Main description:

The period that followed World War II has witnessed a dramatic change in neurology. From being a discipline in which its partici- pants were castigated for being interested solely in diagnosis, usually of disorders of unknown causation without effective therapy, neurology has evolved into a highly active treatment- orientated subject. This transition is clearly reflected in the ap- proach to diseases of the peripheral nervous system, and to the Guillain-Barre syndrome (GBS) in particular. In a state-of-the- art review made in 1952, Elkington (1952) observed that no less than 56% of neuropathies remained undiagnosed, and amongst those of unknown causation he listed GBS. With intensive in- vestigation and follow-up, the proportion of neuropathies seen at tertiary referral centres which elude diagnosis is now as little as 13% (McLeod et al. 1984). Overall, of course, the proportion is even less. This change is partly because of the introduction of new diagnostic techniques and partly because of the application of the great expansion in knowledge evident throughout medicine.
In this book, Professor Richard Hughes has assembled current information on GBS and related disorders, including chronic in- flammatory demyelinating polyneuropathy (CIDP), the existence of which was not appreciated until Austin's perspicacious study published in 1958. In the Introduction, Professor Hughes gives an account of the way in which recognition of the GBS emerged and matured, and shows that it followed, pari passu, with the realisation that paral- ysis and sensory loss may result from peripheral nerve disorders.

Contents:

1 History and Definition.- Landry's Acute Ascending Paralysis.- Acute Febrile Polyneuritis.- Acute Infective Polyneuritis.- A Syndrome of Radiculoneuritis with Albumino-cytological Dissociation.- Guillain-Barre Syndrome or Landry's Ascending Paralysis.- Chronic Idiopathic Demyelinating Polyradiculoneuropathy.- Guillain-Barre Syndrome in History and the News.- Summary.- References.- 2 Immunobiology of the Peripheral Nervous System.- Wallerian Degeneration Versus Primary Demyelination.- Myelin.- Blood-Nerve Barrier.- Antigen Presentation in the Peripheral Nervous System.- Final Common Pathway of Immunologically Mediated Demyelination.- Antibody-Mediated Demyelination.- Antibody-Dependent Cell-Mediated Demyelination.- Cell-Mediated Cytotoxicity Causing Demyelination.- Delayed Hypersensitivity to Myelin Antigens Causing Demyelination.- Bystander Demyelination.- Summary.- References.- 3 Experimental Allergic Neuritis.- Experimental Allergic Encephalomyelitis.- Pathology of EAN.- Neurological Signs of EAN.- Experimental Autonomic Neuropathy.- Chronic Relapsing Experimental Allergic Neuritis.- Neurophysiology.- Cerebrospinal Fluid.- Identification of the Antigen Responsible for EAN.- Genetic Factors.- Antibody Production in EAN.- Cell-Mediated Immunity in EAN.- Galactocerebroside Neuritis.- Treatment of EAN.- Summary.- References.- 4 Pathology of Guillain-Barre Syndrome.- Autopsy Observations of Guillain-Barre Syndrome.- Biopsy Studies in Guillain-Barre Syndrome.- Immunohistochemical Studies of Nerves in GBS.- Remyelination.- Summary.- References.- 5 Epidemiology.- Swine Influenza Vaccine Epidemic.- Post-Rabies Vaccine Neuritis.- Viral Infections as Antecedent Events.- Mycoplasma, Bacterial and Other Infections as Antecedent Events.- Other Possible Precipitants of GBS.- Summary.- References.- 6 Clinical Features of Guillain-Barre Syndrome.- Presentation.- Clinical Course.- Differential Diagnosis.- Miller Fisher Syndrome.- Autonomic Dysfunction.- Papilloedema.- Other Complications.- Summary.- References.- 7 Clinical Neurophysiology.- Frequency of Abnormalities of Motor Nerve Conduction.- Time Course of Nerve Conduction Abnormalities.- Sensory Nerve Conduction.- Axonal Degeneration in GBS.- Myokymia in GBS.- Evoked Potentials.- Electrophysiological Evidence and Prediction of Prognosis.- Mechanisms.- Summary.- References.- 8 Treatment of Guillain-Barre Syndrome.- Prognosis.- General Care.- Steroids.- Plasma Exchange.- Intravenous Immunoglobulin.- Immunosuppressive Drugs.- Rehabilitation.- Summary.- References.- 9 Immunology of Guillain-Barre Syndrome.- Cerebrospinal Fluid.- Diseases Associated with Guillain-Barre Syndrome.- HLA Associations.- Immunoglobulins, Complement and Immune Complexes.- Complexes.- Antibodies.- Cellular Immunity.- Summary.- References.- 10 Chronic Idiopathic Demyelinating Polyradiculoneuropathy.- Diagnostic Criteria.- Preceding Events.- Clinical Features.- Differential Diagnosis.- Evidence for CNS Involvement in CIDP.- Neurophysiology.- Cerebrospinal Fluid.- Pathology.- Immunology.- Treatment.- Summary.- References.- 11 Animal Models of Guillain-Barre Syndrome.- Marek's Disease.- Coonhound Paralysis.- Animal Idiopathic Polyradiculoneuropathy.- Cauda Equina Neuritis of the Horse.- Summary.- References.- 12 Other Inflammatory or Demyelinating Neuropathies.- Vasculitic Neuropathy.- Sarcoid Neuropathy.- Plasma Cell Dyscrasias and Neuropathy.- Leprosy.- Human Immunodeficiency Virus Infection and Neuropathy.- Summary.- References.- Appendix. Guillain-Barre Syndrome: A Short Guide for the Patient, Relative and Friend.