Guillain-Barre Syndrome, vol. 34: Contemporary Neurology Series.

Guillain-Barre Syndrome, Volume 34: Contemporary Neurology Series

Ropper AH, Wijdicks EFM, Truax BT. Philadelphia, PA 19103-1493, FA Davis Co, 1991, hardback, 369 pp, illus, $70. This monograph was written by a group of neurologists with extensive clinical experience in the diagnosis and treatment of Guillain-Barre syndrome (GBS). Guillain-Barre syndrome has long been regarded as an unassociated group of signs and symptoms that do not fit easily into more established diagnoses such as multiple sclerosis. This book serves to organize relevant information and dispense with confounding myths, thereby elevating the label of GBS to that of a bona fide neurological diagnosis. Chapters cover historic background, neuropathy, clinical features, diagnosis, treatment, and finally, rehabilitation issues. This book provides a major contribution to the understanding of GBS by combining information gathered from published literature, extensive clinical experience, and personal accounts. A chapter detailing the history of GBS describes the bewildering development of the "GBS eponym" that has replaced multiple aliases used in the past. Anyone who has struggled to understand the difference between "Landry-GBS," "GB-Strohl," "polyradiculoneuropathy," and "acute ascending paralysis" would appreciate these chapters on historical background. A chapter on diagnostic criteria clarifies the essential clinical findings that differentiate GBS from other demyelinating disorders. One of the most fascinating aspects of GBS is the rapid time course during the recovery period. Clinical studies are described that attempt to characterize the recovery period. In addition, the authors have succeeded in accurately describing the clinical features of the typical patients with GBS, placing emphasis on the progession of the symptoms. They clearly delineate those features that are common from those that are rare. In addition, they have summarized the special features found in chronic relapsing inflammatory polyneuropathy and in other variant syndromes. Taken together, the middle chapters of the book serve to differentiate the many presentations of the syndrome while emphasizing the features that bind them under the diagnosis of GBS. The final two chapters on respiratory failure and rehabilitation are chapters of direct interest to the physical therapist. Respiratory failure represents the major cause of death in GBS, and the physical therapist plays a major role in assisting with chest physical therapy. The chapter on rehabilitation discusses outcome expectations, early and late physical therapy interventions, biofeedback treatment, orthotic intervention, and pain management in a nondetailed, abstracted format. Most of the suggestions are basic ideas that are relevant in the treatment of all patients with quadriparesis. The absence of reported studies that document the effectiveness of physical therapy intervention is probably due to the lack of their existence in the literature. This volume, written primarily for the neurologist, places most of its emphasis on medical diagnosis and treatment. Patients with GBS are represented in small numbers in most physical therapy clinics, and, as the sections on rehabilitation are written in a general manner, this book may not be use to most therapists. The physical therapist with an interest in GBS, however, will find this monograph an essential resource, as a full understanding of its medical nature will lend insight into the factors that contribute to the often fascinating recovery of patients with GBS. David A Brown, PhD, PT Palo Alto VAMC (153) Rehabilitation Research & Development

Center Palo Alto, Calif