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September 14, 1984

Guillain-Barré Syndrome and Bell's Palsy in Hawaii in 1981

Author Affiliations

University of Vermont
Vermont Department of Health Burlington

JAMA. 1984;252(10):1282. doi:10.1001/jama.1984.03350100016016

To the Editor.—  We have reviewed the article entitled "Simultaneous Outbreaks of Guillain-Barré Syndrome and Bell's Palsy in Hawaii in 1981"1 and have a few comments about the methods used in control selection. Proper control selection is of paramount importance for some of the serological comparisons made in this article. Unfortunately, the reader is left questioning how the childhood and adult control groups were actually selected. The reader is given no assurances that selection biases were not introduced. The Lilienfelds2 and Sackett and Whelan3 discuss the possible introduction of biases with controls selected from an unrepresentative population.What percentage of the childhood control subjects had disorders that produced immunodeficiency? Persons selected as controls with underlying conditions may not respond to antigenic challenges to agents such as cytomegalovirus or herpesviruses. This could help explain the differences in titer results between case and control populations. The author states that