1
|
Wachira VK, Farinasso CM, Silva RB, Peixoto HM, de Oliveira MRF. Incidence of Guillain-Barré syndrome in the world between 1985 and 2020: A systematic review. GLOBAL EPIDEMIOLOGY 2023; 5:100098. [PMID: 37638372 PMCID: PMC10445966 DOI: 10.1016/j.gloepi.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy that affects the peripheral nervous system. The study aimed to describe the incidence of GBS in the world up to the year 2020. Methods A systematic review was conducted. Searches were done in four databases, PUBMED, EMBASE, EBSCO and Biblioteca virtual em Saude (BVS), and in grey literature and manual search in the reference lists of eligible studies. Results A total of 72 studies were included. The incidence of GBS among the cohort studies varied from 0.30 to 6.08 cases per 100.000 habitants and 0.42 to 6.58 cases per 100.000 person-years. Among the self-controlled studies, the risk incidence ranged from 0.072 to 1 case per 100.000 habitants and 1.73 to 4.30 cases per 100.000 person-years. Conclusions The reported incidence of GBS in the world among the studies included in the review is slightly higher than that reported in previous studies. The highest incidence rates were associated with public health events of international concern.
Collapse
Affiliation(s)
- Virginia Kagure Wachira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | | | | | - Henry Maia Peixoto
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
| |
Collapse
|
2
|
Li X, Ostropolets A, Makadia R, Shoaibi A, Rao G, Sena AG, Martinez-Hernandez E, Delmestri A, Verhamme K, Rijnbeek PR, Duarte-Salles T, Suchard MA, Ryan PB, Hripcsak G, Prieto-Alhambra D. Characterising the background incidence rates of adverse events of special interest for covid-19 vaccines in eight countries: multinational network cohort study. BMJ 2021; 373:n1435. [PMID: 35727911 PMCID: PMC8193077 DOI: 10.1136/bmj.n1435] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To quantify the background incidence rates of 15 prespecified adverse events of special interest (AESIs) associated with covid-19 vaccines. DESIGN Multinational network cohort study. SETTING Electronic health records and health claims data from eight countries: Australia, France, Germany, Japan, the Netherlands, Spain, the United Kingdom, and the United States, mapped to a common data model. PARTICIPANTS 126 661 070 people observed for at least 365 days before 1 January 2017, 2018, or 2019 from 13 databases. MAIN OUTCOME MEASURES Events of interests were 15 prespecified AESIs (non-haemorrhagic and haemorrhagic stroke, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, anaphylaxis, Bell's palsy, myocarditis or pericarditis, narcolepsy, appendicitis, immune thrombocytopenia, disseminated intravascular coagulation, encephalomyelitis (including acute disseminated encephalomyelitis), Guillain-Barré syndrome, and transverse myelitis). Incidence rates of AESIs were stratified by age, sex, and database. Rates were pooled across databases using random effects meta-analyses and classified according to the frequency categories of the Council for International Organizations of Medical Sciences. RESULTS Background rates varied greatly between databases. Deep vein thrombosis ranged from 387 (95% confidence interval 370 to 404) per 100 000 person years in UK CPRD GOLD data to 1443 (1416 to 1470) per 100 000 person years in US IBM MarketScan Multi-State Medicaid data among women aged 65 to 74 years. Some AESIs increased with age. For example, myocardial infarction rates in men increased from 28 (27 to 29) per 100 000 person years among those aged 18-34 years to 1400 (1374 to 1427) per 100 000 person years in those older than 85 years in US Optum electronic health record data. Other AESIs were more common in young people. For example, rates of anaphylaxis among boys and men were 78 (75 to 80) per 100 000 person years in those aged 6-17 years and 8 (6 to 10) per 100 000 person years in those older than 85 years in Optum electronic health record data. Meta-analytic estimates of AESI rates were classified according to age and sex. CONCLUSION This study found large variations in the observed rates of AESIs by age group and sex, showing the need for stratification or standardisation before using background rates for safety surveillance. Considerable population level heterogeneity in AESI rates was found between databases.
Collapse
Affiliation(s)
- Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | - Azza Shoaibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Gowtham Rao
- Janssen Research and Development, Titusville, NJ, USA
| | - Anthony G Sena
- Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Bio-Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg, Gent, Belgium
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Talita Duarte-Salles
- Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Marc A Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, USA
| | - Patrick B Ryan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
3
|
Li X, Ostropolets A, Makadia R, Shaoibi A, Rao G, Sena AG, Martinez-Hernandez E, Delmestri A, Verhamme K, Rijnbeek PR, Duarte-Salles T, Suchard M, Ryan P, Hripcsak G, Prieto-Alhambra D. Characterizing the incidence of adverse events of special interest for COVID-19 vaccines across eight countries: a multinational network cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.25.21254315. [PMID: 33791732 PMCID: PMC8010764 DOI: 10.1101/2021.03.25.21254315] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND As large-scale immunization programs against COVID-19 proceed around the world, safety signals will emerge that need rapid evaluation. We report population-based, age- and sex-specific background incidence rates of potential adverse events of special interest (AESI) in eight countries using thirteen databases. METHODS This multi-national network cohort study included eight electronic medical record and five administrative claims databases from Australia, France, Germany, Japan, Netherlands, Spain, the United Kingdom, and the United States, mapped to a common data model. People observed for at least 365 days before 1 January 2017, 2018, or 2019 were included. We based study outcomes on lists published by regulators: acute myocardial infarction, anaphylaxis, appendicitis, Bell's palsy, deep vein thrombosis, disseminated intravascular coagulation, encephalomyelitis, Guillain-Barre syndrome, hemorrhagic and non-hemorrhagic stroke, immune thrombocytopenia, myocarditis/pericarditis, narcolepsy, pulmonary embolism, and transverse myelitis. We calculated incidence rates stratified by age, sex, and database. We pooled rates across databases using random effects meta-analyses. We classified meta-analytic estimates into Council of International Organizations of Medical Sciences categories: very common, common, uncommon, rare, or very rare. FINDINGS We analysed 126,661,070 people. Rates varied greatly between databases and by age and sex. Some AESI (e.g., myocardial infarction, Guillain-Barre syndrome) increased with age, while others (e.g., anaphylaxis, appendicitis) were more common in young people. As a result, AESI were classified differently according to age. For example, myocardial infarction was very rare in children, rare in women aged 35-54 years, uncommon in men and women aged 55-84 years, and common in those aged ≥85 years. INTERPRETATION We report robust baseline rates of prioritised AESI across 13 databases. Age, sex, and variation between databases should be considered if background AESI rates are compared to event rates observed with COVID-19 vaccines.
Collapse
Affiliation(s)
- Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Rupa Makadia
- Janssen Research and Development, Titusville, NJ, USA
| | - Azza Shaoibi
- Janssen Research and Development, Titusville, NJ, USA
| | - Gowtham Rao
- Janssen Research and Development, Titusville, NJ, USA
| | - Anthony G. Sena
- Janssen Research and Development, Titusville, NJ, USA
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Antonella Delmestri
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Talita Duarte-Salles
- Fundacio Institut Universitari per a la recerca a l’Atencio Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Marc Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
| | - Patrick Ryan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
- Janssen Research and Development, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Tavares-Da-Silva F, Mahaux O, Van Holle L, Haguinet F, Seifert H, Stegmann JU. Post-Marketing Safety Surveillance for the Adjuvanted Recombinant Zoster Vaccine: Methodology. Drug Saf 2020; 43:1223-1234. [PMID: 32862397 PMCID: PMC7686206 DOI: 10.1007/s40264-020-00989-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A diligent, systematic, regular review of aggregate safety data is essential, particularly early after vaccine introduction, as this is when safety signals not identified during clinical development may emerge. In October 2017, the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommended the adjuvanted recombinant zoster vaccine (RZV; Shingrix, GSK) as the preferred vaccine for preventing herpes zoster (HZ) and related complications in immunocompetent adults aged ≥ 50 years. Subsequently, GSK experienced an unprecedented high demand for RZV. In this methodology paper, we summarize the enhanced measures undertaken to assess RZV safety during its early post-marketing experience in the USA, Canada and Germany. In addition to the routine signal-detection methods already in place for all vaccines, GSK established tailored and enhanced safety monitoring for RZV based on aggregate data of spontaneous reports and manufacturing data. Proactive, near real-time detection and evaluation of signals was a key objective. A dedicated in-house signal-detection tool customized for RZV was employed on a weekly (rather than the routine monthly) basis, allowing for a centralized, more frequent review of data on a single web-based platform. We also identified the background incidence rates of preselected medical events of interest in the first countries to introduce RZV (USA, Canada and Germany) to perform observed-to-expected analyses. This approach may offer a solution to the challenges associated with the assessment and monitoring of vaccine safety in an efficient and timely manner in the context of high vaccine uptake.
Collapse
Affiliation(s)
| | | | - Lionel Van Holle
- GSK, Avenue Fleming 20, 1300 Wavre, Belgium
- Present Address: UCB Pharma, 1420 Braine-l’Alleud, Belgium
| | | | | | | |
Collapse
|
5
|
Stojanov A, Berisavac I, Bozovic I, Arsenijevic M, Lukic‐Rajic S, Petrovic M, Stojiljkovic‐Tamas O, Jovin Z, Djordjevic G, Jovanovic D, Stojanovic M, Martic V, Basta I, Peric S. Incidence and mortality rates of
Guillain‐Barré
syndrome in Serbia. J Peripher Nerv Syst 2020; 25:350-355. [DOI: 10.1111/jns.12412] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 01/03/2023]
Affiliation(s)
| | - Ivana Berisavac
- Neurology Clinic Clinical Center of Serbia Belgrade Serbia
- Faculty of Medicine University of Belgrade Belgrade Serbia
| | - Ivo Bozovic
- Neurology Clinic Clinical Center of Serbia Belgrade Serbia
| | | | | | | | | | - Zita Jovin
- Neurology Clinic Clinical Center of Vojvodina Novi Sad Serbia
| | - Gordana Djordjevic
- Neurology Clinic Clinical Center Nis Nis Serbia
- Faculty of Medicine University of Nis Nis Serbia
| | - Dejana Jovanovic
- Neurology Clinic Clinical Center of Serbia Belgrade Serbia
- Faculty of Medicine University of Belgrade Belgrade Serbia
| | | | - Vesna Martic
- Neurology Clinic Military Medical Academy Belgrade Serbia
| | - Ivana Basta
- Neurology Clinic Clinical Center of Serbia Belgrade Serbia
- Faculty of Medicine University of Belgrade Belgrade Serbia
| | - Stojan Peric
- Neurology Clinic Clinical Center of Serbia Belgrade Serbia
- Faculty of Medicine University of Belgrade Belgrade Serbia
| |
Collapse
|
6
|
Tavares-Da-Silva F, Co MM, Dessart C, Hervé C, López-Fauqued M, Mahaux O, Van Holle L, Stegmann JU. Review of the initial post-marketing safety surveillance for the recombinant zoster vaccine. Vaccine 2020; 38:3489-3500. [DOI: 10.1016/j.vaccine.2019.11.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/04/2023]
|
7
|
Guillain–Barré syndrome subtypes: A clinical electrophysiological study of 100 patients. Rev Neurol (Paris) 2019; 175:73-80. [DOI: 10.1016/j.neurol.2018.01.379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/22/2022]
|
8
|
Sipilä JOT, Soilu-Hänninen M, Ruuskanen JO, Rautava P, Kytö V. Epidemiology of Guillain-Barré syndrome in Finland 2004-2014. J Peripher Nerv Syst 2017; 22:440-445. [PMID: 29095548 PMCID: PMC5765466 DOI: 10.1111/jns.12239] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/21/2017] [Accepted: 10/25/2017] [Indexed: 11/28/2022]
Abstract
At total mean incidence of 0.84–1.1/100,000 the occurrence of Guillain‐Barré syndrome (GBS) is reported to be low in Finland compared to other Caucasian populations. However, a recent study from Southwestern Finland reported an incidence of 1.82/100,000 which is comparable to other Caucasian populations. We analyzed discharge data covering the years 2004 through 2014 on all neurological admissions in all Finnish university and central hospitals with a primary diagnosis of GBS. A total of 989 admissions due to GBS (917 individuals) were identified. The standardized (European population) annual incidence rate was 1.70/100,000 person‐years (95% confidence interval 1.60–1.81). GBS incidence had an increasing trend with age. The likelihood of GBS was higher among girls and adolescent women than boys and men of same age (male:female incidence rate ratio [IRR] 0.56), while in the older age groups (>19 years) the occurrence of GBS was higher among males than females (male:female IRR 1.59). The incidence of GBS remained stable during the study period. There was no seasonal variation in GBS admission frequencies (p = 0.28). No significant effect of the 2009–2010 H1N1 influenza or vaccination against it for GBS occurrence was observed. We suggest that GBS is as common, and has similar age‐distribution in Finland as in other European countries. Sex‐associated susceptibility for GBS appears to be different in children‐adolescents and adults.
Collapse
Affiliation(s)
- Jussi O T Sipilä
- Siun sote, North Karelia Central Hospital, Department of Neurology, Joensuu, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Merja Soilu-Hänninen
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Jori O Ruuskanen
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland.,Medbase Ltd, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku and Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| |
Collapse
|
9
|
Abstract
Neuromuscular disorders as a group are linked by anatomy with significant differences in pathogenetic mechanisms, clinical expression, and time course of disease. Each neuromuscular disease is relatively uncommon, yet causes a significant burden of disease socioeconomically. Epidemiologic studies in different global regions have demonstrated certain neuromuscular diseases have increased incidence and prevalence rates over time. Understanding differences in global epidemiologic trends will aid clinical research and policies focused on prevention of disease. There is a critical need to understand the global impact of neuromuscular diseases using metrics currently established for communicable and noncommunicable diseases.
Collapse
Affiliation(s)
- Jaydeep M Bhatt
- Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.
| |
Collapse
|
10
|
Abstract
Understanding of Guillain-Barré syndrome (GBS) has progressed substantially since the seminal 1916 report by Guillain et al. Although Guillain, Barré, and Strohl summarised the syndrome based on observations of two French infantrymen, 2012 saw the beginning of an ambitious collaborative study designed to collect detailed data from at least 1,000 patients worldwide (IGOS, www.gbsstudies.org/about-igos). Progress has been made in many areas even since GBS was last reviewed in this journal in 2009. GBS subsequently received prominent attention in light of concerns regarding H1N1 influenza vaccinations, and several large-scale surveillance studies resulted. Despite these developments, and promising pre-clinical studies, disease-modifying therapies for GBS have not substantially altered since intravenous immunoglobulin was introduced over 20 years ago. In other areas, management has improved. Antibiotic prophylaxis in ventilated patients reduces respiratory tract infection, thromboprophylaxis has reduced the risk of venous thromboembolism, and there is increasing awareness of the benefit of high-intensity rehabilitation. This article highlights some of the interesting and thought-provoking developments of the last 3 years, and is based on a plenary lecture given at the 2012 Peripheral Nerve Society (PNS) meeting.
Collapse
Affiliation(s)
- Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
| |
Collapse
|
11
|
Hense S, Schink T, Kreisel SH, Marcelon L, Simondon F, Tahden M, Garbe E. Estimation of Background Incidence Rates of Guillain-Barré Syndrome in Germany - A Retrospective Cohort Study with Electronic Healthcare Data. Neuroepidemiology 2014; 43:244-52. [DOI: 10.1159/000369344] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/19/2014] [Indexed: 11/19/2022] Open
|
12
|
Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain 2013; 137:33-43. [PMID: 24163275 DOI: 10.1093/brain/awt285] [Citation(s) in RCA: 456] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Guillain-Barré syndrome is an acute polyradiculoneuropathy with a variable clinical presentation. Accurate diagnostic criteria are essential for patient care and research, including clinical trials and vaccine safety studies. Several diagnostic criteria for Guillain-Barré syndrome have been proposed, including the recent set by the Brighton Collaboration. In the present study we describe in detail the key diagnostic features required to meet these Brighton criteria in a study population of 494 adult patients with Guillain-Barré syndrome, previously included in therapeutic and observational studies. The patients had a median age of 53 years (interquartile range 36-66 years) and males slightly predominated (56%). All patients developed bilateral limb weakness which generally involved both upper and lower extremities. The weakness remained restricted to the legs in 6% and to the arms in 1% of the patients. Decreased reflexes in paretic arms or legs were found initially in 91% of patients and in all patients during follow-up. Ten (2%) patients however showed persistence of normal reflexes in paretic arms. Disease nadir was reached within 2 weeks in 80%, within 4 weeks in 97% and within 6 weeks in all patients. A monophasic disease course occurred in 95% of patients, of whom 10% had a treatment-related fluctuation. A clinical deterioration after 8 weeks of onset of weakness occurred in 23 (5%) patients. Cerebrospinal fluid was examined in 474 (96%) patients. A mild pleocytosis (5 to 50 cells/μl) was found in 15%, and none had more than 50 cells/μl. An increased cerebrospinal fluid protein concentration was found only in 64% of patients, highly dependent on the timing of the lumbar puncture after onset of weakness (49% at the first day to 88% after 2 weeks). Nerve electrophysiology was compatible with the presence of a neuropathy in 99% of patients, but only 59% fulfilled the current criteria for a distinct subtype of Guillain-Barré syndrome. Patients with a complete data set (335) were classified according to the Brighton criteria, ranging from a high to a low level of diagnostic certainty, as level 1 in 61%, level 2 in 33%, level 3 in none, and level 4 in 6% of patients. Patients categorized in these levels did not differ with respect to proportion of patients with preceding events, initial clinical manifestations or outcome. The observed variability in the key diagnostic features of Guillain-Barré syndrome in the current cohort study, can be used to improve the sensitivity of the diagnostic criteria.
Collapse
Affiliation(s)
- Christiaan Fokke
- 1 Department of Neurology, Erasmus Medical Centre Rotterdam, Rotterdam, 3000 CA, The Netherlands
| | | | | | | | | | | |
Collapse
|
13
|
Chen Y, Ma F, Zhang J, Chu X, Xu Y. Population incidence of Guillain−Barré syndrome in parts of China: three large populations in Jiangsu province, 2008-2010. Eur J Neurol 2013; 21:124-9. [PMID: 24102733 DOI: 10.1111/ene.12265] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 08/23/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Chen
- Department of Expanded Program on Immunization; Jiangsu Provincial Center for Disease Control and Prevention; Nanjing Jiangsu Province China
| | - F. Ma
- Department of Expanded Program on Immunization; Jiangsu Provincial Center for Disease Control and Prevention; Nanjing Jiangsu Province China
| | - J. Zhang
- Department of Expanded Program on Immunization; Jiangsu Provincial Center for Disease Control and Prevention; Nanjing Jiangsu Province China
| | - X. Chu
- Department of Neurology; Jiangsu Provincial People's Hospital; Nanjing Jiangsu Province China
| | - Y. Xu
- Department of Neurology; Nanjing Brain Hospital; Nanjing Jiangsu Province China
| |
Collapse
|