1
|
van Doorn PA, Van den Bergh PYK, Hadden RDM, Avau B, Vankrunkelsven P, Attarian S, Blomkwist-Markens PH, Cornblath DR, Goedee HS, Harbo T, Jacobs BC, Kusunoki S, Lehmann HC, Lewis RA, Lunn MP, Nobile-Orazio E, Querol L, Rajabally YA, Umapathi T, Topaloglu HA, Willison HJ. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. Eur J Neurol 2023; 30:3646-3674. [PMID: 37814552 DOI: 10.1111/ene.16073] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal-paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2-4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12-15 L in four to five exchanges over 1-2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.
Collapse
Affiliation(s)
- Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter Y K Van den Bergh
- Neuromuscular Reference Centre, Department of Neurology, University Hospital Saint-Luc, Brussels, Belgium
| | | | - Bert Avau
- Cochrane Belgium, CEBAM, Leuven, Belgium
- CEBaP, Belgian Red Cross, Mechelen, Belgium
| | - Patrik Vankrunkelsven
- Department of Public Health and Primary Care KU Leuven, Cochrane Belgium, CEBAM, Leuven, Belgium
| | - Shahram Attarian
- Centre de Référence des Maladies Neuromusculaires et de la SLA, APHM, CHU Timone, Marseille, France
| | | | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H Stephan Goedee
- Department of Neurology, University Medical Center Utrecht, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Susumu Kusunoki
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Helmar C Lehmann
- Department of Neurology, Medical Faculty Köln, University Hospital Köln, Cologne, Germany
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael P Lunn
- Department of Neurology and MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Institute, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Luis Querol
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yusuf A Rajabally
- Neuromuscular Service, Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | | | - Hugh J Willison
- Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
| |
Collapse
|
2
|
van Doorn PA, Van den Bergh PYK, Hadden RDM, Avau B, Vankrunkelsven P, Attarian S, Blomkwist-Markens PH, Cornblath DR, Goedee HS, Harbo T, Jacobs BC, Kusunoki S, Lehmann HC, Lewis RA, Lunn MP, Nobile-Orazio E, Querol L, Rajabally YA, Umapathi T, Topaloglu HA, Willison HJ. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. J Peripher Nerv Syst 2023; 28:535-563. [PMID: 37814551 DOI: 10.1111/jns.12594] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal-paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2-4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12-15 L in four to five exchanges over 1-2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.
Collapse
Affiliation(s)
- Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter Y K Van den Bergh
- Neuromuscular Reference Centre, Department of Neurology, University Hospital Saint-Luc, Brussels, Belgium
| | | | - Bert Avau
- Cochrane Belgium, CEBAM, Leuven, Belgium
- CEBaP, Belgian Red Cross, Mechelen, Belgium
| | - Patrik Vankrunkelsven
- Department of Public Health and Primary Care KU Leuven, Cochrane Belgium, CEBAM, Leuven, Belgium
| | - Shahram Attarian
- Centre de Référence des Maladies Neuromusculaires et de la SLA, APHM, CHU Timone, Marseille, France
| | | | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H Stephan Goedee
- Department of Neurology, University Medical Center Utrecht, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Susumu Kusunoki
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Helmar C Lehmann
- Department of Neurology, Medical Faculty Köln, University Hospital Köln, Cologne, Germany
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael P Lunn
- Department of Neurology and MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Institute, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Luis Querol
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yusuf A Rajabally
- Neuromuscular Service, Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | | | - Hugh J Willison
- Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
| |
Collapse
|
3
|
Xue G, Zhang Y, Wang R, Yang Y, Wang H, Li J, He X, Zhang Q, Yang X. Construction and evaluation of a prognostic prediction model based on the mEGOS score for patients with Guillain-Barré syndrome. Front Neurol 2023; 14:1303243. [PMID: 38099064 PMCID: PMC10720072 DOI: 10.3389/fneur.2023.1303243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background Guillain-Barré syndrome (GBS) is an immune-mediated acute peripheral neuropathy in which up to 20% patients remain unable to walk independently after 6 months of onset. This study aimed to develop a clinical prognostic model based on the modified Erasmus GBS Outcome Score (mEGOS) for predicting the prognosis of GBS patients at 6 months of onset. Methods The clinical data of 201 GBS patients were retrospectively analyzed. According to the GBS disability score (GBS-DS) at 6 months of onset, patients were divided into a good prognosis group (GBS-DS <3 points) and a poor prognosis group (GBS-DS≥3 points). Univariate and multivariate analysis was used to screen out independent risk factors for poor prognosis, and a prediction model was accordingly constructed for GBS prognosis. Results The mEGOS score, serum albumin (ALB) and fasting plasma glucose (FPG) were independent risk factors for poor prognosis in patients with GBS, and the above risk factors were used to construct a prognostic model of mEGOS-I and a nomogram. The receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of mEGOS-I at admission and at 7 days of admission to predict poor prognosis at 6 months of GBS onset was 0.891 and 0.916, respectively, with sensitivities of 82.7% and 82.6% and specificities of 86.5% and 86.6%, respectively. Decision curve analysis showed that the nomogram had a very high clinical benefit. Conclusion To our knowledge, this is the first report of the construction of a prognostic prediction model based on the mEGOS score, ALB, and FPG that can accurately and stably predict the prognosis of GBS patients at 6 months of onset.
Collapse
Affiliation(s)
- Gaojie Xue
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yani Zhang
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ruochen Wang
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yue Yang
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Huihui Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Jiangping Li
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Xuexian He
- Department of Cerebrospinal Fluid Laboratory, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Qing Zhang
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiao Yang
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China
| |
Collapse
|
4
|
Downregulation of LKB1/AMPK Signaling in Blood Mononuclear Cells Is Associated with the Severity of Guillain-Barre Syndrome. Cells 2022; 11:cells11182897. [PMID: 36139470 PMCID: PMC9496801 DOI: 10.3390/cells11182897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
AMP-activated protein kinase (AMPK) is an intracellular energy sensor that regulates metabolic and immune functions mainly through the inhibition of the mechanistic target of rapamycin (mTOR)-dependent anabolic pathways and the activation of catabolic processes such as autophagy. The AMPK/mTOR signaling pathway and autophagy markers were analyzed by immunoblotting in blood mononuclear cells of 20 healthy control subjects and 23 patients with an acute demyelinating form of Guillain–Barré syndrome (GBS). The activation of the liver kinase B1 (LKB1)/AMPK/Raptor signaling axis was significantly reduced in GBS compared to control subjects. In contrast, the phosphorylated forms of mTOR activator AKT and mTOR substrate 4EBP1, as well as the levels of autophagy markers LC3-II, beclin-1, ATG5, p62/sequestosome 1, and NBR1 were similar between the two groups. The downregulation of LKB1/AMPK signaling, but not the activation status of the AKT/mTOR/4EBP1 pathway or the levels of autophagy markers, correlated with higher clinical activity and worse outcomes of GBS. A retrospective study in a diabetic cohort of GBS patients demonstrated that treatment with AMPK activator metformin was associated with milder GBS compared to insulin/sulphonylurea therapy. In conclusion, the impairment of the LKB1/AMPK pathway might contribute to the development/progression of GBS, thus representing a potential therapeutic target in this immune-mediated peripheral polyneuropathy.
Collapse
|
5
|
Ali S, Karam A, Lalani A, Jawed S, Moin M, Douba Z, Ali M. A Remarkable Case of Acute Motor-Sensory Axonal Polyneuropathy (AMSAN) Variant of Guillain Barré Syndrome, in a Diabetic Patient Infected With COVID-19: A Case Report and Review of the Literature. Front Neurol 2022; 13:937989. [PMID: 35928139 PMCID: PMC9344130 DOI: 10.3389/fneur.2022.937989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease- 2019 (COVID-19), has been a global epidemic in our healthcare system. SARS-CoV-2 primarily affects the respiratory system, but neurological involvement has also been reported, including Guillain–Barré syndrome (GBS) development. Case Presentation A 58-year-old male with known co-morbid hypertension and type 2 diabetes mellitus presented to the emergency room with complaints of worsening shortness of breath, dry cough, and fever for the past 10 days. On day 20 of hospitalization, he developed neurological symptoms after being tested positive for COVID-19. A neuroelectrophysiology study was conducted to evaluate neurological symptoms and suggested that the patient suffers from acute motor-sensory axonal polyneuropathy (AMSAN). CSF analysis showed elevated protein levels that confirmed the diagnosis of GBS. He was subsequently treated with oral prednisolone and IVIG, which improved neurological symptoms. Conclusion Ever since the emergence of COVID-19, GBS has surfaced as to its potentially dangerous outcome. Healthcare professionals should be mindful of GBS and should rule it out in anyone having sensory symptoms or weakness during or after a COVID-19 infection. Its early detection and treatment can result in improved clinical outcomes.
Collapse
Affiliation(s)
- Sajjad Ali
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Alvina Karam
- Department of Medicine, Khyber Medical College, Peshawar, Pakistan
| | - Aarish Lalani
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Sadia Jawed
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Musfirah Moin
- Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Zain Douba
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
- CME Office, Faculty of Medicine, University of Aleppo, Aleppo, Syria
- *Correspondence: Zain Douba ; orcid.org/0000-0001-9662-9492
| | - Murtaza Ali
- Department of Medicine, Dr. Ruth K.M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| |
Collapse
|
6
|
Kubota T, Hasegawa T, Ikeda K, Aoki M. Case Report: Isolated, unilateral oculomotor palsy with anti-GQ1b antibody following COVID-19 vaccination. F1000Res 2021; 10:1142. [PMID: 35444796 PMCID: PMC8990240 DOI: 10.12688/f1000research.74299.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 12/17/2023] Open
Abstract
Neurological complications following vaccinations are extremely rare, but cannot be eliminated. Here, we report the first case of unilateral oculomotor nerve palsy (ONP) with anti-GQ1b antibody after receiving the Pfizer-BioNTech COVID-19 (BNT162b2) mRNA vaccine. A 65-year-old man developed diplopia and ptosis in the right eye 17 days after vaccination, without preceding infection. Neurological examination revealed mild blepharoptosis, limitation of adduction, and vertical gaze on the right side. Increased levels of anti-GQ1b ganglioside antibody in the serum and albuminocytologic dissociation in the cerebrospinal fluid were detected. Cranial magnetic resonance imaging showed swelling and enhancement of the right oculomotor nerve. The patient was diagnosed with right ONP accompanied with anti-GQ1b antibody, and intravenous immunoglobulin (IVIG) therapy for 5 days was administered. The limitation of adduction and vertical gaze improved, and ptosis markedly resolved after IVIG treatment. Given the temporal sequence of disease progression, laboratory findings, and a favorable response to IVIG, a causal relationship cannot be ruled out between the occurrence of ONP and COVID-19 immunization. Since immunomodulatory treatments significantly hasten the recovery and minimize the residual symptoms in anti-GQ1b antibody syndrome, clinicians should be aware of this clinical condition following COVID-19 vaccination.
Collapse
Affiliation(s)
- Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Kensuke Ikeda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| |
Collapse
|
7
|
Kubota T, Hasegawa T, Ikeda K, Aoki M. Case Report: Isolated, unilateral oculomotor palsy with anti-GQ1b antibody following COVID-19 vaccination. F1000Res 2021; 10:1142. [PMID: 35444796 PMCID: PMC8990240 DOI: 10.12688/f1000research.74299.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/20/2022] Open
Abstract
Neurological complications following vaccinations are extremely rare, but cannot be eliminated. Here, we report the first case of unilateral oculomotor nerve palsy (ONP) with anti-GQ1b antibody after receiving the Pfizer-BioNTech COVID-19 (BNT162b2) mRNA vaccine. A 65-year-old man developed diplopia and ptosis in the right eye 17 days after vaccination, without preceding infection. Neurological examination revealed mild blepharoptosis, limitation of adduction, and vertical gaze on the right side. Increased levels of anti-GQ1b ganglioside antibody in the serum and albuminocytologic dissociation in the cerebrospinal fluid were detected. Cranial magnetic resonance imaging showed swelling and enhancement of the right oculomotor nerve. The patient was diagnosed with right ONP accompanied with anti-GQ1b antibody, and intravenous immunoglobulin (IVIG) therapy for 5 days was administered. The limitation of adduction and vertical gaze improved, and ptosis markedly resolved after IVIG treatment. Given the temporal sequence of disease progression, laboratory findings, and a favorable response to IVIG, a causal relationship cannot be ruled out between the occurrence of ONP and COVID-19 immunization. Since immunomodulatory treatments significantly hasten the recovery and minimize the residual symptoms in anti-GQ1b antibody syndrome, clinicians should be aware of this clinical condition following COVID-19 vaccination.
Collapse
Affiliation(s)
- Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Takafumi Hasegawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Kensuke Ikeda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, 980-8574, Japan
| |
Collapse
|
8
|
Velásquez-Rimachi V, López-Saavedra AV, Rodriguez-López E, Elguera-Huaman H, Meza K, Alva-Díaz C, Pacheco-Barrios K. Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:697-704. [PMID: 34550186 DOI: 10.1590/0004-282x-anp-2020-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system. Severe motor deficit (SMD), respiratory impairment, cranial nerve involvement and autonomic dysfunction are associated with a poor prognosis. OBJECTIVE To investigate the association between the clinical-epidemiological characteristics and the discharge results among Peruvian patients with GBS. METHODS We carried out a retrospective observational study on patients with GBS who survived until discharge. We used the Brighton Collaboration's criteria and considered Hughes Severity Scale (HSS) scores greater than two to be SMD. We defined the discharge results as an improvement if the HSS score decreased by at least one point from admission to hospital discharge and defined hospital stay as prolonged if > 14 days. RESULTS We analyzed 92 patients, among whom 70.7% were male. Quadriparesis (81.1%) and hyporeflexia (86.8%) were the most characteristic manifestations. We observed that more than half of the cases were in summer and winter. Gastrointestinal infections were associated with a higher proportion of prolonged stays. The proportion of improvement was lower among patients who had an SMD at hospital admission. We confirmed these results through fitting in multivariate models. CONCLUSIONS The prolonged stay was related to previous gastrointestinal infection, while a less improvement in SMD individuals at admission. Prospective multicenter surveillance systems are needed for monitoring GBS cases in low-income settings like Peru.
Collapse
Affiliation(s)
- Victor Velásquez-Rimachi
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.,Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Universidad Científica del Sur, Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Lima, Peru
| | - Angélica Verónica López-Saavedra
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.,Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru
| | - Ethel Rodriguez-López
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.,Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru
| | - Hillary Elguera-Huaman
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru
| | - Kelly Meza
- Weill Cornell Medicine, Department of Pediatrics, Division of Pediatric Nephrology, New York NY, USA
| | - Carlos Alva-Díaz
- Universidad Científica del Sur, Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Lima, Peru.,Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
| | - Kevin Pacheco-Barrios
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.,SYNAPSIS Mental Health and Neurology Non-Profit Organization, Lima, Peru
| |
Collapse
|
9
|
Gong Q, Liu S, Xiao Z, Fu X, Lu Z. Elevated blood and cerebrospinal fluid glucose levels affect the severity and short-term prognosis of Guillain-Barré syndrome. Neurol Res 2021; 44:121-127. [PMID: 34382919 DOI: 10.1080/01616412.2021.1965337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to explore the correlation of elevated glucose levels in the blood and cerebrospinal fluid with the progression and short-term prognosis of Guillain-Barré syndrome (GBS). METHODS The medical records of 982 patients who were diagnosed with GBS in 31 representative tertiary hospitals, located in 14 provinces in southern China, were collected and retrospectively reviewed. Patients were grouped according to the levels of fasting plasma glucose (FPG) and cerebrospinal fluid (CSF) glucose, as well as the concentration of blood hemoglobinAlc (HbA1c). The Hughes grade scale was used to quantify functional outcomes. RESULTS Compared to patients with normal FPG and CSF glucose levels, those in the high FPG and high CSF glucose groups were characterized by a higher proportion of severe patients (HFGS ≥ 3) at admission (58.8 vs. 73.1, P = 0.000; 57.6 vs. 71.2, P = 0.000), at nadir (67.4 vs. 83.0, P = 0.000; 66.2 vs. 80.4, P = 0.000), and at discharge (29.8 vs. 46.3, P = 0.000; 26.4 vs. 45.0, P = 0.000). Patients in the high HbA1c group also had more severe disability at admission (74.6 vs. 56.1, P = 0.005) and at nadir (80.3 vs. 64.3, P = 0.012) compared to the normal HbA1c group. Moreover, elevated levels of FPG and CSF glucose were significantly correlated with more severe disability at admission, at nadir, and at discharge. CONCLUSIONS The present study showed that elevated glucose levels in the blood and cerebrospinal fluid were associated with the severity and short-term prognosis of GBS. TRIAL REGISTRATION chicTR-RRc-17,014,152. ABBREVIATIONS GBS, Guillain-Barré syndrome; FPG, fasting plasma glucose; CSF, cerebrospinal fluid; HFGS, Hughes Functional Grading Scale; HbA1c, hemoglobin A1c. DM, diabetes mellitus; NCS, nerve conduction study; AIDP, acute inflammatory demyelinating polyneuropathy; AMAN, acute motor axonal neuropathy; AMSAN, acute motor sensory axonal neuropathy; MV, mechanical ventilation.
Collapse
Affiliation(s)
- Qiaoyu Gong
- Department Of Neurology, Renmin Hospital Of Wuhan University, Wuhan, Hubei Province, P.R.C. China
| | - Shuping Liu
- Department Of Neurology, Renmin Hospital Of Wuhan University, Wuhan, Hubei Province, P.R.C. China
| | - Zheman Xiao
- Department Of Neurology, Renmin Hospital Of Wuhan University, Wuhan, Hubei Province, P.R.C. China
| | - Xiujuan Fu
- Department Of Neurology, Renmin Hospital Of Wuhan University, Wuhan, Hubei Province, P.R.C. China
| | - Zuneng Lu
- Department Of Neurology, Renmin Hospital Of Wuhan University, Wuhan, Hubei Province, P.R.C. China
| |
Collapse
|
10
|
Kamel WA, Ibrahim Ismail I, Al-Hashel JY. Guillain-Barre Syndrome following COVID-19 Infection: First Case Report from Kuwait and Review of the Literature. DUBAI MEDICAL JOURNAL 2021. [PMCID: PMC8089421 DOI: 10.1159/000513382] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy that is often related to a previous infectious exposure. GBS emerged as a potentially serious complication of coronavirus disease 2019 (COVID-19) since its declaration as a global pandemic. We report the first case from Kuwait, to the best of our knowledge. Clinical Presentation A 72-year-old male presented with 3 weeks history of acute progressive and ascending lower limbs weakness. He developed these symptoms 3 weeks after testing positive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electrophysiological studies showed acute demyelinating polyradiculoneuropathy and cerebrospinal fluid showed protein-cell dissociation. He was successfully treated with intravenous immunoglobulins (IVIGs). Conclusion Neurologists should be aware of GBS as a potentially serious complication associated with COVID-19. Our patient had a favorable outcome with IVIG with no autonomic or respiratory affection.
Collapse
Affiliation(s)
- Walaa A. Kamel
- Neurology Department, Ibn-Sina Hospital, Safat, Kuwait
- Neurology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ismail Ibrahim Ismail
- Neurology Department, Ibn-Sina Hospital, Safat, Kuwait
- *Ismail Ibrahim Ismail, Department of Neurology, Ibn Sina Hospital, PO Box 25427, Gamal Abdel Nasser Street, Sabah Medical Area, 13115 Safat (Kuwait),
| | - Jasem Yousef Al-Hashel
- Neurology Department, Ibn-Sina Hospital, Safat, Kuwait
- Depatrment of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| |
Collapse
|
11
|
Ding L, Chen Z, Sun Y, Bao H, Wu X, Zhong L, Zhang P, Lin Y, Liu Y. Guillain-Barré syndrome following bacterial meningitis: a case report and literature review. BMC Neurol 2018; 18:208. [PMID: 30558576 PMCID: PMC6296051 DOI: 10.1186/s12883-018-1211-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023] Open
Abstract
Background We reported a case of an adult that presented Guillain-Barré syndrome (GBS) after bacterial meningitis which was secondary to chronic suppurative otitis media (CSOM). To our knowledge, this is the first case involving an adult presenting with GBS following bacterial meningitis. Case presentation A 46-year man with type 2 diabetes and otitis media (OM) suffered with fever, headache, and vomiting for 6 days. The patient’s neck stiffness was obvious and the Kernig and Brudzinski signs were produced. The result of cerebrospinal fluid (CSF) analysis and cytological examination of the CSF supported the diagnose of bacterial meningitis. On day 17 the patient felt numbness in both hands and feet, which gradually progressed to weakness of the limbs. Bladder dysfunction occurred, which required catheterization. The patient showed a tetraparesis with emphasis on the legs. The deep tendon reflexes of limbs were absent. The patient had peripheral hypalgesia and deep sensory dysfunction. The symptoms were possibly a result of GBS. Nerve conduction study showed that the F wave latency of the upper and lower limbs was prolonged, particularly the lower limbs. 8 days later the repeated nerve conduction study showed a low compound muscle action potential (3.3 mV) with a normal distal motor latency (14.2 ms) and a low motor nerve conduction velocity (34.3 m/s) in the tibial nerve. The patient still required assistance when walking 3 months after onset. Conclusions GBS following bacterial meningitis is rare and limbs weakness in patients with bacterial meningitis was usually considered because of weakness. This case should serve as a reminder for clinical doctors that when a patient with bacterial meningitis complains about limbs numbness or weakness, GBS should be considered, especially when the patient had diabetes mellitus (DM) history.
Collapse
Affiliation(s)
- Li Ding
- Department of Neurology, the Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China
| | - Zhongjun Chen
- Neuro-Interventional Ward, Dalian Municipal Central Hospital of Dalian Medical University, Dalian City, China
| | - Yan Sun
- Anesthesiology Department, Jilin University, China Japan Union Hospital, Changchun City, China
| | - Haiping Bao
- Department of Nerve Electrophysiology, the Second Hospital of Dalian Medical University, Dalian City, China
| | - Xiao Wu
- Department of Neurology, the Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China
| | - Lele Zhong
- Department of Neurology, the Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China
| | - Pei Zhang
- Department of Neurology, the Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China
| | - Yongzhong Lin
- Department of Neurology, the Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China.
| | - Ying Liu
- Department of Neurology, the Second Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian City, 116027, Liaoning Province, China.
| |
Collapse
|
12
|
Zhang Y, Zhao Y, Wang Y. Prognostic factors of Guillain-Barré syndrome: a 111-case retrospective review. Chin Neurosurg J 2018; 4:14. [PMID: 32922875 PMCID: PMC7398209 DOI: 10.1186/s41016-018-0122-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/21/2018] [Indexed: 02/08/2023] Open
Abstract
Background To identify the predictive factors associated with worse prognosis in the Guillain-Barré syndrome (GBS), which can be helpful to fully evaluate the disease progression and provide proper treatments. Methods Clinical data of 111 GBS patients who were diagnosed from 2010 to 2015 were collected and retrospectively analyzed. Results Patients with diabetes (P=0.031), high blood pressure at admission (P=0.034), uroschesis (P=0.028), fever (P<0.001), ventilator support (P<0.001) during hospitalization, disorder of consciousness (p=0.007) and absence of preceding respiratory infection(P=0.016) were associated with worse outcome at discharge, while abnormal sensation, ataxia, weakness and decrease of tendon reflex seemed not correlated with the Medical Research Council(MRC) score at discharge. Compared with the subtype of acute inflammatory demyelinating polyneuropathy, prognosis of Miller-Fisher syndrome (p<0.001) and cranial nerve variant (p<0.038) were better, but prognosis of acute motor axonal neuropathy(AMAN) was worse (p<0.032). Laboratory examinations at admission showed that hyperglycemia (P=0.002), high leukocyte count (P=0.010), hyperfibrinogenemia (P=0.001), hyponatremia (P=0.020), hypoalbuminemia (P=0.005), abnormal hepatic (P=0.048) and renal (P=0.009) functions were associated with poorer prognosis at discharge, while albuminocytologic dissociation in cerebrospinal fluid, GM1 and GQ1b antibody showed no correlation with the MRC score at discharge. γ-Globulin and glucocorticoid therapies showed no difference in the MRC score at the discharge. Conclusions AMAN, diabetes, high blood pressure, uroschesis, high body temperature, ventilator support, consciousness disorder, absence of upper respiratory tract preceding infection, hyperglycemia, hyponatremia, hypoalbuminemia, high leukocyte count, hyperfibrinogenemia, abnormal hepatic and renal function were demonstrated as poor prognostic factors.
Collapse
Affiliation(s)
- Yitao Zhang
- Department of neurology, Huashan Hospital affiliated to Fudan University, 12 M.Wulumuqi Rd, Jina'an District Shanghai, People's Republic of China
| | - Yanyin Zhao
- Department of neurology, Huashan Hospital affiliated to Fudan University, 12 M.Wulumuqi Rd, Jina'an District Shanghai, People's Republic of China
| | - Yi Wang
- Department of neurology, Huashan Hospital affiliated to Fudan University, 12 M.Wulumuqi Rd, Jina'an District Shanghai, People's Republic of China
| |
Collapse
|
13
|
Schapira AHV. Advances and insights into neurological practice 2016−17. Eur J Neurol 2017; 24:1425-1434. [DOI: 10.1111/ene.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
14
|
Pyun SY, Kang MR, Lee JY, Kuk KJ, Oh SI, Bae JS. Early discrimination of sensorimotor Guillain-Barré syndrome into demyelinating or axonal subtype by automated nerve excitability testing. J Peripher Nerv Syst 2017; 22:85-91. [DOI: 10.1111/jns.12208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 01/25/2023]
Affiliation(s)
- So Young Pyun
- Department of Neurology; National Police Hospital; Seoul Korea
| | - Mi-Ri Kang
- Department of Neurology; Busan Paik Hospital, Inje University College of Medicine; Busan Korea
| | - Ju Young Lee
- Department of Neurology, Kangdong Sacred Heart Hospital; Hallym University College of Medicine; Seoul Korea
| | - Kim Jong Kuk
- Department of Neurology; Dong-A University College of Medicine; Busan Korea
| | - Seong-Il Oh
- Department of Neurology; Busan Paik Hospital, Inje University College of Medicine; Busan Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital; Hallym University College of Medicine; Seoul Korea
| |
Collapse
|
15
|
Peric S, Bozovic I, Bjelica B, Berisavac I, Stojiljkovic O, Basta I, Beslac-Bumbasirevic L, Rakocevic-Stojanovic V, Lavrnic D, Stevic Z. Diabetes mellitus may affect short-term outcome of Guillain-Barré syndrome. J Peripher Nerv Syst 2017; 22:127-130. [DOI: 10.1111/jns.12206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine; University of Belgrade; Belgrade Serbia
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine; University of Belgrade; Belgrade Serbia
| | - Bogdan Bjelica
- Neurology Clinic, Clinical Center of Serbia, School of Medicine; University of Belgrade; Belgrade Serbia
| | - Ivana Berisavac
- Neurology Clinic, Clinical Center of Serbia, School of Medicine; University of Belgrade; Belgrade Serbia
| | - Olivera Stojiljkovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine; University of Belgrade; Belgrade Serbia
| | - Ivana Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine; University of Belgrade; Belgrade Serbia
| | | | | | - Dragana Lavrnic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine; University of Belgrade; Belgrade Serbia
| | - Zorica Stevic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine; University of Belgrade; Belgrade Serbia
| |
Collapse
|
16
|
Zhang B, Wu X, Shen D, Li T, Li C, Mao M, Zhang HL, Liu K. The clinical characteristics and short-term prognosis in elderly patients with Guillain-Barré syndrome. Medicine (Baltimore) 2017; 96:e5848. [PMID: 28072747 PMCID: PMC5228707 DOI: 10.1097/md.0000000000005848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To investigate the clinical characteristics and short-term prognosis of elderly patients with Guillain-Barré syndrome (GBS).We retrospectively analyzed the clinical data of adult GBS. According to the age, the enrolled subjects were divided into 2 groups, that is, patients ≥60 years (elderly group) and those aged 18 to 59 years (nonelderly group). The clinical characteristics and short-term prognosis of the patients in the 2 groups were compared.In total, 535 patients were enrolled. There were 67 patients fell into the elderly group with a mean age of 69 years old; while 468 patients fell into the nonelderly group with a mean age of 39 years old. We found that the elderly patients had significantly lower incidence of antecedent infections (49.3% vs 66.2%, P < 0.01). The time from onset to admission (5 vs 4 days, P < 0.05) and time from onset to nadir (7 vs 6 days, P < 0.05) were significantly longer in the elderly patients. It was noteworthy that more elderly patients were found with lymphocytopenia (55.4% vs 37.3%, P < 0.01), hyponatremia (25.0% vs 10.2%, P < 0.01), hypoalbuminemia (9.0% vs 2.6%, P < 0.05), and hyperglycemia (34.3% vs 15.2%, P < 0.01). Importantly, the elderly patients had longer duration of hospitalization (17 vs 14 days, P < 0.05), higher incidence of pneumonia (29.9% vs 18.8%, P < 0.05), and poorer short-term prognosis (58.2% vs 42.7%, P < 0.05). In patients with severe GBS, no significant differences were observed in disease severity, treatment modality, incidence of pneumonia, and duration of hospitalization between the 2 groups. However, more patients in the elderly group showed poor short-term prognosis (84.1% vs 63.8%, P < 0.01). Further, old age (≥60 years) (OR = 2.906, 95% CI: 1.174-7.194, P < 0.05) and lower Medical Research Council (MRC) score at nadir (OR = 0.948, 95% CI: 0.927-0.969, P < 0.01) were risk factors for poor short-term prognosis in severe GBS patients.The clinical characteristics and short-term prognosis of elderly patients with GBS are distinct from nonelderly adults. Old age (≥60 years) and lower nadir MRC score serve as predictor for poor short-term prognosis in severe GBS patients.
Collapse
|