The prognostic indicators and outcome in 297 patients with Guillain-Barre syndrome were analysed at the Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milan, Italy. Patients, recruited from Italian centers, were followed for 24 months or until recovered. Only 5% were children <15 years; approximately 50% were older than 50 years. The commonest antecedent illnesses were influenza (26%), URI (15%), and gastroenteritis (9%). Immunizations were causative in 5 patients: influenza vaccine in 4 and DPT in 1. The mean times to nadir, improvement and recovery were 12, 28 and 200 days; 71% recovered, 16% had residua, and 11% died. Cardiac arrest with dysautonomic syndrome was the main cause of death. The percentage with respiratory failure increased with age (7% <35 years, 31% >35 years). Predictors of a more favorable outcome included young age at onset, influenza antecedent illness, mild symptoms and signs, short latency to nadir, short duration of active disease, and normal or demyelinating electrodiagnostic features. Prognosis was less favorable in older patients, with gastroenteritis antecedent illness, respiratory insufficiency, long latency to nadir, long duration of active disease, and axonal damage. Treatments were effective only during the active phase and did not influence chance of recovery. 
COMMENT. Guillain-Barre syndrome can no longer be regarded as an acute or subacute demyelinating inflammatory polyradiculopathy with a favorable outcome and complete recovery in a majority of patients. Recent reports of cases with a less favorable prognosis have been asociated with antecedent Campylobacter enteritis, axonal damage and a positive response to anti-GMl antibodies. This multicenter, prospective study supports the concept of a heterogeneous disorder with variable prognosis, dependent on age, antecedent illness, axonal damage, and duration of active disease. Perhaps the antecedent illness and the causative role of vaccines, especially influenza, require more attention.
Immune globulins are effective and safe in severe childhood-onset Guillain-Barre syndrome, according to a multicentre prospective study of 26 children reported from the Rambam Medical Center, Haifa, Israel.