Pain, autonomic dysfunction, and course of disease in Guillain-Barré Syndrome

The Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy. Until now, GBS remains a descripti ve diagnosis for which there are no specific diagnostic tests. The combinati on of rapidly progressive symmetrical weakness in arms and legs with or without sensory disturbances, hypo- or areflexia, in the absence of a cerebrospinal fluid (CSF) cellular reacti on, remains the hallmark for the clinical diagnosis of GBS. In GBS, there is a broad spectrum of clinical symptoms and severity in the acute phase. During the subsequent course of disease, the presence and severity of residual symptoms is highly variable. In most treatment studies only severely aff ected pati ents (those being unable to walk without assistance; GBS disability scale grade have been included. Because progressive paralysis is the most striking and alarming symptom of GBS, most att enti on generally is given to the rapid progression and severity of weakness in the acute phase. There are however some underexposed but important issues in GBS like residual fi ndings in parti cular in pati ents which limited weakness (mildly aff ected pati ents), a fl uctuati ng course aft er initi al improvement (treatment related fl uctuati ons (TRF)), the transiti on to chronic infl ammatory demyelinati ng polyneuropathy (CIDP) and the frequency and nature of pain and autonomic dysfuncti on that have been studied limited so far. These issues have formed the basis of the studies described in this thesis. The following cases illustrate the importance of these underexposed issues.

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