Increasing the incidence of the Guillain-Barre syndrome in Curacao

OBJECTIVE: To confirm an observed increase in the occurrence of Guillain-Barre syndrome (GBS) in patients in Curacao. DESIGN AND METHODS: Between 1987 and 1999, medical records of all patients who fulfilled the National Institute of Neurological Communicative Disorders and Stroke (NINCDS) criteria for GBS were reviewed. RESULTS: Forty-nine patients were diagnosed as GBS resulting in an incidence rate (IR) of 2.53/100,000 inhabitants (95 percent CI 1.87-3.35). From 1987 to 1991, the IR remained stable, whereas from 1992 to 1999, there was a linear increase in the IR. There was a high IR in the colder months and a low IR in the warmer months. Patients showed a low percentage of sensory involvement (17 percent, generally 65 percent), rapid progression of the disease (83 percent, generally 30 percent), high percentage of artificial respiration (31 percent, generally 17 percent) and high mortality rate (23 percent, generally 3-5 percent). Fifty-five percent of the patients reported a preceding gastroenteritis (GE); 9/10 serum samples showed evidence of a recent Campylobacter jejuni infection. CONCLUSIONS: This is the first report of an increase in IR of GBS over a longer period, associated with low percentage of sensory involvement, a more severe course and a high mortality rate. The characteristics suggest a role for C jejuni. Prospective research is needed to show whether the increase in GBS is due to an overall increase in IR of C. jejuni infections on the island.(Au)

The Guillain-Barre syndrome following dengue fever

A 44 year old female presented with fever, muscle aches, rash and a low platelet count. IgM antibody to dengue virus was positive. Two weeks later she developed a flaccid areflexic quadriparesis. Nerve conduction studies showed a predominantly demyelitinating sensory motor polyneuropathy consistent with Guillain-Barre syndrome. Despite the relatively common occurence of dengue fever, an associated polyradiculoneuropathy is distinctly uncommon.(AU)

Back from the brink: a personal account of the illness Guillain-Barre Syndrome

Dr. Wahid Ali has spent a long and useful life, almost two decades of which were dedicated to public service. This book is a further contribution to that life of public service in that it gives a detailed account of the symptoms and effects of Guillain-Barre Syndrome, a disease which so few of us know about. This account is also, sadly, a reflection of the inadequacy of health care in our society. That Dr. Ali was able to emerge alive and well after the attack seems surely the result of his position in the society, and his ability to afford health care at the best institutions. He makes constant reference to this inequality. This autobiography demonstrates quite clearly the close link between the spirit and the physical being. It shows how positive thinking can affect the physical well-being of our human persons. The book recommends itself as a serious reflection of the condition of our lives in this place as we seek to create a new culture out of the diverse elements of this New World (Dr. Brinsley Samaroo-back cover)

Modified plasma exchange in life-threatening Guillain-Barre syndrome - abstract

Modified plasma exchange (MPE), a simpler procedure than a conventional plasmapheresis which uses automated equipment and expensive replacement fluids, has recently been recommended for use in hospitals with limited resources in the management of patients with Guillain-Barre Syndrome (GBS). We have performed MPE in 7 patients with life-threatening respiratory failure due to GBS, using fresh frozen plasma as replacement fluid. In 5 out of 6 patients, in whom MPE was started at the onset of mechanical ventilation, rapid improvement inconsistent with the natural history of the disease was noted. In 2 of these patients, due to severity of illness, more plasma per day than previously recommended was safely removed. In one patient, MPE was started with a peak expiration flow rate of 2.2 litres per minute and assisted ventilation was unnecessary due to rapid improvement. Death occurred in one patient from respiratory complications and was not directly due to MPE. Our study confirms the safety and efficacy of MPE and suggests that more plasma can be safely exhanged by this method than previously recommended (AU)

Plasmapheresis in the Guillain-Barre Syndrome: a preliminary report

This is a preliminary report on two patients with the Guillain-Barre syndrome and respiratory insufficiency who responded dramatically to plasmapheresis. Firm conclusions about the role of plasmapheresis in the management of these patients should not be made without the results of adequately controlled trials (AU)

Acute polyneuritis (Guillain-Barre) syndrome seen at the University Hospital of the West Indies, 1970 - 1975

Data from 23 cases of the Guillain-Barre Syndrome seen at the University Hospital of the West Indies is presented. The clinical features of the syndrome were similar to those seen in previous reports. Data from this study revealed that a period of onset of less than 10 days was significantly associated with severe disease thereby causing admission to the Intensive Care Unit. Of the 10 patients admitted to the Intensive Care Unit, 8 required admission to the Intensive Care Unit because of incipient or established respiratory failure, in only 6 of the 19 adults was this nescessary. The problems associated with anaesthesia in this syndrome are discussed, and the need for intensive monitoring of patients with severe disease is emphasized. (AU)