A New Poster Boy for Guillain-Barré Syndrome?

The paralysis that struck President-to-be Franklin Delano Roosevelt in 1921 probably wasn’t caused by poliomyelitis, as physicians and historians have long assumed, according to UTMB researchers. Their study, which ran last November in the Journal of Medical Biography, published by Royal Society of Medicine Press, said the likeliest cause was Guillain-Barré syndrome, an autoimmune disease that damages sensory and motor nerves. Stories about the controversial analysis appeared in every major newspaper in the United States and in a feature report on the CBS Evening News with Dan Rather.

Roosevelt’s vigorous exercise preceding his illness, initial fever, and permanent paralysis all were consistent with poliomyelitis, said lead author Armond S. Goldman, but many other aspects weren’t. Features the study said were typical of Guillain-Barré syndrome included FDR’s age when he got the disease (thirty-nine), the near symmetry and ascending nature of his paralysis, his early facial paralysis, how long the paralysis progressed, the numbness, extreme prolonged pain, bladder and bowel dysfunction, and the descending pattern of recovery from his paralysis. While patients with mild to moderate Guillain-Barré syndrome usually recover entirely, those with severe disease who aren’t treated using modern methods often experience permanent paralysis, the authors noted.

The diagnosis of Guillain-Barré syndrome was supported by a statistical analysis that considered the frequency of paralytic poliomyelitis and Guillain-Barré syndrome in adults of Roosevelt’s age in 1921 and the likelihood of his symptoms occurring in either of the two diseases. Six of eight probabilities ranked in the analysis favored Guillain-Barré syndrome, while only two (fever and permanent paralysis) favored poliomyelitis.

Although the study found Guillain-Barré syndrome the probable diagnosis, Goldman acknowledged: “No one can be absolutely sure because relevant laboratory diagnostic studies weren’t performed or weren’t available at the time of his illness.” If Guillain-Barré syndrome had been diagnosed in 1921, Goldman said Roosevelt’s outcome would have been the same because effective treatment for that disease was not discovered until the latter part of the twentieth century.