Sequence of demyelination-remyelination in Guillain-Barré disease

A detailed investigation of nerve conduction was made in a patient with Guillain-Barré disease. Conduction velocity and configuration of the compound action potential in distal (median), intermediate (tibial) and central (sciatic) nerve segments were studied serially as the patient weakened and then recovered. Demyelination was found to follow a centripetal pattern, occurring first in the most distal portion of nerve and progressing, as the patient weakened, to the spinal root level. Motor and sensory fibres were equally affected although clinically motor weakness predominated. During recovery, central conduction was the first to improve. The pattern of demyelination-remyelination in Guillain-Barré disease appears to be one in which clinical recovery follows remyelination at the spinal root level and in which the first nerve segments to be demyelinated are the last to be remyelinated.