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To establish the efficacy of intravenous immunoglobulins (IVIG) in the treatment of acute Guillain-Barré syndrome (GBS), we treated nine consecutive pediatric cases (age 2.5-13.5 years) fulfilling the criteria for GBS with a single dose of IVIG (Sandoglobulin; 2 g/kg/BW). None of the patients experienced any IVIG related side-effects. The mean time required to improve by at least one grade on the functional GBS scale after IVIG treatment was 3.5 days, while the mean period to regain ambulation was 11.2 days. Full mobilization without evidence of relapse in the follow-up period (mean 14.5 months) was noted in all but one patient who relapsed after 5 months. We conclude that the early use of a single IVIG dose may prevent further progression of the disease, thus shortening the clinical course of childhood GBS. The most beneficial IVIG dose regimen remains to be determined by controlled trials.

Four children with the Guillain-Barresyndrome seen during the autumn of 1968 had high complement-fixing antibody titres to Mycoplasma pneumoniœ, and in two this mycoplasma was isolated from the nasopharynx during the neurological illness. These observations indicate that M. pneumoniœ is yet another determinant of the syndrome, and perhaps more common than hitherto recognised.

The effect of corticosteroids on the Guillain-Barresyndrome was studied in thirty-eight episodes of the disease. Twenty-five patients received corticosteroids and thirteen did not. The two groups were similar as regards age, sex, and severity of illness. In mild and moderately severely affected cases the recovery-time and length of stay in hospital was prolonged in the group receiving corticosteroids. In severely affected cases, however, these times were not influenced. It is recommended that corticosteroids should not be prescribed in the Guillain-Barresyndrome.

The case-records of 71 patients from previous therapeutic trials were used to determine features in clinical presentation that might be useful in predicting the outcome of the Guillain-Barre syndrome. The major features adversely affecting prognosis were severe maximum deficit requiring ventilation and failure to improve within 3 weeks of reaching peak deficit. The risk of poor outcome in a patient who required ventilation and failed to improve within 3 weeks was 86%.

A patient with the Landry-Guillain-Barresyndrome required 266 days of complete ventilatory support. The complete respiratory and extremity paralysis then improved remarkably over the next 2 weeks, and the patient could be removed from the ventilator and the tracheostomy was removed. Further neuromuscular recovery followed. This case represents the longest period of paralysis, with ultimate recovery, on record.

Sixty patients with suspected lumbar herniated disk and/or canal stenosis were studied prospectively with surface coil MRI, CT, and/or myelography, and the results were compared with the surgically confirmed abnormality. Forty-eight patients had lumbar surgery at 62 levels. There were no negative explorations. Thirty-nine patients had a myelogram and CT. Thirty of the CTs were performed following the injection of metrizamide for myelography. Nine patients had a CT without intrathecal contrast material 1 to several days before the myelogram. Six patients had myelography only, and three patients had CT only. All studies were evaluated for the location and type of disease in a forced choice fashion. Independent of the surgically correlated levels, there was 86.8% agreement between the MR and CT studies in all patients at 151 levels and 87.2% agreement between MR and myelography at 218 levels. At the operative levels, there was 82.6% agreement between MR and surgical findings for both type and location of disease; 83% agreement between CT and surgical findings; and 71.8% agreement between myelography and surgical findings. There was 92.5% agreement when MR and CT were used jointly, and 89.4% agreement when CT and myelography were used jointly. The results of this study indicate that a technically adequate MR examination was equivalent to CT and myelography in the diagnosis of lumbar canal stenosis and herniated disk disease. CT and MR can be complementary studies, and surface coil MR can be viewed as an alternative to myelography.