterhaus), Erasmus University Medical Center Rotterdam, the Netherlands.
Address correspondence and reprint requests to Dr. R. Van Koningsveld, Department of Neurology, Erasmus University Medical Center Rotterdam, PO BOX 1738, 3000 DR Rotterdam, the Netherlands; e-mail: vankoningsveld{at}neur.azr.nl
Objective: Twenty-eight percent of patients with the Guillain–Barré syndrome remain able to walk unaided. Studying patients with the mild form of Guillain–Barré syndrome can further contribute to knowledge of the spectrum of the syndrome and explore whether this subgroup may need treatment with IV immunoglobulin.
Methods: Patients fulfilling the National Institute of Neurologic and Communicative Disorders and Stroke criteria for Guillain–Barré syndrome were included in a nationwide survey over a 2-year period. Clinical characteristics and serum samples were collected prospectively. In addition, a questionnaire was completed concerning the course and outcome of the disease.
Results: A total of 139 patients were included. Nineteen of the patients (14%) included were mildly affected, and 120 (86%) were severely affected. Infections with Epstein–Barr virus were found more frequently in mildly affected patients (p = 0.02). Antiganglioside antibodies were less frequently found in the mildly affected patients (p = 0.03). The degree of severity of the disease between mildly and severely affected patients was different on the day of admission (p < 0.01). Thereafter, the groups showed a remarkably similar rate of progression. Thirty-eight percent of mildly affected patients report problems in hand function and an inability to run at 3 and 6 months (all women, p = 0.02).
Conclusion: The difference in severity of Guillain–Barré syndrome seems to be determined in an early phase of the disease. Preceding infections and antiganglioside antibodies may influence the initial immune attack, determining the severity of the disease. The presence of residual signs in patients with mild disease may advocate the use of early treatment in mildly affected patients.
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