Guillain-Barré syndrome (GBS) and hallucinations

Guillain-Barré syndrome (GBS) and hallucinations
   GBS is known under more than 20 names, including Guillain-Barré-Strohl syndrome, Landry-Guillain-Barré syndrome, Landry's paralysis,
   Landry's ascending paralysis, Landry's syndrome, Kussmaul-Landry syndrome, Landry-Kussmaul syndrome, acute plexitis, acute inflammatory demyelinating polyneuropathy, acute idiopathic polyradiculoneuritis, acute idiopathic polyneuritis, acute postinfective polyradiculoneuropathy, and French polio. The eponym Guillain-Barré syndrome was introduced in 1927 by the French neurologists H. Draganesco and J. Claudion. It refers to the French neurologists Georges Charles Guillain (1876-1961) and Jean Alexandre Barré (1880-1967) who in 1916, in collaboration with the French physiologist André Strohl (1887-1977), provided the first full description of the concomitant syndrome and its cere-brospinal fluid (CSF) peculiarities. The condition itself had been described as early as 1828 by the French pathologist Auguste François Chomel (1788-1858). Today the eponym Guillain-Barré syndrome refers to a polyradiculoneuritis with an unknown cause and an auto-immune-mediated pathophysiology which results in an ascending type of sensory and motor impairment with are-flexia. In accordance with clinical and electrodi-agnostic criteria, various classifications of GBS have been devised. GBS may be complicated by autonomic dysfunction, aspiration pneumonia, and respiratory failure. As a consequence, the affected individual may have to undergo *antibiotic treatment and/or invasive ventilation. Although GBS expresses itself basically as a disorder of the peripheral nervous system, CNS complications are not uncommon. These include hyponatraemia due to abnormal antidiuretic hormone secretion, REM sleep motor behaviour disorders, excessive daytime sleepiness, and abnormally low levels of hypothalamic neuropeptides such as CSF hypocretin-1. A group headed by the French neurologist Isabelle Arnulf, who studied 139 hospitalized individuals with GBS, report that more than 30% of the affected individuals display psychiatric symptoms such as anxiety, depression, * delirium, and * psychosis. Among these individuals, 19% report * nightmares and other vivid *dreams, 30% *illusions, and 60% hallucinations. The illusions tend to consist of visual, auditory, and tactile phenomena, as well as * metamorphopsias, * body schema illusions, *environmental tilt, and a *kinaesthetic illusion of 'floating' weightlessly. Among the hallucinations reported are * complex visual hallucinations (including *personifications, *zoopsia, and *lilliputian hallucinations), and * tactile hallucinations. As these hallucinations occur mostly upon closing of the eyes, and tend to linger on for a while after the eyes have been reopened, these may perhaps be regarded as * hypnagogic and * hypnopompic hallucinations. Pathophysio-logically, the mechanisms underlying the illusions and hallucinations in GBS would seem to be nonspecific. General risk factors such as stress due to immobilization, as well as the use of therapeutics such as *morphine and *antibiotics may well play a role in their mediation. Additional risk factors suggested by Arnulf's group include sleep disturbances, autonomic dysfunction, assisted ventilation, relatively high CSF protein levels, and low CSF hypocretin-1 levels.
   Cochen, V., Arnulf, I., Demeret, S., Neu-lat, M.L., Gourlet, V., Drouot, X., Moutereau, S., Derenne, J.P., Similowski, T., Willer, J.C.,
   Pierrot-Deseiligny, C., Bolgert, F. (2005). Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome. Brain, 128, 2535-2545.
   Draganesco, H., Claudian, J. (1927). Sur un cas de radiculo-névrite curable (syndrome de Guillain-Barré) apparue au cours d'une ostéomyélite du bras. Revue Neurologique,2, 517-521.
   Guillain, G., Barré, J.A., Strohl, A. (1916). Sur un syndrome de radiculonévrite avec hyper-albuminose du liquide céphalo-rachidien sans réaction cellulaire. Remarques sur les caractères cliniques et graphiques des réflexes tendineux. Bulletins et Mémoires de la Société des Médecins des Hôpitaux de Paris, 40, 1462-1470.

Dictionary of Hallucinations. . 2010.

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