Query

In his Query column of 7 June 2005, 172(12), Dr. Ursus tells us of his missing the diagnosis of Guillain Barre Syndrome when he reassured a patient who was in the early stages with tingling in her feet. A few days later he found her intubated in ICU. As president of the board of Guillain Barre Syndrome Foundation of Canada Inc. I would like to respond on behalf of the membership which includes patients with both GBS and its more chronic counterpart Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). The diagnostic error is all too common a scenario and results in patients being sent home from emergency rooms many times before their diagnosis is made. As they worsen, they then have much further to work their way back from on the long road to recovery. If every case could be picked up early, fewer patients would have severe long term disabilities as treatments started early can help the condition plateau more quickly and shorten both hospitalization and recovery periods. Some patients worsen quickly and are in need of respiratory support within hours of onset; for most it is slower, and takes a few days. If patients present with bizarre paresthesiae, think of GBS, check their deep tendon reflexes, and if they are absent or diminished, warning lights should go on and the patient should be assessed further for GBS with neurology consult, careful observation and lumbar puncture. Further information on GBSFCI which provides support, education and research is available from www.gbsfi.com where you can access the Canadian page. We welcome enquiries from health care professionals and from affected patients and their families.

References: 1. Dr. Ursus, CMAJ 2005; 172(12) 1648. 2. Bowes D, The Doctor as patient: an encounter with Guillain-Barre syndrome. CMAJ vol 131 Dec 1,1984 pp 1343-8. 3.Steinberg, Joel, Guillain Barre Syndrome, An Overview for the Lay Person, 9th edition, publ. GBSFI.