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Objective: To determine the long-term impact of Guillain-Barre syndrome (GBS) on work and private life of patients and their partners. Methods: Three to six years after the onset of GBS 150 patients who participated in the Dutch Guillain-Barre trial received a questionnaire specifically drafted for this study to survey their present psychosocial status. Furthermore, their present physical status was established. Results: A total of 122 patients participated. Thirty-one percent showed moderate to serious physical residua after a functional assessment. Due to GBS, 38% of the patients who held a job had to change it, 44% altered their leisure activities, 37% of the patients did not function as well at home as before GBS and 39% reported a change in their partners' lives. Almost half of the patients still had negative comments on their present psychosocial situation. Conclusion: GBS has a serious long-term impact on the patients' work and private life and that of their partners. (C) 2002 Elsevier Science B.V All rights reserved.

In order to document the sensory deficit still present several years after onset of Guillain-Barre syndrome (GBS) and to determine if the sensory residua have a disrupting effect on daily life, 122 patients were asked to cooperate in a neurological examination and to complete a questionnaire three to six years after onset. On functional assessment 84 patients had no or only minor neurological symptoms or signs, 24 patients showed moderate recovery and 14 patients were left with severe residual signs. On neurological examination, residual sensory deficit was found in the arms of 38% of the patients and in the legs of 66% of the patients. Sensory disturbance was experienced as moderate to severe in the arms of 27% of the patients and in the legs of 40% of the patients. Muscle aches and cramps were still present in 48%. There was a statistically significant relation between muscle aches and cramps and objective residual sensory deficit but not with residual weakness. Furthermore, in the group of patients with a pure motor GBS, significantly fewer people suffered from muscle aches and cramps than in the remaining patients (p=0.04). Twenty-five percent of patients changed jobs after their illness, and 44% gave up some leisure activities. It can be concluded that many patients still suffer from sensory deficit, and a considerable number experience these as moderately to seriously disruptive, especially in the legs. Muscle aches and cramps seems to be related to sensory rather than motor dysfunction.

Three to six years after onset of Guillain-Barre syndrome, 63% of 122 patients showed one or more changes in their lifestyle, work, or leisure activities, or in the life of their partners. The changes were influenced by an impaired final functional outcome, along with loss of power and poor condition, although physically recovered patients showed these changes as well.

Lipopolysaccharides (LPS) from Campylobacter jejuni strains isolated from patients with Guillain-Barre syndrome (GBS) display molecular mimicry with GM1. We immunized rabbits with C. jejuni LPS from GBS-associated strains containing a GM1-like epitope. All animals produced high titre anti-LPS antibodies that were cross-reactive with GM1. We conclude that C. jejuni strains from GBS patients are able to induce antibodies that cross-react with gangliosides and LPS. This study further confirms the role of molecular mimicry in the induction of anti-ganglioside antibodies in GBS patients.

Recent reports suggest the possible beneficial effects of haemopoietic stem cell transplantation (HSCT) in autoimmune diseases such as multiple sclerosis (MS). The definition of the risk/benefit ratio for such a treatment is perceived as a major issue for the neurological community worldwide. The First Consensus Conference on Bone Marrow Transplantation in Patients with Multiple Sclerosis was held in Milan, Italy on 21 February 1998. Participants from 16 European, North American, and South American countries discussed the guidelines form performing HSCT in MS. This conference was organized in order to : (a) define criteria for patient selection; (b) define transplantation procedures to maximize efficacy of the treatment and minimize its toxicity; (c) standardize patient outcome evaluation; and (d) establish an international working group to evaluate the efficacy and safety of HSCT in MS and to study the immunological changes related to HSCT in MS patients. During the meeting in Milan agreement was reached on: (a) the preparation and distribution of a consensus report on HSCT in MS and (b) the design of an open trial for an initial assessment of the safety and efficacy of HSCT in MS. The consensus reached during the meeting and the design of the clinical trial are summarized in this contribution.