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??????? ?? ???? ??? ??????? ???? ????? "????? ???????? ??????-???". ????? ????? ? - ?????? 2010 (??????)

Pain in Guillain-Barr syndrome

A long-term follow-up study

  1. L. Ruts, PhD, MD,
  2. J. Drenthen, MD,
  3. J.L.M. Jongen, PhD, MD,
  4. W.C.J. Hop, PhD,
  5. G.H. Visser, PhD, MD,
  6. B.C. Jacobs, PhD, MD,
  7. P.A. van Doorn, PhD, MD and
  8. On behalf of the Dutch GBS Study Group

+ Author Affiliations

  1. From the Departments of Neurology (L.R., J.D., J.L.M.J, G.H.V., B.C.J., P.A.V.D.), Immunology (B.C.J.), and Epidemiology and Biostatistics (W.H.), Erasmus MC, Rotterdam, the Netherlands.
  1. Address correspondence and reprint requests to Dr. L. Ruts, Erasmus MC, University Medical Center, Department of Neurology, Room BA-450, s-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands כתובת דוא"ל זו מוגנת מפני spambots, יש לאפשר JavaScript על-מנת לראות את הכתובת

Abstract

Background: Pain in Guillain-Barr syndrome (GBS) may be pronounced and is often overlooked.

Objectives: To obtain detailed information about pain in GBS and its clinical variants.

Methods: This was a prospective cohort study in 156 patients with GBS (including 18 patients with Miller Fisher syndrome [MFS]). We assessed the location, type, and intensity of pain using questionnaires at standard time points during a 1-year follow-up. Pain data were compared to other clinical features and serology.

Results: Pain was reported in the 2 weeks preceding weakness in 36% of patients, 66% reported pain in the acute phase (first 3 weeks after inclusion), and 38% reported pain after 1 year. In the majority of patients, the intensity of pain was moderate to severe. Longitudinal analysis showed high mean pain intensity scores during the entire follow-up. Pain occurred in the whole spectrum of GBS. The mean pain intensity was predominantly high in patients with GBS (non-MFS), patients with sensory disturbances, and severely affected patients. Only during later stages of disease, severity of weakness and disability were significantly correlated with intensity of pain.

Conclusions: Pain is a common and often severe symptom in the whole spectrum of GBS (including MFS, mildly affected, and pure motor patients). As it frequently occurs as the first symptom, but may even last for at least 1 year, pain in GBS requires full attention. It is likely that sensory nerve fiber involvement results in more severe pain.

Footnotes

    A-CIDP
    acute onset chronic inflammatory demyelinating polyneuropathy
    AIDP
    acute inflammatory demyelinating polyneuropathy
    AMAN
    acute motor axonal neuropathy
    CMAP
    compound muscle action potential
    DML
    distal motor latency
    FSS
    Fatigue Severity Scale
    GBS
    Guillain-Barr syndrome
    GRAPH
    GBS Research about Pain and Heterogeneity
    INCAT
    Inflammatory Neuropathy Cause and Treatment
    IVIg
    IV immunoglobulin
    MFS
    Miller Fisher syndrome
    mNCV
    motor nerve conduction velocity
    MP
    methylprednisolone
    NRS
    numerical rating scale
    ODSS
    overall disability sumscore
    SNAP
    sensory nerve action potential
    sNCV
    sensory nerve conduction velocity
  • Editorial, page 1406

  • Supplemental data at www.neurology.org

  • Received January 30, 2010.
  • Accepted June 29, 2010.
 

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