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Khedr EM, Mohamed MZ, Shehab MMM. The early clinical and laboratory predictors of GBS outcome: hospital-based study, Assiut University, Upper Egypt. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Abstract
Background
This study was designed to identify factors that influence outcomes in a large group of well-defined Guillain–Barré syndrome (GBS) patients with a 3-month follow-up period. Sixty-two cases of GBS with a mean age of 37.15 ± 17.60 years (33 males and 29 females) were recruited in the first 2 weeks after onset. Clinical history, examination, and a variety of rating scales including Medial Research Council sum score (MRC), Erasmus Guillain-Barré respiratory insufficiency score (EGRIS), at admission and 10 days later were performed. Follow-up investigations at 3 months included the Hughes Disability Scale (HDS), and Overall Neuropathy Limitation Scale (ONLS).
Results
64.5% of participants had cranial nerve deficits, 45% had neck muscle weakness, 30.6% had dysautonomia, and 8.1% were mechanically ventilated. C-reactive protein was elevated in 38.7%, and hyponatremia was recorded in 30.6% of patients. Older age, antecedent events particularly diarrhea, neck muscles weakness, low MRC sum score, impaired cough reflex, dysautonomia, and hyponatremia, were all significantly associated with poor outcomes at 3 months using HDS and ONLS. Regression analysis with dependent variables of HDS outcome showed that the presence of an antecedent event particularly diarrhea, neck muscle weakness, hyponatremia and the presence cytoalbuminous dissociation of CSF at onset, and low MRC sum score at 10th day after treatment, were predictors of poor outcome.
Conclusion
Clinical and laboratory predictors of poor outcome were older age, the presence of an antecedent event particularly diarrhea, low MRC sum score at the 10th day, elevated CRP, hyponatremia and the presence cytoalbuminous dissociation.
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Pizzo F, Di Nora A, Di Mari A, Costanza G, Testa E, Strazzieri M, Greco F, Timpanaro T, Basile A, Belfiore G, Giugno A, Rocca R, Ruggieri M, Fiumara A, Pavone P. Case report: Incidence and prognostic value of brain MRI lesions and elevated cerebrospinal fluid protein in children with Guillain-Barré syndrome. Front Neurol 2022; 13:885897. [PMID: 36341115 PMCID: PMC9635623 DOI: 10.3389/fneur.2022.885897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Guillain-Barrè syndrome (GBS) is an acute immune-mediated disorder affecting peripheral nerves and nerve roots with a variable clinical course and outcome. Epidemiologic analyses have revealed that the incidence of the syndrome increases linearly among the age. The clinical diagnosis of GBS is based on the family history, physical and neurological examination, electrodiagnostic exams, and cerebrospinal fluid analysis with the classical presence of albumin-cytologic dissociation. Prognosis is associated with the severity of clinical signs and the type of peripheral nerves involved. Methods This study aims to clarify which clinical features can be used for prognostic purposes. We evaluated the correlation between (1) brain MRI lesions and grade of disability; (2) brain MRI lesions and elevated cerebrospinal fluid (CSF) protein; and (3) increased levels of CSF protein and grade of disability. Statistical analysis extracted from these data indicated a good correlation to be a prognostic indicator in children affected by GBS. We found little evidence regarding laboratory tests, imaging, and prognosis. We enrolled 12 continuous patients who met the Brighton criteria for GBS in this retrospective study. Each patient was clinically evaluated at the time of disease onset to assess the GBS disability score and after 2 weeks. Results We estimated Pearson's correlation index to evaluate the possible correlation between MRI and disability and CSF protein levels and disability. The correlation coefficient was 0.92 and 0.85, respectively. In addition, we developed a graph to see the trend of the disability values, proteins in the CSF, and damage assessed with MRI in the 12 patients. It seems that these parameters have a parallel trend and a good correlation in each patient. Finally, we calculated the correlation between MRI and CSF protein values, with an r-value of 0.87. The values suggest a correlation among the MRI score, CSF protein, and prognosis. Conclusion The MRI and CSF laboratory parameters can be important tools for the clinician not only for diagnosis but also to evaluate the possible worsening of general conditions or the need to prepare measures to support life parameters. Patients who need ventilatory support could be established early from patients who have less severe GBS and can begin rehabilitation earlier. We suggest MRI should be performed routinely in children with GBS to be able to estimate the evolution of the clinical condition.
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Affiliation(s)
- Francesco Pizzo
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessandra Di Nora
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessia Di Mari
- Radiology Unit, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - Giuseppe Costanza
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Elisabetta Testa
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Marianna Strazzieri
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Filippo Greco
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Tiziana Timpanaro
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Antonio Basile
- Radiology Unit, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - Giuseppe Belfiore
- Radiology Unit, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Catania, Italy
| | - Andrea Giugno
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Roberta Rocca
- Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
- *Correspondence: Martino Ruggieri
| | - Agata Fiumara
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
- Piero Pavone
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李 承, 孙 瑞, 冯 丽, 江 军. Risk factors associated with the need for mechanical ventilation in children with Guillain-Barré syndrome. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:922-926. [PMID: 34535207 PMCID: PMC8480164 DOI: 10.7499/j.issn.1008-8830.2106003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To study the risk factors associated with the need for mechanical ventilation in children with Guillain-Barré syndrome (GBS). METHODS The medical data of 107 children with GBS were retrospectively reviewed. According to whether mechanical ventilation was required, the children were divided into a mechanical ventilation group with 16 children and a non-mechanical ventilation group with 91 children. The risk factors associated with the need for mechanical ventilation in children with GBS were identified by a multivariate logistic regression analysis. RESULTS Among the 107 children, 16 (15.0%) required mechanical ventilation. Compared with the non-mechanical ventilation group, the mechanical ventilation group had a significantly higher proportion of children with facial and/or bulbar muscle weakness, a significantly shorter duration from the onset to the peak of the disease, and a significantly higher Hughes Functional Grading Scale score at the first visit (P<0.05). Facial and/or bulbar muscle weakness and short duration from the onset to the peak of the disease were risk factors associated with the need for mechanical ventilation in children with GBS (OR=5.053 and 1.239 respectively, P<0.05). CONCLUSIONS Facial and/or bulbar muscle weakness and short duration from the onset to the peak of the disease may increase the risk of mechanical ventilation in children with GBS. Citation.
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Jawaid W, Sana R, Umer SR, Nisa Q, Butt M, Shahbaz N. Relationship between cerebrospinal fluid protein level and electrophysiologic abnormalities in the acute inflammatory demyelinating polyradiculoneuropathy variant of Guillain-Barré syndrome. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2021; 19:Doc12. [PMID: 34539302 PMCID: PMC8422794 DOI: 10.3205/000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/02/2021] [Indexed: 11/30/2022]
Abstract
Objective: Guillain-Barré syndrome (GBS) is an autoimmune disease characterized by weakness in limbs or cranial nerve innervated muscles. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common variant. Electrophysiologic abnormalities and elevated cerebrospinal fluid (CSF) protein are frequently present in AIDP, but the relationship between these two parameters is not well known. We aimed to fill this gap by studying this relationship. Methods: This was a prospective cross-sectional study conducted for two years in the Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan. All 90 adult patients with the AIDP variant of GBS were selected. Nerve conduction studies were performed to determine the degree of demyelination through the four electrophysiologic demyelination criteria. The CSF sample was sent to lab immediately after lumbar puncture. SPSS version 20.0 was used. The CSF protein level was measured with mean ±SD. Demyelination criteria were measured in frequency and percentages. Chi-square test was applied to a number of demyelination criteria and T-test/ANOVA was applied on mean CSF protein level. Results: We found a mean CSF protein of 37.41 mg/dl (±3.69) with one demyelination criterion, 81.87 mg/dl (±17.39) with two demyelination criteria, 119.75 mg/dl (±31.42) with three demyelination criteria, and 134.00 mg/dl (±42.87) with four demyelination criteria (P-value <0.001). Conclusion: This study demonstrates a significant relationship between CSF protein levels and degree of demyelination in the AIDP variant of GBS. This is an under-researched area in GBS and this study adds favorably to limited data in this regard.
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Affiliation(s)
- Wajid Jawaid
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Sana
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
| | - Sumera Rafat Umer
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
| | - Qamar Nisa
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
| | - Mehwish Butt
- Department of Medicine & Allied, Jinnah Medical College Hospital Korangi, Karachi, Pakistan
| | - Naila Shahbaz
- Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi & Dow University of Health Sciences, Karachi, Pakistan
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TunÇ A, TekeŞİn A, GÜzel V, ÜnlÜbaŞ Y, SeferoĞlu M. The prognostic value of demyelinating electrophysiologic findings and cerebrospinal fluid protein levels in acute inflammatory demyelinating polyneuropathy. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:481-487. [PMID: 32844898 DOI: 10.1590/0004-282x20200042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Guillain-Barre syndrome is an acute immune-mediated polyneuropathy characterized by rapidly evolving symptoms and disability. Cerebrospinal fluid analysis and electrophysiological studies are crucial in the diagnosis of this syndrome. OBJECTIVE To evaluate the prognostic value of the type and number of demyelinating findings and cerebrospinal fluid protein levels in patients with acute inflammatory demyelinating polyneuropathy. METHODS We retrospectively analyzed electrophysiological data and cerebrospinal fluid of 67 consecutive patients with acute inflammatory demyelinating polyneuropathy from Istanbul, Turkey (2011-2019) studied ≤ 24 hours post-onset. RESULTS The patients who met a higher number of demyelinating criteria had increased disability scores in the first day and first month, and higher cerebrospinal fluid protein levels were correlated with worse prognosis both on the first day and the first month. However, the disability scores did not correlate with any single specific criterion, and no significant correlation was found between the number of satisfied criteria and cerebrospinal fluid protein levels. CONCLUSIONS The number of demyelinating criteria that are met and high cerebrospinal fluid protein levels at the disease onset may be valuable prognostic markers. More systematic studies conducted with serial nerve conduction studies are required to highlight the roles of the suggested criteria in clinical practice.
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Affiliation(s)
- Abdulkadir TunÇ
- Sakarya University, Sakarya Training and Research Hospital, Department of Neurology, Sakarya, Turkey
| | - Aysel TekeŞİn
- Health Sciences University, Istanbul Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Vildan GÜzel
- Bezmialem Vakif University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Yonca ÜnlÜbaŞ
- Sakarya University, Sakarya Training and Research Hospital, Department of Neurology, Sakarya, Turkey
| | - Meral SeferoĞlu
- Bursa Yüksek İhtisas Education and Research Hospital, Department of Neurology, Bursa, Turkey
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Varma-Doyle AV, Garvie K, Walvekar S, Igi M, Garikepati RM. Ascending Paralysis in a 36-Year-Old Woman With Bipolar Disorder and Recent Aspiration Pneumonia. J Investig Med High Impact Case Rep 2020; 8:2324709620931649. [PMID: 32525426 PMCID: PMC7290259 DOI: 10.1177/2324709620931649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy affecting both motor and sensory peripheral nerves. Typically presenting after a gastrointestinal or a respiratory tract infection, it manifests as ascending paralysis with concomitant areflexia in patients. Cytoalbuminologic dissociation is a supportive finding on cerebrospinal fluid (CSF) analysis. Due to variability in presentation, misdiagnosis and delay in treatment can occur, and consequently, GBS can become life threatening due to respiratory failure. We report ascending paralysis in a 36-year-old woman with known history of bipolar disorder who recently recovered from aspiration pneumonia following a drug overdose event. Given her psychiatric history, she was initially misdiagnosed as conversion disorder. Intravenous immunoglobulin (IVIG) therapy was initiated at our hospital due to strong suspicion of GBS, based on history and physical examination findings consistent with flaccid quadriparesis and impending respiratory failure. CSF analysis and radiological findings subsequently supported our clinical suspicion and clinical findings. Concurrent IVIG therapy, pain management, aggressive physical and respiratory therapy, and monitoring resulted in symptom improvement. One must have a high index of suspicion for GBS when presented with acute inflammatory demyelinating neuropathies in patients who present with ascending paralysis. Early initiation of therapy is key and can prevent life-threatening complications.
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Affiliation(s)
- Aditi Vian Varma-Doyle
- Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Louisiana State University, New Orleans, LA, USA
| | | | - Seema Walvekar
- Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Louisiana State University, New Orleans, LA, USA
| | - Mae Igi
- Louisiana State University, New Orleans, LA, USA
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Tunç A. Early predictors of functional disability in Guillain-Barré Syndrome. Acta Neurol Belg 2019; 119:555-559. [PMID: 30963477 DOI: 10.1007/s13760-019-01133-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/02/2019] [Indexed: 02/06/2023]
Abstract
This study investigated the predictors of prognosis at admission and after the first month in Guillain-Barré syndrome (GBS) patients. This retrospective study used the electronic records of 81 GBS patients. Age, gender, previous GBS history, antecedent febrile illness and presence of cranial nerve dysfunction were recorded. Detailed neurological examinations, routine biochemical and haematological investigations, cerebrospinal fluid (CSF) analysis and electrophysiological studies, GBS subtypes and treatments were assessed. Hughes disability scores (HDSs) were evaluated at the end of the first day and first month. The GBS patient group included 44 male (54.3%) and 37 female (45.7%) patients. The mean age was 52.2 ± 18.5. The mean HDS score was 2.96 at admission and 1.94 at the end of the first month. Plasma sodium, albumin, and CSF protein levels were significantly correlated with low admission HDS scores (p = 0.03, p = 0.011, p = 0.036, and p < 0.001, respectively). Age, plasma sodium, albumin, neutrophil, neutrophil/lymphocyte ratio (NLR) levels, C-reactive protein (CRP) and CSF protein levels were significantly correlated with poor prognosis at the end of the first month (p < 0.05). Concomitant cranial nerve palsies were significantly correlated with low HDS scores (p = 0.011, p = 0.02) but antecedent events were not correlated with functional disability (p = 0.686, p = 0.413). Decreased albumin and sodium levels and increased CSF protein levels indicated poor GBS prognosis. Higher age, elevated NLR, and higher CRP levels indicated worse prognosis at the end of the first month. However, further studies are needed.
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Affiliation(s)
- Abdulkadir Tunç
- Clinic of Neurology, Sakarya Training and Research Hospital, Sakarya University, Sakarya, Turkey.
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Esposito S, Longo MR. Guillain–Barré syndrome. Autoimmun Rev 2017; 16:96-101. [DOI: 10.1016/j.autrev.2016.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
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Abstract
The evaluation and management of childhood pain syndromes of neuromuscular origin have distinct challenges, as the patterns of disease presentation and the ability of a child to describe symptoms may differ from that of an adult. Advances in scientific and clinical knowledge are leading to significant progress in the care of affected children. The genetic origins of Fabry disease and the inherited form of erythromelalgia are better understood. The increasing interest in neuroimmunology among pediatric neurologists has led to more sophisticated diagnostic and therapeutic approaches. Treatment protocols for complex regional pain syndrome have become more standardized. In addition, investigations continue into potential new interventions for metabolic muscle diseases such as McArdle disease and carnitine palmitoyl transferase deficiency type II. In the years to come, children with pain of neuromuscular origin will have access to more precise diagnostic tools and novel therapies that would alleviate this particularly distressing category of disease.
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Affiliation(s)
- Anthony C Rodrigues
- Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, MA.
| | - Peter B Kang
- Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL
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