Residual neuropathy in long-term population-based follow-up of Guillain–Barré syndrome

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Abstract
Objective: To estimate the occurrence of residual neuropathy and its self-reported health consequences in a population-based group of patients with Guillain–Barré syndrome (GBS) and to characterize quantitatively the concomitant motor, sensory, and autonomic impairments. Methods: Forty patients (mean age 46 years) with a confirmed diagnosis of GBS were studied a mean of 7 years (range 1 to 13 years) after the acute attack together with 40 healthy control subjects. The Dyck minimal criteria of neuropathy, the Neuropathy Symptom Score, the Neuropathy Disability Score, the Short Form-36 (SF-36) generic health questionnaire, isokinetic dynamometry at ankle and wrist, quantitative sensory testing of thresholds for vibration, cold, and pain, autonomic function tests, nerve conduction studies, and a summed Neuropathy Rank Sum Score (NRSS) were applied. Results: Nineteen patients (48%) had residual neuropathy, which was independent of follow-up time. The patients with GBS reported lower health status than control subjects on the SF-36 Physical Component Summary Scale (PCS; p = 0.01), and the PCS scores correlated with the NRSS (r = −0.41, p = 0.009). In patients with GBS, muscle strength at ankle dorsal flexion was reduced by 13.9% (p = 0.001), sensory thresholds for vibration were increased in the foot (p < 0.05), and sensory thresholds for cold were increased in the hand and foot (p < 0.05), whereas autonomic functions and pain thresholds were unaffected. Conclusions: Residual neuropathy affecting large- and medium-sized myelinated fibers endures long after the acute attack of Guillain–Barré syndrome in approximately half of all patients, leads to motor and sensory dysfunction, and shows a trend toward impairing self-reported physical health status.