Axonal Guillain-Barré syndrome

The issue of “axonal” Guillain–Barré syndrome (GBS) remains controversial. Supportive evidence comes from pathological examination of peripheral nerves in 4 extreme cases of GBS 17–29 days after onset which showed severe axonal degeneration without inflammatory‐demyelination. It has been suggested that inflammatory‐demyelination may have been missed. This is difficult to disprove but it seems unlikely, given the known correlation between the severity of axonal degeneration and inflammation/demyelination in the experimental model of GBS, experimental allergic neuritis (EAN). Electrically inexcitable nerves in GBS may reflect axonal degeneration, terminal demyelination or both. This finding proved to be a sign of poor prognosis in 19 of 27 (70%) patients, although a good outcome occurred in some cases. © 1994 John Wiley & Sons, Inc.