[Guillain-Barré syndrome. Recent clinical and therapeutic aspects]

Guillain-Barré syndrome is an acute primary polyradiculoneuritis. A prototype of demyelinating disease, its essential characteristic is that it spontaneously evolves towards recovery from paralysis. Yet the vital and functional prognosis may be compromised in severe cases. Death and motor sequelae are particularly to be feared when the maximum deficit is severe and the maximum paralysis phase is prolonged. Cardiovascular vegetative disorders are also more frequent in these extended types. Symptomatic treatment rests on close supervision of the patients during the paralysis extension phase. Transferring the patient to an intensive care unit is mandatory as soon as disorders of deglutition and/or a significant decrease of vital capacity appear. Plasma exchange is the only treatment proven to be effective. It must be carried out early on in patients whose deficit is severe enough to interfere with walking and for whom this treatment is not contra-indicated. Fresh frozen plasma must not be used as replacement solution: it creates more incidents and complications than diluted albumin and has no additional beneficial effect on the course of the neurological disease.