Talk:Guillain–Barré syndrome

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Header[edit]

"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 (talkcontribs) 04:33, 8 January 2015 (UTC)

Treatment[edit]

"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 (talkcontribs) 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)

Prognosis[edit]

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 (talkcontribs) 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[edit]

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. Wikipedia:Hatnote describes the guidance. JFW | T@lk 14:25, 20 February 2014 (UTC)

Why are the H1N1 vaccine cases not included in the cause section?[edit]

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 | T@lk 19:26, 30 June 2014 (UTC)

Guillain-Barre Syndrome Notable Cases[edit]

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Long discussion about notable patients
The following is a closed debate. Please do not modify it.

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)

Aloha27, 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 – Hollywood actors, sports stars, musicians, TV anchors, a few politicians – 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 – information not found elsewhere – 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[edit]

■  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.

■  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.

■  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.

■  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.

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

■  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.

■  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.

■  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[edit]

(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[edit]

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, Medical Rights 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 | 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[edit]

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 <img> 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 Medical Rights) has independent notability. Not everyone is sufficiently famous to get mentioned on Wikipedia. JFW | T@lk 23:14, 20 October 2014 (UTC)

Discussion closed for archiving. JFW | T@lk 15:54, 29 October 2014 (UTC)

Classifcation[edit]

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

Epidemiology papers: doi:10.1159/000184748 (2009) and doi:10.1159/000324710 (2011); different approaches and probably both worth citing.
Association with vaccines: doi:10.2165/00002018-200932040-00005 (2009) and doi:10.7774/cevr.2014.3.1.50 (2014). JFW | T@lk 09:10, 30 October 2014 (UTC)
Brighton criteria were brought about by vaccine worries: doi:10.1016/j.vaccine.2010.06.003 JFW | T@lk 23:54, 30 November 2014 (UTC)

Updating[edit]

This article has needed tidying up for some time.

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

Sources:

Will try to do some stuff here. Help appreciated as always. JFW | T@lk 00:00, 2 November 2014 (UTC)

I've got that book "Guillain-Barré: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: doi:10.1542/pir.33-4-164 JFW | T@lk 08:43, 1 January 2015 (UTC)

Epidemiology[edit]

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." <ref>http://www.karger.com/Article/FullText/324710</ref>

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 Wikimol03. I will rephrase. Always feel free to change something yourself; great articles come about because folk like yourself are BOLDly updating pages. JFW | 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[edit]

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.<ref>{{cite journal|last1=Suarez|first1=G. A.|last2=Fealey|first2=R. D.|last3=Camilleri|first3=M.|last4=Low|first4=P. A.|title=Idiopathic autonomic neuropathy: Clinical, neurophysiologie, and follow-up studies on 27 patients|journal=Neurology|date=1 September 1994|volume=44|issue=9|pages=1675–1675|doi=10.1212/WNL.44.9.1675|pmid=7936295}}</ref> 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 doi: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 (doi: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 | T@lk 22:06, 7 December 2014 (UTC)

Babinski in Bickerstaff[edit]

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 | 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)
PizzaMan 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 | 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[edit]

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 | T@lk 21:40, 23 June 2015 (UTC)

Another push[edit]

So, having some time available, I might just be able to finish the work on this and get it nominated for GA:

  •  Done Address the point of the anonymous editor in the previous section
  •  Done Finish the "neurophysiology" section with sources listed above (Uncini in particular) - a neurology colleague has explained the key points of NCS/EMG
  •  Done "Citation needed" in "clinical subtypes" with regards to Bickerstaff
  •  Done Complete the "rehabilitation" section, replacing the content that is based on primary sources.
  •  Done In "prognosis", incorporate the HRQL discussion from doi:10.1111/jns5.12051
  •  Done In "prognosis", address the "citation needed" tags

Help appreciated as always. JFW | T@lk 20:54, 22 June 2015 (UTC)

possible references[edit]

Brain human normal inferior view

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)

@Ozzie10aaaa: I wasn't planning on adding more sources, and you will find that I've referenced the relevant Cochrane reviews. JFW | T@lk 18:26, 26 June 2015 (UTC)

ref[edit]

GA Review[edit]

This review is transcluded from Talk:Guillain–Barré syndrome/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Doc James (talk · contribs) 08:35, 9 July 2015 (UTC)

Lead[edit]

  1. This content "(French pronunciation: ​[ɡiˈlɛ̃ baˈʁe],English pronunciation: /ɡiːˈjænbɑrˈeɪ/)" would be better in the body of the article rather than the first sentence. We should get to the definition sooner.
  •  Done
  1. Simplified the lead some.
  2. Would be good to have refs in the lead to prevent citation needed tags but of course not required
  •  Not done Every other article has pronunciation guidance in the opening sentence. It is the most appropriate place and I don't think there is scope for a separate section on pronunciation and nomenclature. JFW | T@lk 10:25, 12 July 2015 (UTC)

Signs and symptoms[edit]

  1. Should "Bickerstaff brainstem encephalitis" be in quotes?
  •  Done
  1. Would move the discussion of ventilation to the treatment section
  •  Done

Causes[edit]

  1. I presume all the vaccination content is support by <ref name=Lehmann2010/>? Would be good to add it as a hidden ref behind each sentence as this content is likely controversial such as <!-- <ref name=Lehmann2010/> -->
    •  Done Yes, although the opening sentence could be covered with all key references (Yuki2012 and NatRevNeurol2014) as this is a widely recognised association. JFW | T@lk 10:42, 12 July 2015 (UTC)

Mechanism[edit]

  1. Would be good to describe what an epitopes is
    •  Done Simply changed to "substances" as this is not the place to have a long discussion about antigen cross-reactivity. JFW | T@lk 10:40, 12 July 2015 (UTC)

Diagnosis[edit]

  1. Simplify "inciting event" to "cause"
  •  Done
  1. What other conditions cause "MRI scan shows enhancement"
    • I would argue that this is not relevant here. The source doesn't discuss it. JFW | T@lk 10:27, 12 July 2015 (UTC)

Treatment[edit]

  • "Subsequent treatment consists" could be just "treatment consists"? Otherwise subsequent to what.
  •  Done
  • Would split this sentence into two "Subsequent treatment consists of attempting to reduce the body's attack on the nervous system, either by plasmapheresis, filtering antibodies out of the bloodstream, or by administering intravenous immunoglobulins (IVIg), to neutralize harmful antibodies and inflammation causing disease" to make it easier to understand.
  •  Done
  • Would add discussion of ventilation here
  •  Done

Prognosis[edit]

Is it known what percentage of people are were on the zero to six scale?

  •  Done The main sources didn't provide a breakdown. I think it really depends on regional distribution, because AIDP is more common in Europe and the USA while axonal variant is more common in Southeast Asia. They have differing prognosis. JFW | T@lk 10:30, 12 July 2015 (UTC)

History[edit]

  • " made further contributions with a further" -> "made contributions with a further"
  •  Done
  • "pharyngeal-cervical-brachial" would be better as "throat, neck, and arm"
  •  Done
    •  Not done Afraid I disagree. This is accepted nomenclature starting with Ropper in the 1980s. The text describes the clinical features adequately, so there is no risk of loss of information because of jargon. No single source I have seen describes this variant as "throat, neck, and arm". JFW | T@lk 10:28, 12 July 2015 (UTC)

Research[edit]

  • Is their enough sources for articles on "quinpramine and fausadil"?
    •  Done I have not made a distinction when discussing the various agents under development, as all of them are discussed in Rinaldi's detailed article. Happy to be corrected on this, but the source does not really distinguish between more and less promising agents. JFW | T@lk 10:40, 12 July 2015 (UTC)
  • Should we link to this charity http://www.gbs-cidp.org/
    •  Done It's in external links. None of the sources make specific mention of the charity's work, but I think they are notable enough to mention in the external links section. I am in two minds as to whether to include http://www.gaincharity.org.uk/ (GAIN charity, UK) in the external links section or not. JFW | T@lk 10:40, 12 July 2015 (UTC)

Doc James (talk · contribs · email) 08:35, 9 July 2015 (UTC)

Looks good. Well formatted per WP:MEDMOS. Well referenced per WP:MEDRS. Passed as a Good article. Doc James (talk · contribs · email) 19:30, 12 July 2015 (UTC)

Respiratory Failure[edit]

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 | T@lk 22:32, 16 July 2015 (UTC)

heritability?[edit]

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)

Jonathan Tweet 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 | 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[edit]

Currently still in "online first" - doi:10.1016/S0140-6736(16)00339-1 JFW | T@lk 20:00, 9 June 2016 (UTC)