Clinical outcome of Guillain-Barré syndrome after prolonged mechanical ventilation.

BACKGROUND: Patients with Guillain-Barré syndrome (GBS) may suffer from respiratory failure for months or longer. The aim of this study was to determine the frequency, clinical course and outcome of patients with GBS requiring prolonged mechanical ventilation (MV). METHODS: Prospectively collected data from 526 patients with GBS participating in previous trials were analysed to determine the frequency and duration of prolonged MV (longer than 2 months). In addition, a cross-sectional study was conducted in patients with GBS requiring MV to determine the clinical course and long-term outcome with the ability to walk unaided as primary endpoint. RESULTS: In the cohort study, 145 of 526 patients with GBS (28%) required MV, including 33 (6%) patients with prolonged MV. Patients requiring prolonged MV had a lower Medical Research Council sum score and more frequent bulbar involvement and inexcitable nerves compared with shorter ventilated patients. At 6 months, 18% of patients with prolonged MV were able to walk unaided compared with 76% of patients requiring shorter MV (P<0.001). In the cross-sectional study, 63 patients requiring MV were included with a median follow-up of 11 years (range 2-44 years). Twenty-six (41%) of these patients needed prolonged MV (median 93 days, range 62-261). Fifteen (58%) of these patients were able to walk unaided at maximum follow-up and eight (31%) reached this endpoint more than 1 year after diagnosis. CONCLUSIONS: Prolonged ventilation in GBS is associated with poor prognosis, yet patients requiring prolonged ventilation may show slow but persistent recovery for years and even reach the ability to walk and live independently.

Hyperpolarization-activated cyclic nucleotide-gated 1 independent grid cell-phase precession in mice.

Cell assemblies code information in both the temporal and spatial domain. One tractable example of temporal coding is the phenomenon of phase precession. In medial entorhinal cortex, theta-phase precession is observed in spatially specific grid cells, with grid spike-times shifting to earlier phases of the extracellular theta rhythm as the animal passes through the grid field. Although the exact mechanisms underlying spatial-temporal coding remain unknown, computational work points to single-cell oscillatory activity as a biophysical mechanism capable of producing phase precession. Support for this idea comes from observed correlations between single-cell resonance and entorhinal neurons characterized by phase precession. Here, we take advantage of the absence of single-cell theta-frequency resonance in hyperpolarization-activated cyclic nucleotide-gated (HCN) 1 knockout (KO) mice to examine the relationship between intrinsic rhythmicity and phase precession. We find phase precession is highly comparable between forebrain-restricted HCN1 KO and wild-type mice. Grid fields in HCN1 KO mice display more experience-dependent asymmetry however, consistent with reports of enhanced long-term potentiation in the absence of HCN1 and raising the possibility that the loss of HCN1 improves temporal coding via the rate-phase transformation. Combined, our results clarify the role of HCN1 channels in temporal coding and constrain the number of possible mechanisms generating phase precession. © 2013 Wiley Periodicals, Inc.