Immunology of Guillain-Barré Syndrome

Abstract

The combination of increased CSF protein concentration and normal cell count was used by Guillain et al. (1916) as a distinguishing feature of the two cases in their original description. This combination remains the most helpful laboratory guide to the diagnosis of GBS but is not an invariable feature. In large series this “albuminocytological dissociation” is reported in about 80%–90% of patients. For instance, in a prospective study of 100 cases in south east England CSF total protein concentrations were abnormal in 80%; the mean concentration was 1.2 g/1 and range 0.1–6.0 g/1. The CSF white cell count was normal in 90%: those patients having a pleocytosis had very few cells, median 8 per µl and range 6–103 per µl (Winer et al. 1988d). Single observations on individual patients suggest that the CSF protein concentration commonly remains normal during the first ten days of the illness, increases as the disease progresses, continues to rise during the plateau and early recovery phases and eventually returns to normal (Wiederholt et al. 1964). This time course was confirmed by serial lumbar punctures in a typical case (Link 1975). No clinical differences have been discovered between those patients with persistently normal CSF protein concentrations and those exhibiting the classical albuminocytological dissociation, although differences, especially in outcome, have been sought in almost every published series.