Talk:Guillain–Barré syndrome

Header
"a result of an acute polyneuropathy"

-- I have found several sources that call this a "polyradiculopathy" Tmbirkhead (talk) 21:21, 8 November 2015 (UTC) L - Landry-Guillain-Barré Syndrome (GB) or Acute Inflammatory Demyelinating Polyradiculopathy to Local Anesthetic Pharmacology pp. 387-397 By May C. M. Pian-Smith and Lisa Leffert. http://ebooks.cambridge.org/chapter.jsf?bid=CBO9780511586057&cid=CBO9780511586057A017 — Preceding unsigned comment added by Tmbirkhead (talk • contribs) 04:33, 8 January 2015 (UTC)

Treatment
"These two treatments are equally effective" No problem with this "and a combination of the two is not significantly better than either alone." Big problem with this I had Guillain-Barre (and 100% recovery, thank goodness) and received both treatments. It is very important to realize that the two treatments are completely incompatible. That is, they absolutely cannot be administered simultaneously, but if administered consecutively, the end result can be superior to just using one of them (or not). With intravenous immunoglobulins (aka IVIG) you are getting other people's white blood cells, in the hope that it makes your own white blood cells behave themselves, as opposed to what they are doing (destroying your peripheral nervous system's myelin sheath). With plasmapheresis, on the other hand, (almost) all of your white blood cells are being removed from your blood, in the hope that the new white blood cells generated by your system (bone marrow) will behave themselves. Stay with me here, either you are getting a whole bunch of extra white blood cells, or you are losing a whole bunch of the white blood cells you already have. You cannot do both at the same time, don't you agree? The idea is to (a) use IVIG to shock the system into some kind of stability, although it is not a cure then (b) once stability but not cure is achieved, to use plasmapheresis to effect a cure. At least, that is what my doctors told me they were doing. And it worked. So my experience is that IVIG, followed by plasmapheresis, *is* significantly better than either alone. Not too sure what to do about providing a reference. IVIG is extremely expensive, so may not be an option in every health-care context. Plasmapheresis is, essentially, just a form of dialysis, so it is not that expensive and should be generally available. — Preceding unsigned comment added by Gsa703 (talk • contribs) 19:09, 7 October 2013 (UTC)
 * Very nice that the combination worked for you. We prefer to base wikipedia on scientific research. The immunoglobulins are way smaller particles than white blood cells, so plasmapheresis of just the white blood cells (and not the plasma fluid with the ivig in it) can be done simultaneosly to ivig administration. But if you're convinced otherwise, please provide scientific sources that contradict the currently used reference. PizzaMan (♨♨) 15:22, 11 December 2014 (UTC)

It's fairly difficult to find information online regarding recovery; added a link to an individual case. -- Anonymous

Prognosis
This section does not appear to have rigorous references.

"Recovery usually starts after the fourth week.."

I had Guillain-Barre. My experience with my doctors was that my recovery time was a direct reflection of my time-to-diagnosis. That is, the sooner I was diagnosed, the less my recovery time. In my case, I was diagnosed in about 50 hours and had a recovery time of about 50 weeks. So one week for every hour until diagnosis (and treatment).

That said, let's talk about when recovery starts. Presumably that means when things start stabilizing. Again, I suggest that it totally depends upon how fast the patient gets to a knowledgeable physician. In my case, I think my recovery started after the second week, but that is not a reflection of Guillain-Barre, nor of the physician, but solely of how fast I noticed that I had a problem, and did something about it.

"About 80% of patients have a complete recovery.."

Where does this come from? My doctors said that 98% of patients have a recovery in which there are no long-term disabilities, such as having to use a cane, or a walker, or take medication, etc. Aside from the fact that I should probably not donate blood, I have zero effects upon my well-being from having had Guillain-Barre. — Preceding unsigned comment added by Gsa703 (talk • contribs) 19:39, 7 October 2013 (UTC)


 * I've added a reference and a little bit of text based on the reference. Note that the reference doesn't support the statement of recovery starting after four weeks. As for the 98%, that's a bit optimistic. For example: "Among severely affected patients, 20% remain unable to walk 6 months after the onset of symptoms." (NEJM 2012). Unfortunately, the appendix doesn't contain the prognostic models it's supposed to when i try to download. And you're right that the onset of therapy is a prognostic factor: "Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of mechanical ventilation" (Walgaard, Ann Neurol. 2010).PizzaMan (♨♨) 15:41, 11 December 2014 (UTC)

Distinguishing between Gilbert and Guillain–Barré Syndromes
I feel that it would be a good idea to add a "not to be confused with" label at the top of the page to distinguish between Gilbert's and Guillain–Barré syndromes. The latter is often pronounced like "gillie-bear" while Gilbert's is sometimes pronounced "jill-bear" (apologies for the bad formatting), opening up the possibility of people looking at the incorrect article, so I'm going to add a tag to both articles. I leave this section open to discussion of the topic as both can be confusing to spell given their non-English etymologies. Zedtwitz (talk) 02:32, 18 February 2014 (UTC)


 * I really doubt that anyone will make the confusion, because Gilbert is one name, and "Guillain-Barré" is always used together. Hatnote describes the guidance. JFW &#124; T@lk  14:25, 20 February 2014 (UTC)

Why are the H1N1 vaccine cases not included in the cause section?
I recently added info and links from a 2009 study of H1N1 influenza vaccines and had it removed citing a link supposedly 'fisking' the ones I provided. Why are recent studies not included in this article? It's currently dated to be archaic (1977?, really?). Editing is still new to me, so please help modify the cause section to include recent info.


 * I removed the sources because they did not meet the criteria outlined in WP:MEDRS; we prefer secondary sources in high-quality publications. I am particularly worried by the reference to MCT lawyers - this is a no-win no-fee outfit, and their content is not peer reviewed. JFW &#124; T@lk  19:26, 30 June 2014 (UTC)


 * You want some sources - someone should Cite these. There is now a known causal link it seems:
 * [HTML] Guillain-Barre syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccine: multinational case-control study in Europe

J Dieleman, S Romio, K Johansen, D Weibel… - Bmj, 2011 - bmj.com Objective To assess the association between pandemic influenza A (H1N1) 2009 vaccine and Guillain-Barré syndrome. Design Case-control study. Setting Five European countries. Participants 104 patients with Guillain-Barré syndrome and its variant Miller-Fisher … Cited by 131 Related articles All 19 versions [HTML] oup.com
 * Guillain-Barre syndrome, influenzalike illnesses, and influenza vaccination during seasons with and without circulating A/H1N1 viruses

L Grimaldi-Bensouda, A Alpérovitch… - American journal of …, 2011 - academic.oup.com The role of influenzalike illnesses and influenza vaccination in the development of Guillain- Barré syndrome (GBS), particularly the role of A/H1N1 epidemics and A/H1N1 vaccination, is debated. Data on all incident GBS cases meeting the Brighton Collaboration criteria that … Cited by 63 Related articles All 11 versions
 * Preliminary results: surveillance for Guillain-Barré syndrome after receipt of influenza A (H1N1) 2009 monovalent vaccine-United States, 2009-2010.

… for Disease Control and Prevention (CDC - MMWR. Morbidity and …, 2010 - ncbi.nlm.nih.gov Guillain-Barré syndrome (GBS) is an uncommon peripheral neuropathy causing paralysis and in severe cases respiratory failure and death. GBS often follows an antecedent gastrointestinal or upper respiratory illness but, in rare cases, can follow vaccination. In … Cited by 82 Related articles
 * Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis

…, N Lurie, H1N1 GBS Meta-Analysis Working Group - The Lancet, 2013 - Elsevier Summary Background The influenza A (H1N1) 2009 monovalent vaccination programme was the largest mass vaccination initiative in recent US history. Commensurate with the size and scope of the vaccination programme, a project to monitor vaccine adverse events was … Cited by 110 Related articles All 18 versions — Preceding unsigned comment added by 104.5.150.41 (talk • contribs)

There is no lack of sources, but we need the good ones. What are the selection criteria? JFW &#124; T@lk  12:18, 13 January 2019 (UTC)
 * See WP:MEDRS. Tornado chaser (talk) 20:05, 13 January 2019 (UTC)


 * I think the criteria seem to be "whatever is fashionable". This page will never be updated accurately, so if you want real information about vaccine side effects try a less politically biased website. 124.169.147.24 (talk) 22:55, 22 June 2021 (UTC)


 * Oh hello. This has absolutely nothing to do with politics. As per the discussion above, we have a fairly transparent process for identifying high-quality sources. If you choose not to engage with that, it is frankly immature to attack the process or the editors. JFW &#124; T@lk  09:27, 23 June 2021 (UTC)

Guillain-Barre Syndrome Notable Cases
If the article was authored by the subject of the article and the references take us to the website of said author, is it considered a Primary Source? Regards,  Aloha27  talk  17:44, 20 October 2014 (UTC)
 * , yes. If the link went to the original publication of the article (in this case the Medical Post), it would still be a primary source, but at least it would be from a secondary website. Primefac (talk) 18:02, 20 October 2014 (UTC)
 * Thank you for that. Regards,  Aloha27  talk  18:44, 20 October 2014 (UTC)

This is an encyclopedia, not People magazine. We should not restrict ourselves to celebrities &#8211; Hollywood actors, sports stars, musicians, TV anchors, a few politicians &#8211; which at present comprise all the Guillain-Barre case reports on Wiki. The only case of real, enduring interest in that list is US President Roosevelt. Your list satisfies a longing to worship celebrities, but that is not enough. After all, we are working under the heading "Notable Cases," not "Notable People."

"Notable Cases" should include case reports that actually teach something about the disease &#8211; information not found elsewhere &#8211; and case reports that illuminate how the rare nature of this disease creates an unforseen struggle within the health-care system. This would serve the public interest. Medical Rights (talk) 04:35, 19 October 2014 (UTC)

Re Ms. Sil's Guillain-Barre Reference
&#9632; &#160;Ms. Sil – Primary reference: The article in question was published in The Medical Post, issue 29(5):32. This journal "gives priority to doctors"; it is their stated mandate. The Medical Post doesn't typically accept patient accounts. That type of writing is left to home-style magazines and media reports; note such consumer sources have a blunting similarity with respect to GBS accounts; all sound the same apart from a change of name, job, and city. By contrast, The Medical Post accepts only articles of interest to doctors, which means that article must teach something new, even to doctors.

&#9632; &#160;Ms. Sil – Secondary reference #1: The Saskatoon Star Phoenix newspaper reprinted Ms. Sil's entire article. Reference: What to Do When Doctor Doesn't Know Best, Star Phoenix, Lifestyle cover story, 24 September 1994.

&#9632; &#160;Ms. Sil – Secondary reference #2: In the same edition of the Star Phoenix, in-depth editor Katheryn Warden devoted her entire column to discussing that piece. Reference: Informed Patients Involved in Medical Decisions, Star Phoenix, page C9, 24 September 1994.

&#9632; &#160;Shortly, these secondary references will be available online. For independent verification visit a University Library, or any large Public Library, and consult their newspapers stored on micro-fiche.

&#9632; &#160;Academic Qualifications: Ms. Sil earned an M.Sc. from the University of British Columbia in the field of Physics (Lasers and Nonlinear Optics).

&#9632; &#160;Peer Review: The Medical Post – before publication as it does for any article – vetted at length the medical information from Ms. Sil. As did the journalist Ms. Sil collaborated with at the Star Phoenix.

&#9632; &#160;The notable concept in Ms. Sil's article is the role reversal between doctor and patient. Many patients struggle to get diagnosed, but very few do the work themselves, with no medical training. Ms Sil applied for and obtained her own medical chart while she was in the hospital and used that chart to work alongside her doctors. She wrote notes to correct errors in her chart; these were accepted. This had the full blessing of Hospital Administration.

&#9632; &#160;Ms. has, on her website Tuum Est, her diagnostic results for Guillain-Barre. Not just word reports, but graphs of Nerve-Conduction Velocity (EMG) tests. There are two sets of graphs, for tests done 3 weeks apart, giving a very clear picture of how the peripheral nerves demyelinate. Since the disease is rare, this would interest doctors (and med students), perhaps most in less advanced countries of the world. Medical Rights (talk) 04:35, 19 October 2014 (UTC)

Hold Wikipedia to an Academic Standard
(1) Wikipedia is an encyclopedia, and the standard should be academic. On the Guillain-Barre page, the focus should be "Notable Cases" – the section's actual title. The title is not "Notable People." Whether a person is a rock star, football coach, or politician has little to do with whether readers will absorb anything of value from the reference. Stars likely receive better medical care during the acute stage of their disease, because then MDs and nurses are under a media magnifying lens, and don't want to be skewered for mistakes or neglect. Thus media reports of "star" cases may not mirror the average patient's experience. Later on when the media report becomes a simple reference, know this: Doctors are not star-struck and neither are most people searching for medical information. An "interesting case" refers to medical interest; doctors care not a jot about the glamor level of a patient's life.

(2) Perhaps there could be three lists: / Notable Cases (Academic) / Notable People (Stars) / GBS Patients Who Published Books /

(3) JDWolff removed Ms. Sil's reference from the Guillain-Barre page on Wiki. On his personal page, JDWolff says he is a “doctor of acute medicine.” If that is true (and I assume it is), then that places JDWolff in a conflict-of-interest position. Physicians as a group have a reputation for being highly sensitive to criticism – any criticism – of other doctors, of clinical skills, of hospitals. I expect JDWolff is no different. JDWolff should not be allowed to remove items that criticize health care, without a backup opinion from an objective administrator at Wiki (objective = someone not connected with health care).

(4) Recently, B.C. doctors began a campaign to increase the medical worth and accuracy of Wiki. Source: Wikipedia’s Medical Errors and One Doctor’s Fight to Correct Them (CBC News, 21 August 2014) at http://www.cbc.ca/news/canada/british-columbia/wikipedia-s-medical-errors-and-one-doctor-s-fight-to-correct-them-1.2743268 That news report says: "Studies have shown that, on average, at least 50 per cent (or more) of doctors use Wikipedia in their practice. Heilman says the website is an easy way for physicians to jog their memories. For medical students, Wikipedia is their second most used information source." Therefore, in the public interest Wiki has a duty on medical pages not to be star-struck, or to simplify the topic to pablum. Post updated. Medical Rights (talk) 04:35, 19 October 2014 (UTC)

Tuum Est Follows Own Motto: It Is Up To You
Tuum Est has no time for edit wars. Yesterday Tuum Est began its own list of Notable Cases with sub-titles such as: Doctors Stricken with GBS, Nurses Stricken with GBS , and Other Notable Cases. The sources are personal accounts published in peer-reviewed medical journals. Physicians, nurses, and other technical people are objective observers during the acute stage of GBS. Such people make incisive observations about symptoms, and about the journey through the health system. Physicians hold such personal accounts in esteem, saying they are highly instructive because the disease is rare. Tuum Est will include only Notable People whose disease has one or more features of medical interest. Roosevelt would be an example. Medical Rights (talk) 04:35, 19 October 2014 (UTC)


 * I would ask an admin to review Ms.Sil's entry here. I think it violates WP:MEDRS as I read it. Regards,  Aloha27  talk  13:18, 19 October 2014 (UTC)


 * Firstly, please reduce the volume of your comments. The immediate response to the above, for many editors, is WP:TLDR.
 * Secondly, I agree that lists of patients are very close indeed to WP:TRIVIA and in many cases they are removed from articles and placed in a separate article; this has happened on epilepsy and List of people with epilepsy. This article hasn't gone through that process yet, probably to a large extent because Guillain-Barré syndrome usually occurs acutely and doesn't have a chronic form (unless you count the resulting neurodisability).
 * Thirdly, we generally only add mention of people who are otherwise notable. I cannot find much evidence that Georgina Sil otherwise meets the general notability guideline. My personal view is that people should only be mentioned in these lists if there is evidence through secondary sources of a lasting impact on the general perception of a medical condition (and Michael J. Fox and Muhammad Ali would be some of the very few names on Parkinson's disease).
 * For now I would not encourage the addition of Georgina Sil to the list of prominent cases of GBS. JFW &#124; T@lk  15:24, 19 October 2014 (UTC)
 * I concur with JFW. The answer to an overabundance of celebrity cases is not to add non-celebrity cases, too, and neither the primary nor the secondary sources for the Sil case give an indication of particular significance. If there were a peer-reviewed scholarly paper on notable cases of Guillain-Barré, or on patient-doctor relationships, discussing this case, it might be worth inclusion. But all we have are her own account and a local newspaper. Huon (talk) 15:46, 19 October 2014 (UTC)

Secondary Sources are Now Online
Ms. Sil's case of Guillain-Barre is supported by secondary sources. We produce these sources which Wiki instructs are important. Tuum Est scanned the original newspaper pages to form electronic JPG or PNG images. Our small scanner size meant we had to separately scan the top and bottom half of each newspaper page. Then we had to make a single document from the two halves. The methods we tried: (a) Concatenate the images in Apple Automator and output the result as a PDF. The result, however, looked very grainy for these old newspaper pages. (b) Then we tried an HTML webpage as a container; the code has a header plus two &#60;img&#62; tags to vertically align the two halves of the newspaper page on a white background. This worked well. You can obtain the individual images by clicking the image on the webpage and choosing "Save As". Medical Rights (talk) 12:29, 20 October 2014 (UTC)

Here are the links to the secondary sources, plus the original Medical Post publication:

http://tuum-est.com/autoimmune/guillain-barre/georgena-sil/star-phoenix/informed-patients-involved-in-medical-decisions-newsclip.html

http://tuum-est.com/autoimmune/guillain-barre/georgena-sil/star-phoenix/what-to-do-when-doctor-doesnt-know-best-newsclip.html

http://tuum-est.com/autoimmune/guillain-barre/georgena-sil/star-phoenix/what-to-do-when-doctor-doesnt-know-best-proquest-citation.pdf

http://tuum-est.com/autoimmune/guillain-barre/georgena-sil/medical-post/coming-to-grips-with-guillain-barre-syndrome-newsclip.html

Message to Aloha27: Place your comments either on the Guillain-Barre Talk Page, or on your own Talk Page. Tuum Est prefers an academic tone; thus we have begun compiling our own lists of Notable Cases, as stated quite definitley above. I suppose you could say Tuum Est has outgrown Wikipedia. Medical Rights (talk) 12:36, 20 October 2014 (UTC)
 * And all of these "secondary sources" (all authored by you) take us to your website. Am I missing something or misinterpreting :the "Primary Source" portion of the program? (I may be wrong, but not all the time.) I'll ask for help again. BTW... Thank You to JFW and Huon for their assistance. Regards,  Aloha27  talk  17:09, 20 October 2014 (UTC)


 * Well, if Tuum Est has outgrown Wikipedia, we're clearly done here. There's one secondary source in all this, a Star Phoenix article not written by Sil herself. The others are all the same article written by Sil herself and re-published in various places. That's no better amount of coverage than for the celebrities Medical Rights objected to. Huon (talk) 17:56, 20 October 2014 (UTC)


 * I thought we were done here as well when Medical Rights (talk) stated on their talk page that they no longer had interest in this article. An hour and six minutes later, the talk page here was edited. Thanks Huon and sorry to have had to ask again. Regards,  Aloha27  talk  18:37, 20 October 2014 (UTC)


 * I still see no evidence that Ms Sil (who I'm presuming is the same as ) has independent notability. Not everyone is sufficiently famous to get mentioned on Wikipedia. JFW &#124; T@lk  23:14, 20 October 2014 (UTC)

Discussion closed for archiving. JFW &#124; T@lk  15:54, 29 October 2014 (UTC)

Classifcation
The classification of GBS has been revised. 10.1038/nrneurol.2014.138 discusses it. JFW &#124; T@lk  12:32, 29 October 2014 (UTC)


 * Epidemiology papers: 10.1159/000184748 (2009) and 10.1159/000324710 (2011); different approaches and probably both worth citing.
 * Association with vaccines: 10.2165/00002018-200932040-00005 (2009) and 10.7774/cevr.2014.3.1.50 (2014). JFW &#124; T@lk  09:10, 30 October 2014 (UTC)


 * Brighton criteria were brought about by vaccine worries: 10.1016/j.vaccine.2010.06.003 JFW &#124; T@lk  23:54, 30 November 2014 (UTC)

Updating
This article has needed tidying up for some time.
 * 1)  Signs and symptoms - needs to be more detailed on the clinical distinction between subtypes
 * 2)  Causes - currently not written; this needs to list the common infectious triggers (chlamydia, campylobacter, herpesviruses, mycoplasma)
 * 3)  Mechanism - needs updating in general, especially with some discussion about the serological signals
 * 4)  Diagnosis - better sourcing for the importance of each test
 * 5)  Treatment - good sources are available, need more about the rehabilitation aspects
 * 6)  Prognosis - recently some information added, although some more QOL information would be valuable
 * 7)  Epidemiology - vaccine triggers should be discussed here discussed under "causes" instead
 * 8)  History - good secondary sources exist for this
 * 9)  Notable cases - should be migrated to its own subarticle
 * 10)  Research directions - we may need to talk about eculizumab
 * 11)  References
 * 12)  Further reading - should be integrated in the content ; the book listed there currently is a good candidate for this section
 * 13)  External links - should be minimalist

Sources:
 * 10.1038/nrneurol.2014.138 (2014), Nat Rev Neurol consensus group on classification
 * 10.1038/nrneurol.2014.121 (2014), Nat Rev Neurol general review
 * 10.1002/mus.24192 (2014), Muscle Nerve mostly about the subtypes with disialosyl antibodies (Miller Fisher syndrome, ataxic GBS and ASAN).
 * 10.1111/jns5.12051 (2014), J Peripher Nerv Syst about HRQOL
 * 10.1097/MOP.0b013e328365ad3f (2013), Curr Opin Pediatr GBS in children (not covered currently)
 * 10.1016/S1474-4422(13)70215-1 (2013), Lancet Neurol axonal GBS
 * 10.1586/1744666X.2013.811119 (2013), Expert Rev Clin Immunol infectious and noninfectious triggers
 * 10.1111/jns5.12020 (2013), J Peripher Nerv Syst general update
 * Epidemiology sources listed above
 * and - review about rehabilitation

Will try to do some stuff here. Help appreciated as always. JFW &#124; T@lk  00:00, 2 November 2014 (UTC)
 * I've got that book "Guillain-Barr&eacute;:From diagnosis to recovery". I'll get more info up and cite it. Let me know if/when I do that incorrectly? Regards,  Aloha27  talk  13:24, 3 November 2014 (UTC)


 * Review in children (in addition to Ryan2013). I have no access: 10.1542/pir.33-4-164 JFW &#124; T@lk  08:43, 1 January 2015 (UTC)

Epidemiology
Epidemiology[edit] In Western countries, the incidence (number of episodes per year) per 100,000 people has been estimated to be between 0.89 and 1.89 cases. The risk increases by 20% for every decade.[29]

My concern is that the sentence "The risk increases by 20% for every decade" could be misinterpreted to mean that the risk of GBS is increasing with every decade for the population as a whole, rather than as the age-related increase observed. The cited study says that "GBS incidence increased by 20% for every 10-year increase in age."

I've not done any editing on Wikipedia, which is why I'm commenting rather than editing myself. Wikimol03 (talk) 06:02, 5 December 2014 (UTC)


 * Thanks . I will rephrase. Always feel free to change something yourself; great articles come about because folk like yourself are BOLDly updating pages. JFW &#124; T@lk  21:11, 6 December 2014 (UTC)

More information: Zika virus infection apparently related to ≈4-fold increase in GBS occurrences. http://crofsblogs.typepad.com/h5n1/2016/04/zika-virus-and-guillain-barr%C3%A9-syndrome-linked-in-new-cdc-study.html http://www.cbc.ca/news/canada/british-columbia/zika-virus-guillain-barre-syndrome-cdc-1.3538726  I will leave it to regular editors of this page to incorporate this properly. Jhardin@impsec (talk) 03:33, 18 April 2016 (UTC)

Acute autonomic neuropathy
I removed the following:


 * Acute panautonomic neuropathy is the rarest variant of GBS, sometimes accompanied by encephalopathy. It is associated with a high mortality rate, owing to cardiovascular involvement, and associated dysrhythmias. Frequently occurring symptoms include impaired sweating, lack of tear formation, photophobia, dryness of nasal and oral mucosa, itching and peeling of skin, nausea, dysphagia, and constipation unrelieved by laxatives or alternating with diarrhea.  Initial nonspecific symptoms of lethargy, fatigue, headache, and decreased initiative are followed by autonomic symptoms including orthostatic lightheadedness, blurring of vision, abdominal pain, diarrhea, dryness of eyes, and disturbed micturition. The most common symptoms at onset are related to orthostatic intolerance, as well as gastrointestinal and sudomotor dysfunction. Parasympathetic impairment (abdominal pain, vomiting, constipation, ileus, urinary retention, dilated unreactive pupils; loss of accommodation) may also be observed.

The reason for this removal is the fact that none of the reviews (NEJM2012, NatRevNeurol2014 and others) mention it as a GBS subtype, and 10.1136/jnnp-2012-302833 states that inclusion is "disputed". A very recent classification system (still need to cite) by Wakerley et al does not include it (10.1038/nrneurol.2014.138). I am happy to be corrected, but for now I will stick to the classifications introduced by the key sources. JFW &#124; T@lk  22:06, 7 December 2014 (UTC)

Babinski in Bickerstaff
Thanks to user:TylerDurden8823 for the contribution. But why remove babinski reflexes from the Bickerstaff symptoms? That's not just a decreased reflex. PizzaMan (♨♨) 08:17, 12 December 2014 (UTC)
 * The source I saw describing BBE did not mention Babinski at all. If you have a source for Bickerstaff that mentions Babinski sign (not a symptom but a medical sign), feel free to add it back in. I didn't think that was something a major review would gloss over and if it were really a prominent feature of BBE, I figured the Nature Review would probably have at least mentioned it once. I'm not opposed to adding it back in though if you or someone else can demonstrate it is part of BBE with a reputable source. TylerDurden8823 (talk) 13:48, 12 December 2014 (UTC)


 * Recent reviews point out that hyperreflexia may occur in the early stages of all cases. I don't think Bickerstaff's is unique. JFW &#124; T@lk  15:32, 12 December 2014 (UTC)
 * So, we don't need to mention it specifically then for BBE? TylerDurden8823 (talk) 22:48, 12 December 2014 (UTC)
 * Very interesting for a disease of the peripheral nervous system. And so would a babinski be, because that's typically caused by a damaged piramidal tract. But yes, in that case it should be mentioned in general then in stead of specifically with Bickerstaff. JFW, can you point us to one of those reviews? Again, TylerDurden8823, thank you for contributing to this article. PizzaMan (♨♨) 13:29, 13 December 2014 (UTC)


 * The finding of hyperreflexia is already mentioned in "Signs and symptoms". The NEJM2012 and NatRevNeurol2014 sources do not actually mention abnormal plantar reflexes, so perhaps that finding is unique to BBE. JFW &#124; T@lk  20:22, 13 December 2014 (UTC)
 * If we do find a good review that does specifically mention this, I have no objection to saying that Babinski is part of BBE. I just want to see verification. TylerDurden8823 (talk) 22:39, 13 December 2014 (UTC)

Guillain-Barré mechanism
The cited NEJM article and 15 July 2014 Nature Neurology review on Guillain-Barré by van den Berg et al. states that BOTH AMAN and AIDP are caused by antibody formation, albeit directed towards different peripheral nerve targets. AIDP is less well characterized, but involves antibodies formed against unidentified antigens of the Schwann cell itself. AMAN is caused by antibodies against GM1 and GD1a gangliosides located in the node of Ranvier. These antibodies are formed via molecular mimicry from Campylobacter lipo-oligosaccharide outer membrane. Please see Figure 2 in the cited NEJM article or Figure 2 in the Nature review.

Nature Reviews Neurology 10, 469–482 (2014) doi:10.1038/nrneurol.2014.121 Published online 15 July 2014 — Preceding unsigned comment added by 173.165.81.169 (talk) 15:57, 2 May 2015 (UTC)


 * The NEJM review uses guarded language ("autoantibodies may bind to myelin antigens") and in the text itself does not mention the antibodies nor their possible epitopes. The van den Berg review similarly is vague on this (apart from discussing anti-GM2 in CMV infections). I will have a look at the wording. Presumably someone has tried to demonstrate the actual presence of IgG on the myelin sheath, but the reviews don't cite this evidence. Thanks for bringing this up. JFW &#124; T@lk  21:40, 23 June 2015 (UTC)

Another push
So, having some time available, I might just be able to finish the work on this and get it nominated for GA:
 * Address the point of the anonymous editor in the previous section
 * Finish the "neurophysiology" section with sources listed above (Uncini in particular) - a neurology colleague has explained the key points of NCS/EMG
 * "Citation needed" in "clinical subtypes" with regards to Bickerstaff
 * Complete the "rehabilitation" section, replacing the content that is based on primary sources.
 * In "prognosis", incorporate the HRQL discussion from 10.1111/jns5.12051
 * In "prognosis", address the "citation needed" tags

Help appreciated as always. JFW &#124; T@lk  20:54, 22 June 2015 (UTC)

possible references

 * review
 * systematic (page)
 * books (page)
 * position statements
 * Cochrane reviews
 * American Association of Neuromuscular & Electrodiagnostic Medicine
 * WHO

I would also recommend this image in symptoms section as half of those affected experience cranial nerve involvement perhaps these can help--Ozzie10aaaa (talk) 22:18, 25 June 2015 (UTC)


 * I wasn't planning on adding more sources, and you will find that I've referenced the relevant Cochrane reviews. JFW &#124; T@lk  18:26, 26 June 2015 (UTC)

Respiratory Failure
Currently states "...This life-threatening scenario is complicated by other medical problems such as pneumonia, severe infections, blood clots in the lungs and bleeding in the digestive tract in 60% of those who require artificial ventilation"

I think the "and" in that list of complications should be an "or" - I presume 60% of patients with respiratory involvement do not get all those complications and a rereading of the sentence implies that ("such as..."), but perhaps not and they get all these and more that have not been fully included (I don't have access to the NEJM article) ?

(Well done on the Good article) David Ruben Talk 21:50, 12 July 2015 (UTC)


 * Comment- I would agree with the above. Although the other complications can manifest themselves, most who require ventilation are patients without any of the additional scenarios. Regards,  Aloha27   talk  22:27, 12 July 2015 (UTC)
 * Agree that "or" is better here as less ambiguous. JFW &#124; T@lk  22:32, 16 July 2015 (UTC)

heritability?
I couldn't find any reference to whether there's a genetic predisposition to this syndrome. Presumably there is a genetic correlation, but how strong is it? Jonathan Tweet (talk) 23:13, 29 February 2016 (UTC)


 * That's because the key sources do not discuss this at all. What makes you think there should be a genetic correlation? I am not saying that there isn't, but it looks like it hasn't been studied well. JFW &#124; T@lk  08:58, 1 March 2016 (UTC)


 * Now that we've mapped the genome and now that personal gene mapping is efficient, epidemiologists are finding genetic correlations to lots of syndromes. Not this one yet, I guess. I would imagine that someone whose blood relative has this condition might want to know to what extent it runs in families. Here's a site that says, "Some studies show that normal variations in certain genes may be associated with an increased risk of developing Guillain-Barré syndrome; however, more research is necessary to identify and confirm associated genes." link The site specifies the TNF gene as associated with GBS. Here's a site where a doctor says that familial predisposition to GBS is real but slight link. That's what I figured because it's really common for genes to influence susceptibility to syndromes even when a syndrome is not strictly speaking heritable. Jonathan Tweet (talk) 20:05, 3 March 2016 (UTC)

Lancet review
Currently still in "online first" - 10.1016/S0140-6736(16)00339-1 JFW &#124; T@lk  20:00, 9 June 2016 (UTC)

Pronunciation
I am confused by the two pronunciations in the box: Wouldn't the L be pronounced as an L in either language? 173.91.88.197 (talk) 06:28, 12 February 2017 (UTC)
 * After doing a bit of legwork, it appears that the French name Guillain is pronounced with L in French, but because that spelling could be pronounced /j/ within the framework of French orthography (and to my ear, it would be), that pronunciation has taken hold widely, at least outside of French-speaking places. (My mother is a GBS survivor and speaks fluent French, and she uses the /j/ pronunciation...) — tooki (talk) 01:14, 26 November 2019 (UTC)

introduction picture
what is the point of showing the picture of the spirometer device? It does not seem all that specific to this disease and instead seems an advertisement for a handheld pulmonary device. It is agreed that GBS patients can and do have breathing issues but that the device is only a subset of the breathing issue, which breathing issues are a subset of the neurological issues. — Preceding unsigned comment added by 23.249.100.250 (talk) 15:43, 16 October 2018 (UTC)


 * I replaced this image with the animation of how GBS damages nerves. Tornado chaser (talk) 02:30, 17 October 2018 (UTC)
 * And I was reverted because animations apparently can't go in the infobox. Tornado chaser (talk) 03:11, 17 October 2018 (UTC)

Causes and Proportions
The Causes section only mentions infections as the cause for "two thirds" of the cases. The rest of the section mentions nothing but infections ... except maybe vaccinations as a separate cause; though I'm not sure if this is being considered here as a totally separate one.

Is it the intention to leave the reader "in the dark" as the exact cause is unknown, as stated in the opening? If that's the intention, it may be a good idea to address again that the remainder of the cases have no known causes — which would be the remaining 1/3 of the whole.

Thanks!

LordJair (talk) 01:35, 23 January 2019 (UTC)

Title formatting
The current title uses an en dash between Guillain and Barré. The article was originally created with a hyphen, but was moved with "en dash connects two names" as the justification. But the relevant section of WP:MOS states: "Generally, use a hyphen in compounded proper names of single entities", and gives the example of Wilkes-Barre, PA, which is named after two people. That's the same situation as here. (The en dash serves to show a separation between the two, as opposed to the hyphen linking them.) As such, I believe this article should be moved back to the hyphenated version. Thoughts? — tooki (talk) 01:17, 26 November 2019 (UTC)

Peru
I have removed the following:
 * A 2018 outbreak of GBS in Peru, triggered a state of emergency and was linked to an enterovirus.

Neither this source or any other sources in English about this outbreak are precise about the enterovirus involved. The Enterovirus group is huge and without more detail I don't think this should be mentioned. JFW &#124; T@lk  15:17, 19 August 2020 (UTC)

J&J COVID-19 vaccine
The U.S. CDC is going to announce that the Johnson & Johnson COVID-19 vaccine has a slight risk of GBS. The editors of this article should be prepared for an influx of edits and pageviews. Madcoverboy (talk) 19:40, 12 July 2021 (UTC)

This seems very early on to be adding this kind of information to this article, and I think we should be especially wary of the quality of such reports, given that right wingers and conspiracy theorists have made this issue extremely political. I think we need a lot more data, before we go around making claims about COVID vaccines, especially given that so many people have already had them, and there don't appear to be significant side effects that exceed normal rates for such complications in the general population. Wikipedia should be a source for reliable information presented in a scholarly manner, for a general audience, not a soapbox for crackpot rednecks.2601:603:4C7F:9A40:A8EA:8BF4:4368:BA41 (talk) 23:24, 12 July 2021 (UTC)
 * I was inclined to agree that any mention of this news in the page is an WP:UNDUE WP:RECENTism, but I hadn't realized that this actually echoes an event in the 1970s. The fact that there's long-term and sometimes high-volume coverage of a connection between vaccination against flu-like diseases and onset of this syndrome suggests that some discussion of the Covid vaccine news in this page is probably warranted. But I think you're both right that the discussion should be kept short (and obviously meticulously WP:VERIFIABLE) for now. - Astrophobe  (talk) 23:39, 12 July 2021 (UTC)

The editors of this article should be prepared for an influx of edits about how the vaccine for the disease is more deadly than the disease. 2A00:23C8:9F93:FB01:29D4:DC11:75E1:394D (talk) 21:56, 18 March 2024 (UTC)

Th-17 and bifidobacterium
has repeatedly added discussions of PMID 29908492 (10.1016/j.intimp.2018.06.015), which is a small study of bifidobacterium in GBS. It is actually an animal study, and a primary source. As such, it does not meet the criteria for discussion in this article. I have advised about this on the user's talk page. JFW &#124; T@lk  14:22, 31 October 2022 (UTC)


 * There are other references to animal studies on this page. In addition to that, the added information is being widely cited by neurologists as a way of mediating MS and GBS, which is driven by Th-17 activation. In that same article, it is noted that humans with GBS have statistically significantly LESS Bifidobacteria longum than healthy controls. The MOA of IVIG is downreg of Th-17. The entire focus of treating GBS is by this mechanism. In addition to that, it opens ideas as to the etiology of GBS. There is evidence that blood serum levels of vitamin D can be associated with decreased levels of th-17 cells. Why is this relevant? Well, Vitamin D levels have already been proven to be associated with lower incidence of certain AI disease that are driven by the same mechanism that GBS is driven on. Finally, all of my edits were filed 'Research Directions'. These are the current research directions for MS and GBS as a way to mediate the progressive form of MS. Seeing that Vit D & the microbiome are directly related in some ways, these are relevant to the page and I believe they still add value.
 * GBS is a rare disease that will not offer many clinical trials, so while I may agree if this were the MS page, we can't wait for RCT's with GBS patients. There is no chance of a prospective RCT with GBS. It isn't ethical to do one in a disease like GBS. Are we going to wait idly by? Being inspired by the researchers who had the gutso to do this research, I added it. I suggest that you discuss this with specialists. The ones I have spoken to find value in these findings and the findings with calcifediol. ShouldveGoneToBerkeley (talk) 16:38, 31 October 2022 (UTC)


 * Hello, thanks for responding here. The difference between the current content in "Research directions" and the study that you wanted to add is that the current content is based on secondary sources (see WP:PSTS for clarification). This is an important principle in identifying the kind of content that we include. Your arguments about not waiting for RCTs are fallacious - are you expecting people with Guillain-Barré to push their clinicians for bifidobacterium on the basis of this data? Perhaps have a look at There is no deadline. JFW &#124; T@lk  16:51, 1 November 2022 (UTC)
 * "are you expecting people with Guillain-Barré to push their clinicians for bifidobacterium on the basis of this data?
 * No, I'm expecting this to be researched more. There are anecdotal case reports of this being used with third world nations where IVIG is a privilege based on accessibility with "success," being categorized either by a faster recovery or an absence of complete paralysis. Seeing that there is a strong argument to be made that the etiology of GBS/MS and other AI disease start in the microbiome, separate from this article, and that these researchers found a way to ameliorate Th-17 ^reg by altering the microbiome, I still think this is relevant. If it is removed the article, that is fine but that is one of the very few directions researchers are going towards to create homeostasis.
 * I don't want to cast aspersions -- is this because they are Chinese researchers? There have been expansive changes in the medical research from China. Major investments in the past decade. There are other references to animal models on the GBS page, so why is this controversial? ShouldveGoneToBerkeley (talk) 12:59, 2 November 2022 (UTC)


 * You have not addressed my key points with regards to the use of secondary sources. It is not reasonable to expect therapeutics that have not yet been properly studied to appear here (see WP:CRYSTAL). As for the research being done in China, this is not the reason I am challenging the addition. JFW &#124; T@lk  13:04, 2 November 2022 (UTC)
 * Agree with JFW. We have WP:MEDRS rules: let’s stick with them. Bondegezou (talk) 13:11, 2 November 2022 (UTC)
 * Are we going to wait idly by?
 * Yes. The English Wikipedia is going to wait idly by, until there is either some evidence whether it works in humans (a systematic review would be ideal), or some evidence that it's being used by mainstream medical practitioners regardless of the state of scientific evidence (any popular medical textbook will do for that point).  We are not going to gaze into a Crystal Ball and try to predict whether this is a good idea, and we are not going to try to solve the world's problems by advertising this idea or promoting any particular research direction.
 * I realize this is frustrating when you believe you have really found something that could save lives. I was pretty excited a while ago about some work on sepsis.  But Wikipedia's medical content follows the science; it doesn't lead it.  We need to wait until the science catches up.  (The sepsis work I was so excited about failed in the big trial.  Good thing I didn't promote it on Wikipedia, and thus give people false hope.) WhatamIdoing (talk) 15:53, 2 November 2022 (UTC)
 * P.S. There are clinical trials running for GBS right now. WhatamIdoing (talk) 16:01, 2 November 2022 (UTC)
 * I agree with others that our "research directions" should be based on secondary sources, not the latest primary research papers, and our "treatments" should reflect clinical practice, ideally evidence based. I disagree with WhatamIdoing that we must wait until there is evidence a therapy works in humans or is in mainstream clinical use, as long as this goes in the "research directions" section and not the "treatment section", and it is backed by reliable secondary sources of expert opinion. I think it is valid for a comprehensive article to have some secondary-sourced-based description of what is being researched but isn't yet in clinical use, and that may involve animal models or descriptions of why the researchers think an approach is promising. WP:CRYSTAL doesn't ban future-gazing (e.g. research is being carried out to see if XYZ might help with ABC) but is concerned that this isn't Wikipedian's own unverifiable speculations or that we become a dumping ground for any old speculations, including those that really have gone past their use-by date.
 * However, I see that the "research directions" is sourced to papers from 2011 and 2013, which sounds due for an update. And the racoon bit sounds more like an "In other animals" section than a research one. -- Colin°Talk 16:32, 2 November 2022 (UTC)


 * I still maintain, replying to everyone here, that Th-17 has to have its place on this page. The main mechanism of demyelination is Th-17 ^reg and this should be addressed forthrightly then segue into 'possible research directions' which may or may not include animal models. A disclaimer can be said that these have not been proven in humans, that this is being researched. There is data to back the Th-17 mechanism, there is data to suggest in more than this one article that B. infantis and certain strains downreg Th-17. There are articles that theorize that MS/GBS & other AI diseases start in the gut and may be caused by dysbiosis in a few diseases-- not 100% proven if it's Chicken or the Egg. There's a confirmed study showing Vitamin D and AI disease are related. Mechanistically Vitamin D downreg Th-17 and this pertains to GBS in another rat model. There are a few things I believe are worth adding to this page. Not because I'm "excited" to add new directions, only that I want to make it known that Th-17 is one of the main mechanisms involved and that it isn't even mentioned on this page prior to my original edit-- why? IVIG has been proven to work in GBS, perhaps mainly, because it downreg Th-17 and creates homeostasis and that IVIG does NOT promote remyelination, it only promotes the downreg of inflammation which stop demyelination.
 * I think a compromised can be reached by adding a chapter beneath research directions that has a disclaimer saying that these are animal models and have not yet been proven to work in an RCT.
 * Also to whoever said my comments on RCT's and GB were "fallacious," I'd like to know why. RCT's in a disabling syndrome like GB are simply not going to happen (not ethical) and if they ever did happen will take over a decade. Should we sit still like Medusa glanced? I think not. Very silly. ShouldveGoneToBerkeley (talk) 18:28, 2 November 2022 (UTC)


 * ShouldveGoneToBerkeley, randomized controlled trials in humans with GBT are already happening. I don't know why you believe that randomized controlled trials that are already happening are "simply not going to happen", but your belief is wrong and not founded on actual facts.  I think you might enjoy reading Bad Science (Goldacre book).  In case this is where you got tripped up (it's a common misunderstanding), where serious illnesses are concerned, you run randomized controlled trials between various reasonable options.  With serious or irreversible problems, it's (usually) unethical to randomize participants to "Alice gets the new treatment, and Bob gets nothing".  It's perfectly ethical to randomize participants to "Alice gets the unproven new treatment, and Bob gets the best proven treatment". WhatamIdoing (talk) 19:30, 2 November 2022 (UTC)


 * Regardless, emergency doctors if they're aware are not going to deny someone something that may help. Things are different in nations like India where IVIG is a privilege. In real world clinical practice they aren't wasting time. ShouldveGoneToBerkeley (talk) 19:07, 3 November 2022 (UTC)


 * You have made this point before, and it has been addressed in the responses from myself and others. I will not respond further. JFW &#124; T@lk  20:00, 3 November 2022 (UTC)


 * ShouldveGoneToBerkeley, you are trying to convince us to include this rat-model research by making claims about the raw science and expecting us to agree. Fundamental to Wikipedia is the idea that anyone can edit, and in order to permit that, we offload the responsibility for proving things are likely to be correct and likely to be important onto secondary sources (like literature or systematic reviews or professional textbooks). We don't trust you to be correct in interpreting the primary research literature and we don't trust me or WhatamIdoing or JFW. If what you are telling us is both correct and important enough to belong in this article, then you need to find high quality secondary sources on GBS that explain it. A source like the review in the Lancet I found below (which AFAICS doesn't mention Th-17). -- Colin°Talk 21:53, 2 November 2022 (UTC)
 * Are you looking for evidence that Th-17 is involved in GBS? ShouldveGoneToBerkeley (talk) 23:34, 2 November 2022 (UTC)
 * No.  WhatamIdoing (talk) 00:21, 3 November 2022 (UTC)


 * is a review ("seminar") of the diseaes in the Lancet in 2021. So that looks like a good source for the article in general. It has a section on "Potential therapeutic compounds" and also "Controversies, uncertainties, and future directions" which may help with the research section. -- Colin°Talk 18:04, 2 November 2022 (UTC)


 * Thanks, I clearly need to update this article with the most recent review. The Lancet seminar is 15 pages so that will keep me busy. JFW &#124; T@lk  18:33, 3 November 2022 (UTC)

Epidemiology and prevalence in sexes
I noticed an inconsistency in the article where it reads in the 1st paragraph:

"Both sexes and all parts of the world have similar rates of disease."

And, in the section called Epidemiology, it reads:

"Men are more likely to develop Guillain–Barré syndrome than women; the relative risk for men is 1.78 compared to women."

Which statement is correct? Zarp (talk) 15:59, 15 August 2023 (UTC)

Person-Years
Do not see a stand alone article or one in here that explains the medicine / scientific perspective of person-years. Just one on productivity as a stand alone article so that is not helpful for medical information and figured it could be added in this article and on here: https://en.wikipedia.org/wiki/Man-hour#Similar_units which is a redirect of person years. 68.48.113.58 (talk) 19:40, 13 October 2023 (UTC)