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Clinical symptoms and subtypes of GBS
GBS is characterized by a rapidly progressive, symmet- rical weakness of the limbs in combination with hypo- reflexia or areflexia.2,4,73 However, GBS is highly diverse with respect to the presence, distribution and extent of cranial nerve deficits, sensory symptoms, weakness, ataxia, pain, autonomic dysfunction, and the course of the disease.
Clinical symptoms and subtypes of GBS
GBS is characterized by a rapidly progressive, symmet- rical weakness of the limbs in combination with hypo- reflexia or areflexia.2,4,73 However, GBS is highly diverse with respect to the presence, distribution and extent of cranial nerve deficits, sensory symptoms, weakness, ataxia, pain, autonomic dysfunction, and the course of the disease. Many patients have sensory deficits, such as numbness and/or paraesthesias.4 About half of the patients have cranial nerve deficits, especially bilateral facial weakness, swallowing difficulties or (sometimes) extraocular motor dysfunction.4 A high propor- tion (54–89%) of patients with GBS experience pain, including painful paraesthesias, backache, muscle pain and meningism, which may even precede the onset of muscle weakness in about one-third of GBS cases.2,4,76,77 Approximately 25% of patients develop respiratory insuf- ficiency requiring artificial ventilation.73,78–80 Autonomic dysfunction (predominantly cardiovascular dysregula- tion) is present in about two-thirds of patients, although its severity is highly variable.2,77,81 About one-third of patients remain able to walk throughout the course of the disease, and are often described as mildly affected.
GBS is a monophasic disease, usually reaching maximum severity (nadir) within 4 weeks.1,2,4 One study showed that 80% of patients with GBS reach the nadir within 2 weeks after onset of weakness, and 97% reach the nadir within 4 weeks.73 A further subset of patients reach the nadir within 4–6 weeks of onset of weakness.73,82 The progressive phase is usually followed by a plateau phase ranging from 2 days to 6 months (median duration 7 days) before patients start to recover (Figure 1).73
Various subtypes of GBS have been reported that differ in their clinical,
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