Guillain-Barre syndrome Miller-Fisher syndrome

The Guillain-Barre syndrome (GBS) is the most common cause of acute paralysis. It has become evident that the syndrome is heterogeneous and includes classical demyelinating polyneuropathy, axonal variants and acute motor axonal polyneuropathy. Morbidity and mortality result from autonomic disturbances, involvement of caudal cranial nerves with respiratory insufficiency and complications secondary to immobilization. Pathogenetically, both humoral and cellular immune reactions against components of the myelin sheath play an important role. Glycolipids are considered important target antigens of a humorally mediated immune attack. In the Miller-Fisher syndrome, circulating antibodies to the ganglioside GQ1b can be detected in serum. Apart from supportive therapy plasma exchange and high dose intravenous immunoglobulin G have been proved efficacious. Their relative merits are currently being evaluated in a large international multicentre trial.