Differences in patterns of progression in demyelinating and axonal Guillain-Barre syndromes

Background: Immune treatments are recommended for patients with Guillain-Barre syndrome (GBS) who cannot walk independently, but a considerable number of GBS patients are in the progressive phase at the first examination. Objective: To investigate whether progression patterns differ in demyelinating and axonal subtypes of GBS. Methods: Clinical, laboratory, and electrophysiologic data on 131 consecutive patients with GBS were reviewed. Patients were classified as having acute inflammatory demyelinating polyneuropathy ( AIDP) or acute motor axonal neuropathy (AMAN) based on electrodiagnostic criteria. Results: Forty-one patients had AIDP, 62 AMAN, and 28 were unclassified. Age, sex, and Hughes Functional Grading Scale score at the first medical examination did not differ for the AIDP and AMAN patients. Mean periods between neurologic onset and first examination (5.3 vs 4.2 days; p = 0.01) and neurologic onset and nadir (18.0 vs 11.5 days; p = 0.001) were longer for the AIDP group. In the subgroup of those with mild disability (able to walk independently at the first neurologic examination), 88% of the AMAN patients had reached the nadir, whereas 65% of the AIDP patients had reached it. The remaining 35% progressed to it over the next 1 to 2 weeks and were unable to walk at nadir. Conclusions: The patterns and speeds of progression differ in AMAN and AIDP, AMAN having a rapid progression and an early nadir. AIDP patients frequently have a significantly long progression after the first examination; therefore, they need to be carefully monitored.