Residual disability and psychosocial status after Guillain Barré syndrome: a 3 to 5 year follow-up study

Guillain-Barré syndrome (GBS) is the most common cause of acute not-traumatic neuromuscular paralysis. Even if the disease usually has a good prognosis, recovery is not always complete and residual motor or sensory signs may remain. Little is known on the incidence of disability and long term psychosocial status in GBS. We present the results of a 3 to 5 year follow-up study of the residual signs, including fatigue, pain and psychosocial status in 75 GBS patients, aged from 20–82 years (mean 56). The functional grading at the onset and at the follow up was performed using the Hughes scale and the data about residual symptoms were obtained at the follow up by phone interview. Among the 56 patients interviewed, 44 (78%) were asymptomatic or had minimal signs of neuropathy (0–1 grade of Hughes scale), 7 (13%) remained moderately disabled (grade 2), 4 (7%) were unable to walk independently (grade 3), and one patient died. 51 (92%) were able to live independently at home while only 3 (5%) needed continuous or partial assistance. 33% of patients (18) reported fatigue in all their activities while 27% (15) had residual pain, which rarely caused restriction in daily living. 23% of patients (13) changed or temporarily or definitively suspended their job. 59% reached the maximum improvement in the first year while 21% continued to improve in the three following years. We observed that patients>40 years old were more severely impaired than the younger ones (76% vs 60% of patients had grade 4 or 5 of Hughes scale) while permanent disability was only observed in those aged>60 years (14% of patients vs none of the younger patients had grade 3). No difference was found in the outcome between patients with or without assisted ventilation. Patients reaching maximal worsening within 10 days achieved maximal improvement more quickly and remained less disabled than the others while those with>10 days plateau duration remained more severely impaired than those with a shorter duration