Epidemiological study of Guillain-Barre syndrome in south east England

Objectives-To determine the incidence, treatment, and outcome of Guillain-Barre syndrome in south east England. Methods-Patients presenting with confirmed Guillain-Barre syndrome between 1 July 1993 and 30 June 1994 were recruited via a voluntary reporting scheme coordinated by the British Neurological Surveillance Unit, hospital activity data collected from acute admitting hospitals within the South East and South West Thames Regional Health Authorities, death certificates, and a contemporary research study of Guillain-Barre syndrome and Campylobacter jejuni infection. All patients were followed up for one year to determine outcome. Results-Seventy nine patients were recruited, 35 (44%) male, 44 (56%) female, including three children (two boys, one girl). The crude (95% confidence interval (95% CI)) annual incidence was 1.2 (0.9-1.4) cases/100 000 population and 1.5 (1.3-1.8)/100 000 when adjusted for undetected cases. Twenty (25%) patients required ventilation for an average (SD) of 42 (64) days. Thirty six (46%) patients received intravenous human immunoglobulin, five (6%) received plasma exchange, 11 (14%) both treatments, three (4%) steroids, and 25 (32%) no immunomodulatory treatment. One year later, six patients (8%) had died, all of whom were older than 60, three (4%) remained bedbound or ventilator dependent, seven (9%) were unable to walk unaided, 14 (17%) were unable to run, and 49 (62%) had made a complete or almost complete recovery. Increasing age was significantly associated with a poorer outcome at one year. Conclusions-Despite the frequent use of modern immunomodulatory treatments Guillain-Barre syndrome still carries considerable morbidity and mortality.