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Acero-Garces D, Zuluaga-Lotero D, Ortiz-Muñoz D, Arango GP, Moyano M, Vargas-Manotas J, Rojas CA, Urrego J, Rojas JP, Rosso F, Ramos-Burbano GE, Llanos MD, Lizarazo J, Lopez-Gonzalez R, Jimenez-Arango JA, Benavides-Melo J, Martinez-Villota VA, Gonzalez G, Dominguez-Penuela SC, Quintero JA, Luque KA, Ruiz AM, Claros K, Osorio L, Pardo CA, Parra B. Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic. J Neurol Sci 2024; 463:123140. [PMID: 39047509 DOI: 10.1016/j.jns.2024.123140] [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: 01/30/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.
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Affiliation(s)
| | | | | | - Gloria P Arango
- Universidad Del Valle, School of Human Rehabilitation, Faculty of Health, Cali, Colombia
| | - Martha Moyano
- Universidad Del Valle, School of Public Health, Cali, Colombia
| | - José Vargas-Manotas
- Universidad Simón Bolívar, Barranquilla, Colombia; La Misericordia Clínica Internacional, Barranquilla, Colombia
| | - Christian A Rojas
- Universidad del Valle, School of Medicine, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia; Clinica Imbanaco, Department of Pediatrics, Cali, Colombia
| | - Jonathan Urrego
- Universidad del Valle, School of Medicine, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia
| | - Juan P Rojas
- Fundación Clínica Infantil Club Noel, Department of Pediatrics, Cali, Colombia; Universidad Libre seccional Cali, Cali, Colombia
| | - Fernando Rosso
- Fundación Valle del Lili, Department of Internal Medicine, Cali, Colombia; Universidad ICESI, Cali, Colombia
| | - Gustavo E Ramos-Burbano
- Universidad del Valle, School of Medicine, Cali, Colombia; Clinica Rey David, Cali, Colombia
| | | | - Jairo Lizarazo
- Hospital Universitario Erasmo Meoz, Cúcuta, Colombia; Universidad de Pamplona, Cúcuta, Colombia
| | | | | | | | | | - Guillermo Gonzalez
- Hospital Universitario de Neiva Hernando Moncaleano Perdomo, Neiva, Colombia; Universidad Surcolombiana, Neiva, Colombia
| | | | - Jaime A Quintero
- Universidad del Valle, Department of Microbiology, Cali, Colombia
| | | | | | - Katherinne Claros
- Hospital Universitario de Neiva Hernando Moncaleano Perdomo, Neiva, Colombia
| | - Lyda Osorio
- Universidad Del Valle, School of Public Health, Cali, Colombia
| | - Carlos A Pardo
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, MD, USA.
| | - Beatriz Parra
- Universidad del Valle, Department of Microbiology, Cali, Colombia
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2
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Khan SA, Das PR, Nahar Z, Dewan SMR. An updated review on Guillain-Barré syndrome: Challenges in infection prevention and control in low- and middle-income countries. SAGE Open Med 2024; 12:20503121241239538. [PMID: 38533198 PMCID: PMC10964449 DOI: 10.1177/20503121241239538] [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: 12/16/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Guillain-Barré syndrome is a rare condition that can be potentially life-threatening. Guillain-Barré syndrome does not have a definitive etiological agent. It is a syndrome that can arise from multiple factors, including various infectious diseases and immunizations. The severity of Guillain-Barré syndrome is exacerbated by these variables, especially in low-income and middle-income countries where healthcare systems are already constrained and struggle to meet the demands of other diseases. The primary aim of our article is to comprehensively examine the life-threatening nature and intensity of Guillain-Barré syndrome by assessing its etiology, progression, and prevalence in low- and middle-income nations while also considering global trends. Furthermore, we proposed the implementation of standard and efficacious treatment and diagnostic resources that are readily accessible and successful in affluent nations and should also be readily accessible in impoverished nations without any unnecessary delay. Our study also emphasized the epidemiological data with molecular epidemiological analysis and the utilization of artificial technology in low- and middle-income nations. The goal was to decrease the incidence of Guillain-Barré syndrome cases and facilitate early detection.
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Affiliation(s)
- Sakif Ahamed Khan
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | - Proma Rani Das
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | - Zabun Nahar
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
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3
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Song Y, Zheng X, Fang Y, Liu S, Liu K, Zhu J, Wu X. Current status of Guillain-Barré syndrome (GBS) in China: a 10-year comprehensive overview. Rev Neurosci 2023; 34:869-897. [PMID: 37145885 DOI: 10.1515/revneuro-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy; a disease involving the peripheral nervous system which is the most common cause of acute flaccid paralysis worldwide. So far, it is still lack of a comprehensive overview and understanding of the national epidemiological, clinical characteristics, and the risk factors of GBS in China, as well as differences between China and other countries and regions in these respects. With the global outbreak of the coronavirus disease 2019 (COVID-19), an epidemiological or phenotypic association between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and GBS has attracted great attention. In this review, we outlined the current clinical data of GBS in China by retrieving literature, extracting and synthesizing the data of GBS in China from 2010 to 2021. Besides, we compared the characteristics of epidemiology, preceding events and clinical profiles of GBS between China and other countries and regions. Furthermore, in addition to conventional intravenous immunoglobulin (IVIG) and plasma exchange (PE) therapy, the potential therapeutic effects with novel medications in GBS, such as complement inhibitors, etc., have become the research focus in treatments. We found that epidemiological and clinical findings of GBS in China are approximately consistent with those in the International GBS Outcome Study (IGOS) cohort. We provided an overall picture of the present clinical status of GBS in China and summarized the global research progress of GBS, aiming to further understand the characteristics of GBS and improve the future work of GBS worldwide, especially in countries with the middle and low incomes.
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Affiliation(s)
- Yanna Song
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, 510000 Guangzhou, China
| | - Xiaoxiao Zheng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Yong Fang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Shan Liu
- The Second Hospital of Jilin University, Jilin University, Ziqiang Street 218, 130022 Changchun, China
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, 17177 Solna, Stockholm, Sweden
| | - Xiujuan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
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Breville G, Sukockiene E, Vargas MI, Lascano AM. Emerging biomarkers to predict clinical outcomes in Guillain-Barré syndrome. Expert Rev Neurother 2023; 23:1201-1215. [PMID: 37902064 DOI: 10.1080/14737175.2023.2273386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an immune-mediated poly(radiculo)neuropathy with a variable clinical outcome. Identifying patients who are at risk of suffering from long-term disabilities is a great challenge. Biomarkers are useful to confirm diagnosis, monitor disease progression, and predict outcome. AREAS COVERED The authors provide an overview of the diagnostic and prognostic biomarkers for GBS, which are useful for establishing early treatment strategies and follow-up care plans. EXPERT OPINION Detecting patients at risk of developing a severe outcome may improve management of disease progression and limit potential complications. Several clinical factors are associated with poor prognosis: higher age, presence of diarrhea within 4 weeks of symptom onset, rapid and severe weakness progression, dysautonomia, decreased vital capacity and facial, bulbar, and neck weakness. Biological, neurophysiological and imaging measures of unfavorable outcome include multiple anti-ganglioside antibodies elevation, increased serum and CSF neurofilaments light (NfL) and heavy chain, decreased NfL CSF/serum ratio, hypoalbuminemia, nerve conduction study with early signs of demyelination or axonal loss and enlargement of nerve cross-sectional area on ultrasound. Depicting prognostic biomarkers aims at predicting short-term mortality and need for cardio-pulmonary support, long-term patient functional outcome, guiding treatment decisions and monitoring therapeutic responses in future clinical trials.
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Affiliation(s)
- Gautier Breville
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Egle Sukockiene
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Maria Isabel Vargas
- Neuroradiology Division, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Agustina M Lascano
- Neurology Division, Neuroscience Department, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Shibeshi MS, Mengesha AA, Gari KT. Pediatric Guillain-Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management Challenges, and Hospital Outcome. Pediatric Health Med Ther 2023; 14:107-115. [PMID: 36993874 PMCID: PMC10040339 DOI: 10.2147/phmt.s401461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Background Guillain-Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. There remain diagnostic and treatment challenges in resource limited settings. This study aimed to describe the clinical presentation, diagnostic and management challenges, and hospital outcome of children with GBS in southern Ethiopia. Methods A retrospective chart review of children aged ≤14 years who were admitted with a diagnosis of GBS to Hawassa University Comprehensive Specialized Hospital from 2017 to 2021 was done. Medical records of 102 children who fulfilled the Brighton Criteria for GBS were reviewed, and data on demographic, clinical characteristics, investigation findings, treatment, and outcome were collected. Logistic regression analysis was done to determine factors associated with mortality. Results The mean age of the study subjects was 7.25±3.91 years and 63.7% were male. Antecedent event was present in 48% of the cases, and the most common triggering factor was upper respiratory tract infection (63.8%). The mean Hughes disability score was 4.23±0.54, 4.48±0.71, and 4.03±0.86 at admission, nadir and discharge from hospital, respectively. Cranial nerve involvement was present in 27.5% of patients and bulbar palsy was the most common finding. Dysautonomia was observed in 57.8% of the participants. Sixty-three patients (61.8%) needed ICU care but only 43 of them (68.3%) were admitted to ICU. Similarly, 31 patients (30.4%) required respiratory support but only 24 of them (77.4%) were on mechanical ventilator. No patient had nerve conduction study. Only 5.9% of patients received IVIG. Thirteen patients (12.7%) died of GBS and the presence of respiratory failure was the only determinant of mortality [AOR = 11.40 (95% CI: 1.818, 71.52), p = 0.009]. Conclusion There is a gap in the diagnosis and management of children with GBS; and mortality from the disease is higher than reports from other settings.
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Affiliation(s)
- Mulugeta Sitot Shibeshi
- Department of Pediatrics and Child Health, Hawassa University, Hawassa, Ethiopia
- Correspondence: Mulugeta Sitot Shibeshi, Email
| | - Adane Alto Mengesha
- Department of Pediatrics and Child Health, Arba Minch University, Arba Minch, Ethiopia
| | - Kefyalew Taye Gari
- Department of Pediatrics and Child Health, Hawassa University, Hawassa, Ethiopia
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6
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Diagnostic Pitfalls in Guillain-Barré Syndrome: Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121969. [PMID: 36553412 PMCID: PMC9776903 DOI: 10.3390/children9121969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Guillain-Barré syndrome (GBS) represents a group of acute immune-mediated polyradiculoneuropathies that is usually characterized by symmetrical limb weakness and areflexia. GBS can also lead to atypical clinical findings, which may lead to confusion and errors in the diagnosis. In this report, we describe a case of Guillain-Barré syndrome in a 7-year-old child who presented with neck stiffness, headache and vomiting mimicking acute meningoencephalitis, arthritis and myositis. Symptoms of ascending paralysis developed subsequently. Clearly, the atypical presentation of GBS is a significant dilemma for pediatricians and may lead to delays in diagnosis and treatment.
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7
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Papri N, Doets AY, Mohammad QD, Endtz HP, Lingsma HF, Jacobs BC, Islam Z. Validation and adjustment of modified Erasmus GBS outcome score in Bangladesh. Ann Clin Transl Neurol 2022; 9:1264-1275. [PMID: 35908170 PMCID: PMC9380155 DOI: 10.1002/acn3.51627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/06/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
Objective We have assessed and improved the performance of the modified Erasmus GBS Outcome Score (mEGOS) among patients with Guillain‐Barré syndrome (GBS) from Bangladesh. Methods Validation cohort consisted of patients with GBS from two prospective cohort studies in Bangladesh. Poor outcome was defined as being unable to walk independently at week 4 and week 26. We excluded patients able to walk independently, patients who died within the first week, or with missing GBS disability scores. Performance of mEGOS at entry and week 1 was determined based on the discriminative ability (ability to differentiate between patients able and unable to walk independently; measured using the area under the receiver operating characteristic curves [AUC]) and calibration (observed probability versus predicted probability of poor outcome). Results A total of 506 patients aged ≥6‐year‐old were enrolled, with 471 and 366 patients included in mEGOS validation analysis at entry and week 1, respectively. The AUC values for predicting poor outcome (1) at week 4 were 0.69 (mEGOS entry) and 0.78 (mEGOS week 1) and (2) at week 26 were 0.67 (mEGOS entry) and 0.70 (mEGOS week 1). Mean predicted probabilities of poor outcome corresponded with observed outcomes except for the probability of poor outcome at week 4 which was overestimated by mEGOS week 1. This was resolved by updating the model intercept. Interpretation The mEGOS shows valid outcome predictions among patients with GBS from Bangladesh. The model can aid the identification of patients at high risk of poor outcome and help to adequately allocate healthcare resources in low‐resource settings.
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Affiliation(s)
- Nowshin Papri
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh.,Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Alex Y Doets
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
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8
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Sommer C. Natural Course of Guillain-Barré Syndrome. Eur J Neurol 2022; 29:2881-2882. [PMID: 35837797 DOI: 10.1111/ene.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Claudia Sommer
- Department of Neurology, University Hospital of Würzburg, Germany
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9
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Sutantoyo FF, Fadil, Basuki M, Fidiana, Hamdan M. Correlation Between Neutrophil-to-Lymphocyte Ratio and Motoric Deterioration in Patients With Guillain-Barre Syndrome. J Clin Neurol 2022; 18:671-680. [DOI: 10.3988/jcn.2022.18.6.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Felisitas Farica Sutantoyo
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Fadil
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Mudjiani Basuki
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Fidiana
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Muhammad Hamdan
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
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I Espiritu A, Separa KJNJ, Milla FJC, Adiao KJB, Leochico CFD, Jamora RDG. Clinical features and real-world outcomes of Guillain-Barré syndrome in the Philippines. Neurol Res 2021; 43:995-1004. [PMID: 34229572 DOI: 10.1080/01616412.2021.1948750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our study aimed to determine the profile of Guillain-Barré syndrome (GBS) in the Philippines, compare the outcomes who received intravenous immunoglobulin (IVIg) and therapeutic plasma exchange (TPE), and determine the factors related to hospital stay and late motor recovery. METHODS We conducted a retrospective cohort study of adult GBS patients admitted to the Philippine General Hospital from 2009 to 2019. RESULTS We included 105 patients with confirmed GBS diagnoses. The median age was 43 years (interquartile range 32 to 56); the female-to-male ratio was 1.62:1; the predominant variant was acute inflammatory demyelinating polyneuropathy (n = 40, 38.1%). The difference in outcomes of patients in the IVIg (n = 44) and TPE (n = 24) groups (walking with aid/GBS-disability scores/ventilator dependency at 1 month, duration dependent on the ventilator, intensive care unit stay, and hospital stay) were not statistically significant, except for mild disability at 1 month (p = 0.009). Pneumonia, urinary tract infection, and dysautonomia were significantly related to a prolonged hospital stay. No predetermined variables were associated with late motor recovery. After adjusting for age and sex, the cumulative hazard risk for late motor recovery was 0.69 (95% CI 0.27-1.74). CONCLUSION Our study presented the first comprehensive information regarding the features and outcomes of GBS patients in the Philippines. ABBREVIATIONS AIDP - Acute inflammatory demyelinating polyneuropathy; AMAN - Acute motor axonal neuropathy; AMSAN - Acute motor and sensory axonal neuropathy; GBS - Guillain-Barré syndrome; GBS-DS - Guillain-Barré syndrome disability scale; ICU - Intensive care unit; IVIg - Intravenous immunoglobulin; MFS - Miller-Fisher syndrome; PGH - Philippine General Hospital; TPE - Therapeutic plasma exchange.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Karl Josef Niño J Separa
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Francis Jordan C Milla
- College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Karen Joy B Adiao
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Carl Froilan D Leochico
- Department of Rehabilitation Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City and Global City, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines
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Roberts M, Jin P, Shin S, Dhamoon M. Readmissions After Guillain-Barre Syndrome: Nationally Representative Data. J Clin Neuromuscul Dis 2021; 22:183-191. [PMID: 34019002 DOI: 10.1097/cnd.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We aimed to obtain nationally representative data on hospital readmission rates after Guillain-Barre syndrome (GBS). METHODS International Classification of Disease, Ninth Revision codes from the 2013 National Readmissions Database identified adult GBS admissions, comorbidities, and readmission diagnoses. Logistic regression estimated odds ratios (ORs) for readmission. RESULTS Of 2109 GBS admissions identified, 20.8% were readmitted within 1 year and 12.2% within 30 days. Age did not predict readmission. Plasmapheresis use showed a nonsignificant trend toward readmission versus intravenous immunoglobulin use [OR 1.43, 95% confidence interval (CI) 1.00-2.051, P = 0.050]. Respiratory failure (OR 1.70, 95% CI 1.23-2.35, P = 0.0014), heart failure (OR 2.14, 95% CI 1.25-3.66, P = 0.0057), and renal failure (OR 2.00, 95% CI 1.20-3.32, P = 0.0078) predicted readmission. Top readmission diagnoses included GBS or chronic inflammatory demyelinating polyneuropathy (42.0%) and sepsis (3.5%). CONCLUSIONS One-fifth of GBS patients were readmitted within 1 year. Comorbid illnesses and respiratory complications increased a readmission risk but age did not.
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Affiliation(s)
- Mallory Roberts
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
| | - Peter Jin
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
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12
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Kasemsap N, Vorasoot N, Kongbunkiat K, Tiamkao S, Chotmongkol V, Sawanyawisuth K, Panitchote A. The epidemiology of Guillain-Barré syndrome in Thailand over 13 years (2005-2017): A nationwide population-based retrospective cohort study. J Peripher Nerv Syst 2021; 26:202-208. [PMID: 33969589 DOI: 10.1111/jns.12453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/30/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
There have been no published studies examining the epidemiology of Guillain-Barré syndrome (GBS) in large populations in Thailand. This study aimed to explore the incidence, patient characteristics, seasonality, treatments, and outcomes of GBS in Thailand. The National Health Security Office (NHSO) provided data on in-patient admission between fiscal year 2005 and 2017. We selected all patients with a primary diagnosis of GBS. We retrieved data regarding the total population from the Department of Provincial Administration. A total of 4521 patients with GBS were included. The median age was 42 years (IQR 22-56), and 61.5% were male. The incidence rate increased from 0.48 to 0.93 per 100 000 population over the 13 years. The incidence was increased with age and a male-to-female ratio of 1.6:1. There was seasonal variation in the rate of admission for GBS, with significantly more patients admitted in rainy vs summer (IRR 1.94, 95%CI 1.80-2.10, P < .001) and winter vs summer (IRR 1.48, 95%CI 1.36-1.60, P < .001). Treatment with IVIg increased from 4.4% to 29.6% (P < .001), whereas plasmapheresis decreased significantly from 4% to 1.32% (P = .017). The mortality rate was 3.5%. Elderly and young adults had a significantly higher mortality rate when compared to children and teenagers (P < .001 and P = .003). The incidence of GBS in Thailand was steady over 13 years and was greater in rainy and winter season. Treatment with IVIg increased while plasmapheresis decreased. Mortality was higher in elderly patients.
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Affiliation(s)
- Narongrit Kasemsap
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Nisa Vorasoot
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Kannikar Kongbunkiat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Veerajit Chotmongkol
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anupol Panitchote
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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13
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Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet 2021; 397:1214-1228. [PMID: 33647239 DOI: 10.1016/s0140-6736(21)00517-1] [Citation(s) in RCA: 240] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/07/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis worldwide. Most patients present with an antecedent illness, most commonly upper respiratory tract infection, before the onset of progressive motor weakness. Several microorganisms have been associated with Guillain-Barré syndrome, most notably Campylobacter jejuni, Zika virus, and in 2020, the severe acute respiratory syndrome coronavirus 2. In C jejuni-related Guillain-Barré syndrome, there is good evidence to support an autoantibody-mediated immune process that is triggered by molecular mimicry between structural components of peripheral nerves and the microorganism. Making a diagnosis of so-called classical Guillain-Barré syndrome is straightforward; however, the existing diagnostic criteria have limitations and can result in some variants of the syndrome being missed. Most patients with Guillain-Barré syndrome do well with immunotherapy, but a substantial proportion are left with disability, and death can occur. Results from the International Guillain-Barré Syndrome Outcome Study suggest that geographical variations exist in Guillain-Barré syndrome, including insufficient access to immunotherapy in low-income countries. There is a need to provide improved access to treatment for all patients with Guillain-Barré syndrome, and to develop effective disease-modifying therapies that can limit the extent of nerve injury. Clinical trials are currently underway to investigate some of the potential therapeutic candidates, including complement inhibitors, which, together with emerging data from large international collaborative studies on the syndrome, will contribute substantially to understanding the many facets of this disease.
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Affiliation(s)
- Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Helmar C Lehmann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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14
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Papri N, Islam Z, Leonhard SE, Mohammad QD, Endtz HP, Jacobs BC. Guillain-Barré syndrome in low-income and middle-income countries: challenges and prospects. Nat Rev Neurol 2021; 17:285-296. [PMID: 33649531 PMCID: PMC7920001 DOI: 10.1038/s41582-021-00467-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
The epidemiology, clinical characteristics, management and outcome of Guillain-Barré syndrome (GBS) differ between low-income and middle-income countries (LMIC) and high-income countries (HIC). At present, limited data are available on GBS in LMIC and the true incidence of GBS in many LMIC remains unknown. Increased understanding of GBS in LMIC is needed because poor hygiene and high exposure to infections render populations in LMIC vulnerable to GBS outbreaks. Furthermore, insufficient diagnostic and health-care facilities in LMIC contribute to delayed diagnosis in patients with severe presentations of GBS. In addition, the lack of national clinical guidelines and absence of affordable, effective treatments contribute to worse outcomes and higher mortality in LMIC than HIC. Systematic population-based surveillance studies, cohort and case-control studies are required to understand the incidence and risk factors for GBS. Novel, targeted and cost-effective treatment strategies need to be developed in the context of health system challenges in LMIC. To ensure integrative rehabilitation services in LMIC, existing prognostic models must be validated, and responsive outcome measures that are cross-culturally applicable must be developed. Therefore, fundamental and applied research to improve the clinical management of GBS in LMIC should become a critical focus of future research programmes.
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Affiliation(s)
- Nowshin Papri
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh ,grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Zhahirul Islam
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sonja E. Leonhard
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Quazi D. Mohammad
- grid.489064.7National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hubert P. Endtz
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.434215.50000 0001 2106 3244Fondation Mérieux, Lyon, France
| | - Bart C. Jacobs
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.5645.2000000040459992XDepartment of Immunology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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15
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Hayat S, Ahmad O, Mahmud I, Howlader MZH, Islam Z. Association of matrix metalloproteinase-9 polymorphism with severity of Guillain-Barré syndrome. J Neurol Sci 2020; 415:116908. [DOI: 10.1016/j.jns.2020.116908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
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16
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Guillain-Barré syndrome in a heart transplantation recipient. J Am Assoc Nurse Pract 2020; 33:639-645. [PMID: 32282569 DOI: 10.1097/jxx.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT A rare case of a heart transplantation recipient with Guillain-Barré syndrome occurred, which was associated with peripheral nervous system damage. Based on a review of epidemiological research, the symptom development process, and diagnostic tools, the authors highlight the extreme rarity of this postinfectious immune disease. After diagnosis, plasma exchange and immunoregulatory therapy should be performed because they result in rapid recovery. If there is delayed diagnosis and treatment, there is a high risk of disability or death. When patients experience acute limb paralysis as the main symptom, nurse practitioners (NPs) should focus on the patient's history, particularly with regard to infectious agents. Closely monitoring the patient to detect respiratory failure and the need for early respiratory intervention can help the patient to avoid the severe complication of permanent brain injury. For NPs, performance of early differential diagnosis is important, especially among patients who have immunosuppressive dependence after transplantation.
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17
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Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, van Doorn PA, Dourado ME, Hughes RAC, Islam B, Kusunoki S, Pardo CA, Reisin R, Sejvar JJ, Shahrizaila N, Soares C, Umapathi T, Wang Y, Yiu EM, Willison HJ, Jacobs BC. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019; 15:671-683. [PMID: 31541214 PMCID: PMC6821638 DOI: 10.1038/s41582-019-0250-9] [Citation(s) in RCA: 401] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Abstract
Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
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Affiliation(s)
- Sonja E Leonhard
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Melissa R Mandarakas
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Francisco A A Gondim
- Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Kathleen Bateman
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maria L B Ferreira
- Department of Neurology, Hospital da Restauração, Recife, Pernambuco, Brazil
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mario E Dourado
- Department of Integrative Medicine, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Richard A C Hughes
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Badrul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - James J Sejvar
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Cristiane Soares
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Eppie M Yiu
- Department of Neurology, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
- Neurosciences Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Hugh J Willison
- College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands.
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.
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18
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Capasso A, Ompad DC, Vieira DL, Wilder-Smith A, Tozan Y. Incidence of Guillain-Barré Syndrome (GBS) in Latin America and the Caribbean before and during the 2015-2016 Zika virus epidemic: A systematic review and meta-analysis. PLoS Negl Trop Dis 2019; 13:e0007622. [PMID: 31449532 PMCID: PMC6730933 DOI: 10.1371/journal.pntd.0007622] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/06/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015-2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS. METHODS AND FINDINGS For this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and timeframe, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS. The study is registered with PROSPERO, number CRD42018086659. Of the 6568 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29-2.12, I2<0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 (95% CI 2.3-2.9) times during ZIKV and 1.9 (95% CI 1.1-3.4) times during chikungunya outbreaks over background rates. A limitation of this review is that the studies included employed different methodologies to find and ascertain cases of GBS, which could contribute to IR heterogeneity. In addition, it is important to consider that data on GBS are lacking for many countries in the region. CONCLUSIONS Background IRs of GBS appear to peak during arboviral disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness, particularly during arboviral epidemics. TRIAL REGISTRATION Registered with PROSPERO: CRD42018086659.
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Affiliation(s)
- Ariadna Capasso
- NYU College of Global Public Health, New York University, New York, New York, United States of America
| | - Danielle C. Ompad
- NYU College of Global Public Health, New York University, New York, New York, United States of America
| | - Dorice L. Vieira
- New York University Health Sciences Library, NYU School of Medicine, NYU Langone Medical Center, New York, New York, United States of America
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Global Health and Epidemiology, University of Umea, Umea, Sweden
| | - Yesim Tozan
- NYU College of Global Public Health, New York University, New York, New York, United States of America
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19
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Doets AY, Verboon C, van den Berg B, Harbo T, Cornblath DR, Willison HJ, Islam Z, Attarian S, Barroso FA, Bateman K, Benedetti L, van den Bergh P, Casasnovas C, Cavaletti G, Chavada G, Claeys KG, Dardiotis E, Davidson A, van Doorn PA, Feasby TE, Galassi G, Gorson KC, Hartung HP, Hsieh ST, Hughes RAC, Illa I, Islam B, Kusunoki S, Kuwabara S, Lehmann HC, Miller JAL, Mohammad QD, Monges S, Nobile Orazio E, Pardo J, Pereon Y, Rinaldi S, Querol L, Reddel SW, Reisin RC, Shahrizaila N, Sindrup SH, Waqar W, Jacobs BC. Regional variation of Guillain-Barré syndrome. Brain 2019; 141:2866-2877. [PMID: 30247567 DOI: 10.1093/brain/awy232] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/23/2018] [Indexed: 12/24/2022] Open
Abstract
Guillain-Barré syndrome is a heterogeneous disorder regarding the clinical presentation, electrophysiological subtype and outcome. Previous single country reports indicate that Guillain-Barré syndrome may differ among regions, but no systematic comparative studies have been conducted. Comparative studies are required to identify factors determining disease susceptibility, variation and prognosis, and to improve diagnostic criteria. The International Guillain-Barré Syndrome Outcome Study is a prospective, observational cohort study including all patients within the diagnostic spectrum, aiming to describe the heterogeneity of Guillain-Barré syndrome worldwide. The current study was based on the first 1000 inclusions with a follow-up of at least 1 year and confirmed the variation in clinical presentation, course and outcome between patients. The full clinical spectrum of Guillain-Barré syndrome was observed in patients from all countries participating in the International Guillain-Barré Syndrome Outcome Study, but the frequency of variants differed between regions. We compared three regions based on geography, income and previous reports of Guillain-Barré syndrome subtypes: 'Europe/Americas', 'Asia' (without Bangladesh), and 'Bangladesh'. We excluded 75 (8%) patients because of alternative diagnoses, protocol violations, or missing data. The predominant clinical variant was sensorimotor in Europe/Americas (n = 387/562, 69%) and Asia (n = 27/63, 43%), and pure motor in Bangladesh (n = 74/107, 69%). Miller Fisher syndrome and Miller Fisher-Guillain-Barré overlap syndrome were more common in Asia (n = 14/63, 22%) than in the other two regions (Europe/Americas: n = 64/562, 11%; Bangladesh: n = 1/107, 1%) (P < 0.001). The predominant electrophysiological subtype was demyelinating in all regions (Europe/Americas: n = 312/573, 55%; Asia: n = 29/65, 45%; Bangladesh: n = 38/94, 40%). The axonal subtype occurred more often in Bangladesh (n = 34/94, 36%) than in Europe/Americas (n = 33/573, 6%) and other Asian countries (n = 4/65, 6%) (P < 0.001). In all regions, patients with the axonal subtype were younger, had fewer sensory deficits, and showed a trend towards poorer recovery compared to patients with the demyelinating subtype. The proportion of patients able to walk unaided after 1 year varied between Asia (n = 31/34, 91%), Europe/Americas (n = 334/404, 83%) and Bangladesh (n = 67/97, 69%) (P = 0.003). A similar variation was seen for mortality, being higher in Bangladesh (n = 19/114, 17%) than in Europe/Americas (n = 23/486, 5%) and Asia (n = 1/45, 2%) (P < 0.001). This study showed that factors related to geography have a major influence on clinical phenotype, disease severity, electrophysiological subtype, and outcome of Guillain-Barré syndrome.
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Affiliation(s)
- Alex Y Doets
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Christine Verboon
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Bianca van den Berg
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Nörrebrogade 44, 8000, Aarhus, Denmark
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University, 733 North Broadway, 21205 MD, Baltimore, USA
| | - Hugh J Willison
- Department of Neurology, University of Glasgow, University Avenue, G12 8QQ, Glasgow, UK
| | - Zhahirul Islam
- Department of Laboratory Sciences and Services Division, The International Centre for Diarrhoeal Disease Research, GBP Box 128, 1000, Dhaka, Bangladesh
| | - Shahram Attarian
- Department of Neurology, CHU Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Fabio A Barroso
- Department of Neurology, Instituto de Investigaciones Neurológicas Raúl Carrea, FLENI, Montañeses 2325, Buenos Aires, Argentina
| | - Kathleen Bateman
- Department of Neurology, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory 7925, Cape Town, South Africa
| | - Luana Benedetti
- Department of Neurology, Ospedale Sant' Andrea La Spezia, Via Vittorio Veneto 197, 19121 SP, La Spezia, Italy
| | - Peter van den Bergh
- Department of Neurology, University Hospital St. Luc, University of Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Carlos Casasnovas
- Department of Neurology, Bellvitge University Hospital, Carrer de la Feixa Llarga 8907, Barcelona, Spain
| | - Guido Cavaletti
- Department of Neurology, University Milano-Bicocca, Via Cadore 48, 20900 MB, Monza, Italy
| | - Govindsinh Chavada
- Department of Neurology, University of Glasgow, University Avenue, G12 8QQ, Glasgow, UK
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, POB 1425, 41110, Larissa, Greece
| | - Amy Davidson
- Department of Neurology, University of Glasgow, University Avenue, G12 8QQ, Glasgow, UK
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Tom E Feasby
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, Canada
| | - Giuliana Galassi
- Department of Neurology, University Hospital of Modena, Via P. Giardini 1455, 41126, Modena, Italy
| | - Kenneth C Gorson
- Department of Neurology, Tufts University School of Medicine, 736 Cambridge Street, 2135, Boston, USA
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty and Center of Neurology and Neuropsychiatry, Heinrich-Heine-University Düsseldorf, Moorenstrasse 1, 40225, Düsseldorf, Germany
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, 7 Chung-Shan S Road, 10002, Taipei City, Taiwan
| | - Richard A C Hughes
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG, London, UK
| | - Isabel Illa
- Department of Neurology, Hospital de la Santa Creu I Santa Pau, C/Sant Antoni M. Claret 167, 8025, Barcelona, Spain
| | - Badrul Islam
- Department of Laboratory Sciences and Services Division, The International Centre for Diarrhoeal Disease Research, GBP Box 128, 1000, Dhaka, Bangladesh
| | - Susumu Kusunoki
- Department of Neurology, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670, Chiba, Japan
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Kerpenerstrasse 62, 50937, Cologne, Germany
| | - James A L Miller
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, NE1 4LP, Newcastle, UK
| | - Quazi Deen Mohammad
- National Institute of Neuroscience and Hospital, Sher-E-Bangla Nagar, 1207, Dhaka, Bangladesh
| | - Soledad Monges
- Department of Neurology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881, 1245, Buenos Aires, Argentina
| | - Eduardo Nobile Orazio
- Department of Neurology, Milan University, Via Manzoni 56, 20089, Rozzano, MI, Milan, Italy
| | - Julio Pardo
- Department of Neurology, Hospital Clínico de Santiago, Travesia Choupana, S/N 15706, Santiago de Compostela (A Coruña), Spain
| | - Yann Pereon
- Department of Clinical Neurophysiology, Reference centre for NMD, CHU Nantes, Place Alexis-Ricordeau, 44093, Nantes, France
| | - Simon Rinaldi
- Department of Clinical Neurosciences, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Headly Way, Headington, OX3 9DU, Oxford, UK
| | - Luis Querol
- Department of Neurology, Hospital de la Santa Creu I Santa Pau, C/Sant Antoni M. Claret 167, 8025, Barcelona, Spain
| | - Stephen W Reddel
- Department of Neurology, Concord Hospital, Hospital Road, 2139, Sydney NSW, Australia
| | - Ricardo C Reisin
- Department of Neurology, Hospital Británico, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Nortina Shahrizaila
- Department of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
| | - Soren H Sindrup
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Waheed Waqar
- Department of Neurology, University of Vermont, 89 South William Street 5401, Burlington, USA
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Immunology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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20
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Verboon C, Doets AY, Galassi G, Davidson A, Waheed W, Péréon Y, Shahrizaila N, Kusunoki S, Lehmann HC, Harbo T, Monges S, Van den Bergh P, Willison HJ, Cornblath DR, Jacobs BC. Current treatment practice of Guillain-Barré syndrome. Neurology 2019; 93:e59-e76. [PMID: 31175208 DOI: 10.1212/wnl.0000000000007719] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/13/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To define the current treatment practice of Guillain-Barré syndrome (GBS). METHODS The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. RESULTS We excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE. CONCLUSIONS In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.
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Affiliation(s)
- Christine Verboon
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alex Y Doets
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Giuliana Galassi
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amy Davidson
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Waqar Waheed
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yann Péréon
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nortina Shahrizaila
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susumu Kusunoki
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Helmar C Lehmann
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas Harbo
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Soledad Monges
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter Van den Bergh
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hugh J Willison
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - David R Cornblath
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bart C Jacobs
- From the Departments of Neurology (C.V., A.Y.D., B.C.J.) and Immunology (B.C.J.), Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Neurology (G.G.), University Hospital of Modena, Italy; Department of Neurology (A.D., H.J.W.), University of Glasgow, UK; Department of Neurology (W.W.), University of Vermont Medical Center, Burlington; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, Nantes University Hospital, France; Department of Medicine (N.S.), University of Malaya, Kuala Lumpur, Malaysia; Department of Neurology (S.K.), Kindai University Faculty of Medicine, Osaka, Japan; Department of Neurology (H.C.L.), Universitätsklinikum Köln, Germany; Department of Neurology (T.H.), Aarhus University Hospital, Denmark; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Department of Neurology (P.V.d.B.), University Hospital St-Luc, University of Louvain, Brussels, Belgium; and Department of Neurology (D.R.C.), Johns Hopkins University School of Medicine, Baltimore, MD.
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Tan CY, Razali SNO, Goh KJ, Shahrizaila N. The utility of Guillain-Barré syndrome prognostic models in Malaysian patients. J Peripher Nerv Syst 2019; 24:168-173. [PMID: 31001904 DOI: 10.1111/jns.12320] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/28/2022]
Abstract
Guillain-Barré syndrome (GBS) is an acute immune-mediated neuropathy that has variable disease course and outcome. The Erasmus GBS outcome score (EGOS), modified EGOS (mEGOS), and Erasmus GBS respiratory insufficiency score (EGRIS) are prognostic models designed to predict the functional outcome of GBS patients at 6 months (EGOS and mEGOS) and the need for mechanical ventilation within a week of admission (EGRIS). The models were primarily developed in the Dutch GBS population, and thus the usefulness of these models in other GBS cohorts is less clear. In the current study, we aimed to validate mEGOS, EGOS, and EGRIS in Malaysian GBS patients. A total of 107 patients with GBS and its variants were consecutively recruited. Patients with GBS and Miller Fisher syndrome (MFS) were analysed separately. In the GBS cohort, high mEGOS and EGOS scores were significantly correlated with poor outcome at 6 months (mEGOS on admission: r = .381, P = .005; mEGOS at day 7 of admission: r = .507, P < .001; EGOS: r = .484, P < .001). However, there were no significant correlations between mEGOS or EGOS and outcome in patients with MFS (mEGOS on admission: r = .152, P = .523; mEGOS at day 7 of admission: r = .008, P = .973; EGOS: r = .110; P = .644). The score of EGRIS for GBS patients with mechanical ventilation was significantly higher than those patients without mechanical ventilation (4 ± 2 vs 3 ± 1; P < .001). We conclude that mEGOS and EGOS are clinically useful and relevant to the Malaysian GBS population but not in patients with classic MFS. EGRIS could be used to predict the need for mechanical ventilation in our local GBS patients.
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Affiliation(s)
- Cheng-Yin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti N O Razali
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean-Jin Goh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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22
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H Siddiqui S, H Siddiqui T, U Babar M, Khoja A, Khan S. Outcomes of patients with Guillain Barre Syndrome – Experience from a tertiary care hospital of a developing Asian country and review of regional literature. J Clin Neurosci 2019; 62:195-198. [DOI: 10.1016/j.jocn.2018.11.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/11/2018] [Indexed: 12/26/2022]
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Islam Z, Papri N, Ara G, Ishaque T, Alam AU, Jahan I, Islam B, Mohammad QD. Risk factors for respiratory failure in Guillain-Barré syndrome in Bangladesh: a prospective study. Ann Clin Transl Neurol 2019; 6:324-332. [PMID: 30847364 PMCID: PMC6389747 DOI: 10.1002/acn3.706] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/06/2022] Open
Abstract
Objective We investigated clinical, biological, and electrophysiological risk factors for mechanical ventilation (MV) and patient outcomes in Bangladesh using one of the largest, prospective Guillain-Barré syndrome (GBS) cohorts in developing world. Methods A total of 693 GBS patients were included in two GBS studies conducted between 2006 and 2016 in Dhaka, Bangladesh. Associations between baseline characteristics and MV were tested using Fisher's exact test, χ2 test, or Mann-Whitney U-test, as appropriate. Risk factors for MV were assessed using multivariate logistic regression. Survival analysis was performed using Kaplan-Meier method; comparisons between groups performed using log-rank test. Results Of 693 patients, 155 (23%) required MV (median age, 26 years; interquartile range [IQR] 17-40). Among the ventilated patients, males were predominant (68%) than females. The most significant risk factor for MV was bulbar involvement (adjusted odds ratio [AOR]:19.07; 95% CI = 89.00-192.57, P = 0.012). Other independently associated factors included dysautonomia (AOR:4.88; 95% CI = 1.49-15.98, P = 0.009) and severe muscle weakness at study entry (AOR:6.12; 95% CI = 0.64-58.57, P = 0.048). At 6 months after disease onset, 20% of ventilated and 52% of non-ventilated patients (P < 0.001) had recovered completely or with minor symptoms. Mortality rate was significantly higher among ventilated patients than non-ventilated patients (41% vs. 7%, P < 0.001). Interpretation Bulbar involvement, dysautonomia and severe muscle weakness were identified as the most important risk factors for MV among GBS patients from Bangladesh. The findings may help to develop predictive models for MV in GBS in developing countries to identify impending respiratory failure and proper clinical management of GBS patients.
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Affiliation(s)
- Zhahirul Islam
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Nowshin Papri
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Gulshan Ara
- Nutrition and Clinical Services Division icddr,b Dhaka Bangladesh
| | - Tanveen Ishaque
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.,Department of Surgery Johns Hopkins School of Medicine Baltimore Maryland
| | - Arafat U Alam
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Israt Jahan
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Badrul Islam
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.,Department of Medical Microbiology and Infectious Diseases Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital Dhaka Bangladesh
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Asiri S, Altwaijri WA, Ba-Armah D, Al Rumayyan A, Alrifai MT, Salam M, Almutairi AF. Prevalence and outcomes of Guillain-Barré syndrome among pediatrics in Saudi Arabia: a 10-year retrospective study. Neuropsychiatr Dis Treat 2019; 15:627-635. [PMID: 30880987 PMCID: PMC6400135 DOI: 10.2147/ndt.s187994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a progressive acute form of paralysis most probably secondary to an immune-mediated process. GBS among Saudis has been seldom investigated, which leaves both clinicians and researchers with scarcity in knowledge. Therefore, this study aims to assess the prevalence and clinical prognosis of GBS among pediatrics admitted with acute paralysis at a large healthcare facility in Riyadh, Saudi Arabia. METHODS This retrospective study reviewed patients' medical records between 2005 and 2015. Eligible cases were children (<14 years old) admitted to the hospital complaining of acute paralysis and later diagnosed with one form or variant of GBS. Pearson's chi-square, Fisher's exact test, and binary logistic regression were employed to analyze the collected data. RESULTS The prevalence of GBS was 49%. The male-to-female ratio was 1.45:1. The mean ± standard deviation age was 7±3.7 years. There were 34 (69.4%) cases with progression to maximum paralysis in ≤2 weeks, while 15 (30.6%) cases occurred beyond 2 weeks. Males (n=24, 82.8%) were more likely to endure progression to maximum paralysis in ≤2 weeks after the disease onset, compared to females (n=10, 50%), P=0.014. All cases complaining of respiratory problems exhibited a progression to maximum paralysis in ≤2 weeks, compared to those with no respiratory problems, P=0.027. Residual paralysis at 60 days post disease onset was highly associated with GBS patients of age 8-14 years (n=15, 65.2%), compared to younger patients (n=8, 30.8%), P=0.016. Patients admitted in colder seasons (n=14, 63.6%) were more likely to suffer residual paralysis too, compared to those in warmer seasons (n=9, 33.3%), P=0.035. GBS cases who complained of facial weakness (n=9, 75%) and ocular abnormalities (n=10, 71.4%) were also more likely to endure residual paralysis at 60 days post disease onset, P=0.025 and P=0.03, respectively. CONCLUSION Male gender could be a determinant of rapid progression to maximum paralysis, while the older age group in pediatrics is expected to endure residual paralysis at 60 days post disease onset. GBS can be accounted as a rare disease, especially in pediatrics, so confirmed cases should be investigated comprehensively for research purposes.
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Affiliation(s)
- Safiyyah Asiri
- Pediatric Neurology, Pediatric Department, King Abdullah Specialist Children's Hospital, Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Waleed A Altwaijri
- Pediatric Neurology, Pediatric Department, King Abdullah Specialist Children's Hospital, Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Duaa Ba-Armah
- Pediatric Neurology, Pediatric Department, King Abdullah Specialist Children's Hospital, Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia
| | - Ahmed Al Rumayyan
- Pediatric Neurology, Pediatric Department, King Abdullah Specialist Children's Hospital, Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Muhammad T Alrifai
- Pediatric Neurology, Pediatric Department, King Abdullah Specialist Children's Hospital, Ministry of National Guard-Health Affairs (MNGHA), Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mahmoud Salam
- Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Adel F Almutairi
- Science and Technology Unit, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
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Islam B, Islam Z, Rahman S, Endtz HP, Vos MC, van der Jagt M, van Doorn PA, Jacobs BC, Mohammad QD. Small volume plasma exchange for Guillain-Barré syndrome in resource-limited settings: a phase II safety and feasibility study. BMJ Open 2018; 8:e022862. [PMID: 30121613 PMCID: PMC6104782 DOI: 10.1136/bmjopen-2018-022862] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the safety and feasibility of small volume plasma exchange (SVPE) for patients with Guillain-Barré syndrome (GBS). DESIGN Non-randomised, single-arm, interventional trial. SETTING National Institute of Neurosciences and Hospital, Dhaka, Bangladesh. PARTICIPANTS Twenty adult (>18 years) patients with GBS presented within 2 weeks of onset of weakness who were unable to walk unaided for more than 10 m. INTERVENTIONS SVPE involves blood cell sedimentation in a blood bag and removal of supernatant plasma after blood cells are retransfused. This procedure was repeated three to six times a day, for eight consecutive days. Fresh frozen plasma (FFP) and normal saline were used as replacement fluid. OUTCOME MEASURES Serious adverse events (SAEs) were defined as severe sepsis and deep venous thrombosis related to the central venous catheter (CVC) used during SVPE. SVPE was considered safe if less than 5/20 patients experienced an SAE, and feasible if 8 L plasma could be removed within 8 days in at least 15/20 patients. RESULTS Median patient age 33 years (IQR 23-46; range 18-55); 13 (65%) were male. Median Medical Research Council (MRC) sum score was 20 (IQR 0-29; range 0-36); three (15%) patients required mechanical ventilation. One patient developed SAE (severe sepsis, possibly related to CVC). The median plasma volume exchanged was 140 mL/kg (range 110-175) and removal of 8 L plasma was possible in 15 (75%) patients. Patients received a median 1 g/kg IgG via FFP although a substantial proportion of IgG was probably removed again by the SVPE sessions. GBS disability score improved by at least one grade in 14 (70%) patients 4 weeks after SVPE started. No patients died. CONCLUSION SVPE seems a safe and feasible alternative treatment to standard plasma exchange (PE) or intravenous immunoglobulin (IVIg) for GBS; further studies of clinical efficacy in low-income and middle-income countries are warranted. TRIAL REGISTRATION NUMBER NCT02780570.
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Affiliation(s)
- Badrul Islam
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Laboratory Sciences and Services Division (LSSD), The International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Zhahirul Islam
- Laboratory Sciences and Services Division (LSSD), The International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Shafiqur Rahman
- Department of Intensive Care Medicine, Uttara Adhunik Medical College & Hospital, Dhaka, Bangladesh
| | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Quazi Deen Mohammad
- Department of Neurology, National Institute of Neurosciences (NINS) and Hospital, Dhaka, Bangladesh, National Institute of Neuroscience (NINS), Dhaka, Bangladesh
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Heart rate variability and baroreflex sensitivity abnormalities in Guillain-Barré syndrome: a pilot study. Clin Auton Res 2018; 29:339-348. [PMID: 29654380 DOI: 10.1007/s10286-018-0525-z] [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: 11/24/2017] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The current study aimed to investigate autonomic dysfunction in Guillain-Barré syndrome (GBS) patients and describe the results of computational heart rate variability (HRV)/baroreflex sensitivity (BRS) and autonomic challenge tests. METHODS GBS patients were consecutively recruited and the results were compared to age- and gender-matched healthy controls. A series of autonomic function tests including computation-dependent tests (power spectrum analysis of HRV and BRS at rest) and challenge maneuvers (deep breathing, eyeball compression, active standing, the Valsalva maneuver, sustained handgrip, and the cold pressor test) were performed. RESULTS Ten GBS patients (six men; mean age = 40.1 ± 13.9 years) and ten gender- and age-matched healthy controls were recruited. The mean GBS functional grading scale at disease plateau was 3.4 ± 1.0. No patients required intensive care unit admission or mechanical ventilation. Low-frequency HRV (p = 0.027), high-frequency HRV (p = 0.008), and the total power spectral density of HRV (p = 0.015) were significantly reduced in patients compared to controls. The mean up slope (p = 0.034), down slope (p = 0.011), and total slope (p = 0.024) BRS were significantly lower in GBS patients. The diastolic rise in blood pressure in the cold pressor test was significantly lower in GBS patients compared to controls (p = 0.008). INTERPRETATION Computation-dependent tests (HRV and BRS) were more useful for detecting autonomic dysfunction in GBS patients, whereas the cold pressor test was the only reliable challenge test, making it useful as a bedside measure of autonomic function in GBS patients.
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Islam Z, Jahan I, Ahammad RU, Shahnaij M, Nahar S, Mohammad QD. FAS promoter polymorphisms and serum sFas level are associated with increased risk of nerve damage in Bangladeshi patients with Guillain-Barré syndrome. PLoS One 2018; 13:e0192703. [PMID: 29432441 PMCID: PMC5809046 DOI: 10.1371/journal.pone.0192703] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune disorder of the peripheral nervous system triggered by molecular mimicry between pathogen lipopolysaccharides and host nerve gangliosides. Polymorphisms in the Fas receptor (FAS) and Fas ligand (FASL) genes may potentially alter the elimination of autoreactive immune cells and affect disease susceptibility or disease severity in GBS. We detected single nucleotide polymorphisms (SNPs) in FAS (-1377G/A and -670A/G) and FASL (-843C/T) in a prospective cohort of 300 patients with GBS and 300 healthy controls from the Bangladeshi population. Genotype distributions were not significantly different between patients with GBS and healthy controls. The FAS -670 AG heterozygous (P = 0.0005, OR = 2.5, 95% CI = 1.5–4.2) and GG homozygous (P = 0.0048, OR = 2.6, 95% CI = 1.3–5.0) genotypes were more common in patients with anti-GM1 antibodies than patients without anti-GM1 antibodies. The FAS -670 G allele was more prevalent in anti-GM1 antibody-positive than -negative patients (P = 0.0002, OR = 1.9, 95% CI = 1.4–2.7) and also in patients with the axonal subtype than demyelinating subtype (P < 0.0001, OR = 4.8, 95% CI = 2.3–10.1). The 1377G/-670G GG haplotype was significantly associated with the axonal subtype (P < 0.0001) and anti-ganglioside antibody-positivity (P = 0.0008) in GBS. Serum sFas (237.5 pg/mL vs. 159.5 pg/mL; P < 0.0001) and sFasL (225.1 pg/mL vs. 183.4 pg/mL; P = 0.0069) were elevated in patients with GBS compared to healthy controls, and among patients with high serum sFas was associated with severe GBS (P = 0.0406). In conclusion, this study indicates FAS-FASL promoter SNPs may promote the production of cross-reactive anti-ganglioside antibodies in GBS.
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Affiliation(s)
- Zhahirul Islam
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Israt Jahan
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Rijwan U. Ahammad
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
- School of Medicine, Nagoya University, Nagoya, Japan
| | - Mohammad Shahnaij
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Shamsun Nahar
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
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