Guillain-Barré syndrome with severe persistent disability: relationship to hyperacute Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is a heterogeneous condition with a variable prognosis. We studied nine patients who were unable to walk unaided 12 months after the onset of their illness to discover whether they belonged to a more homogeneous subgroup. Sis of the nine patients had symptoms of gastroenteritis shortly before the onset of their neuropathic symptoms and a hyperacute onset of weakness so that they were bed-bound within 24 h. These patients had predominantly motor rather than sensory involvement We compared these nine poor outcome patients with 66 patients with lesser degrees of persistent disability of whom only three had both a history of prodromal gastroenteritis and a hyperacute onset (p < 0.0001). The poor and better outcome groups did not differ significantly in the severity of disability or other clinical or neurophysiological features in the acute stage. Patients with previous gastroenteritis and hyperacute onset of weakness may represent a relatively homogeneous subgroup of "hyperacute GB" in which severe axonal damage is caused by an aberrant immune response to a gastrointestinal pathogen such as Campylobacter jejuni.