Parkinson Disease, Guillain-Barré Syndrome, and ALS

These three disorders can all produce difficulty walking, falls, weakness, and loss of independence, but the bedside pattern is different. | Feature | Parkinson disease | Guillain-Barré syndrome | Amyotrophic lateral sclerosis | |---|---|---|---| | Tempo | Chronic, progressive | Acute, usually days to weeks | Progressive, usually months to years | | Primary system | Basal ganglia and extrapyramidal motor circuits | Peripheral nerves and nerve roots | Upper and lower motor neurons | | Hallmark motor pattern | Bradykinesia plus rest tremor or rigidity | Symmetric weakness with reduced or absent reflexes | Weakness with a mixture of spasticity, brisk reflexes, wasting, and fasciculations | | Sensation | Usually preserved | Tingling, pain, or sensory symptoms may occur | Typically preserved | | Respiratory threat | Aspiration, dysphagia, medication-related immobility | Rapid neuromuscular respiratory failure | Gradual ventilatory muscle weakness | | Eye movements and sphincters | May be affected by disease complications | Autonomic and bladder dysfunction can occur | Extraocular movement and bowel or bladder control are usually spared | The quickest bedside discriminator is often...