GUILLAIN-BARRE-SYNDROME WITHOUT SENSORY LOSS (ACUTE MOTOR NEUROPATHY) - A SUBGROUP WITH SPECIFIC CLINICAL, ELECTRODIAGNOSTIC AND LABORATORY FEATURES

We analysed data obtained from 27 out of a group of 147 patients with Guillain-Barre syndrome, who did not have sensory loss during a follow-lip period of 6 months (motor Guillain-Barre syndrome). These patients had a distinctive clinical pattern compared with the other 120 Guillain-Barre syndrome patients. The clinical course was marked by a more rapid onset of weakness (3.9 versus 6.1 days, P = 0.002), an earlier nadir (6.3 versus 9.1 days, P < 0.001), an initially predominant distal weakness (67% versus 27%, P < 0.001), sparing of the cranial nerves (26% versus 68%, P < 0.001) and the disease was more often preceded by a gastro-intestinal illness (41% versus 13%, P = 0.001) often caused by a Campylobacter jejuni infection (67% versus 28% in the other Guillain-Barre syndrome patients, P < 0.001). High titres of anti-GM1 antibodies were also significantly more common in motor Guillain-Barre syndrome patients (42% versus 5%, P < 0.001). Electromyographic data of the motor Guillain-Barre syndrome patients at nadir revealed little or no evidence for demyelination. Abundant denervation activity was present in half of the patients. The response to immune globulin treatment was good but with plasma exchange significantly fewer motor Guillain-Barre syndrome patients reached the stage of independent locomotion after a follow-up period of 6 months especially if the acute motor neuropathy occurred after a C. jejuni infection. The distinctive clinical, electrophysiological and laboratory features of motor Guillain-Barre syndrome patients show that the acute motor neuropathy represents a specific subgroup within the Guillain-Barre syndrome and recognizing these patients may have consequences for the choice of therapy.