Severe acute Guillain-Barré syndrome

Six of 58 consecutive patients with Guillain-Barré syndrome had an acute, severe, and prolonged initial illness, with quadriplegia in 2 to 5 days and mechanical ventilation for over 2 months. The average times in the ICU, on a ventilator, in the hospital, and in rehabilitation were 62, 141, 157, and 148 days, respectively. Four were still bedbound and ventilated at 6 months. Three (5%) were limited to a chair, and three walked unsteadily or required foot splints 2 to 3 years after onset. Only 2 of 13 other ventilated patients with slower initial progression of weakness, and none of 38 nonventilated patients were chairbound 6 months after onset (1 died at 2 months); all were walking independently by a year. Quadriplegia appearing over 2 to 5 days is associated with the most severe and prolonged weakness and, in some patients, leads to a permanent chairbound state. Improvement stops at 1 1/2 to 2 years.