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Zhang X, Yu D. Superacute onset of Guillain-Barré syndrome after elective spinal surgery: A case report and literature review. Medicine (Baltimore) 2024; 103:e37925. [PMID: 38701319 PMCID: PMC11062723 DOI: 10.1097/md.0000000000037925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
RATIONALE Guillain-Barré syndrome (GBS) epitomizes an acute peripheral neuropathy hallmarked by an autoimmune retort directed at the myelin sheath enwrapping peripheral nerves. While it is widely acknowledged that a majority of GBS patients boast a history of antecedent infections, the documentation of postoperative GBS occurrences is progressively mounting. Drawing upon an exhaustive compendium of recent case reports, the disease's inception spans a gamut from within 1 hour to 1.2 years. PATIENT CONCERNS At this juncture, we proffer a singular case: an instance involving a 51-year-old gentleman who underwent lumbar spine surgery, only to encounter immediate debilitation of limb and respiratory musculature. DIAGNOSES Post elimination of variables linked to anesthetic agents, encephalon, and spinal cord pathologies, a potent suspicion of superacute GBS onset emerged. INTERVENTIONS Subsequent to immunoglobulin therapy, plasmapheresis, and adjunctive support, the patient's ultimate demise became manifest. OUTCOMES No progress was found to date. LESSONS Given GBS's potential to instigate paralysis, respiratory collapse, and autonomic nervous system aberrations, alongside other pernicious sequelae, coupled with the exceptional rarity of the temporal onset in this particular instance, it undeniably proffers an imposing conundrum for anesthetists in the realm of differential diagnosis and therapeutic conduct. During the postoperative convalescence phase under anesthesia, should the patient evince deviant limb musculature vigor and compromised respiratory sinews, the prospect of GBS must not be consigned to oblivion. Precision in diagnosis conjoined with apt therapeutic measures could well be the harbinger of a divergent denouement for the afflicted patient.
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Affiliation(s)
- Xinyu Zhang
- Department of Anesthesiology, The Second People’s Hospital of Yibin, Yibin, China
| | - Deshui Yu
- Department of Anesthesiology, The Second People’s Hospital of Yibin, Yibin, China
- Clinical Research and Translational Center, Second People’s Hospital of Yibin City-West China Yibin Hospital, Sichuan University, Yibin, China
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2
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Li X, Zhang C. Guillain-Barré syndrome after surgery: a literature review. Front Neurol 2024; 15:1368706. [PMID: 38638310 PMCID: PMC11024248 DOI: 10.3389/fneur.2024.1368706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/26/2024] [Indexed: 04/20/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare postoperative complication that is sometimes characterized by serious motor weakness and prolonged weaning from mechanical ventilation. Although the exact nature of the relationship between GBS and the surgical procedure is still unclear, there is a clear increased incidence of GBS in post-surgical patients compared to non-surgical patients. GBS after surgery is unique in several ways. The course of post-surgical GBS unfolds more rapidly than in other situations where GBS develops, the condition is often more severe, and respiratory muscles are more commonly involved. Prompt diagnosis and appropriate treatment are essential, and the condition can worsen if treated inappropriately. Postoperative sedation, intubation, and restraint use make the diagnosis of GBS difficult, as the onset of symptoms of weakness or numbness in those contexts are not obvious. GBS is often misdiagnosed, being attributed to other postoperative complications, and subsequently mishandled. The lack of relevant information further obscures the clinical picture. We sought to better understand post-surgical GBS by performing an analysis of the relevant literature, focusing on clearly documenting the clinical characteristics, diagnosis, and management of GBS that emerges following surgery. We underscore the importance of physicians being aware of the possibility of GBS after major surgery and of performing a variety of laboratory clinical investigations early on in suspected cases.
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Affiliation(s)
| | - Chao Zhang
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
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Galassi G, Mazzoli M, Ariatti A, Bedin R, Marzullo D, Bastia E, Agnoletto V, Gozzi M, Valzania F, Meletti S, Marchioni A. Predictors of respiratory failure in Guillain-Barré syndrome: a 22 year cohort study from a single Italian centre. Eur J Neurol 2024; 31:e16090. [PMID: 37823704 PMCID: PMC11235807 DOI: 10.1111/ene.16090] [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: 05/01/2023] [Revised: 08/23/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE The study aimed to identify predictors of respiratory failure leading to mechanical ventilation (MV) and tracheostomy in Guillain-Barré syndrome (GBS). METHODS Two hundred and thirty adult cases admitted to the Neurology Unit of Modena, Italy, between January 2000 and December 2021 were studied. A cut-off of MV starting within 8 weeks from onset of weakness was used. Univariable, multivariable logistic and Cox regression analyses were used to determine which pre-specified clinical and diagnostic characteristics were capable of predicting MV and tracheostomy, due to weaning failure. The model was internally validated within the full cohort. The Erasmus GBS Respiratory Insufficiency Score was retrospectively applied. RESULTS One hundred and seventy-six cases (76.5%) were classified as classical sensorimotor GBS and 54 (23.4%) as variants. Thirty-two patients (13.9%) needed MV: 84.3% required respiratory support within 7 days. Independent predictors of respiratory failure and MV were older age, facial, bulbar, neck flexor weakness, dysautonomia, axonal electrophysiological subtype, cardiovascular comorbidities and higher disability score at entry. There was no association with abnormal spinal fluid parameters nor with positive serology for recent infections. Twenty-two patients (68.7%) were ventilated for more than 7 days; 4.7% died within 8 weeks. The patients who required MV were treated more often with plasma exchange. Independent predictors of tracheostomy due to weaning trial failure were facial, bulbar, neck flexor weakness, autonomic dysfunction, associated cardiovascular morbidities and axonal electrophysiological subtype on nerve conduction study. CONCLUSIONS Our study indicates distinct predictors of MV and tracheostomy in GBS patients.
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Affiliation(s)
- Giuliana Galassi
- Department of Biomedical, Metabolic and Neural SciencesUniversity HospitalsModenaItaly
| | - Marco Mazzoli
- Department of Biomedical, Metabolic and Neural SciencesUniversity HospitalsModenaItaly
| | - Alessandra Ariatti
- Department of Biomedical, Metabolic and Neural SciencesUniversity HospitalsModenaItaly
| | - Roberta Bedin
- Department of Biomedical, Metabolic and Neural SciencesUniversity HospitalsModenaItaly
| | - Donato Marzullo
- Department of Biomedical, Metabolic and Neural SciencesUniversity HospitalsModenaItaly
| | | | | | - Manuela Gozzi
- Department of ImagingUniversity Hospitals of ModenaModenaItaly
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural SciencesUniversity HospitalsModenaItaly
| | - Alessandro Marchioni
- Respiratory Disease Unit, Department of Medical and Surgical SciencesUniversity Hospitals of ModenaModenaItaly
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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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Papri N, Islam Z, Ara G, Saha T, Leonhard SE, Endtz HP, Jacobs BC, Mohammad QD. Management of Guillain-Barré syndrome in Bangladesh: Clinical practice, limitations and recommendations for low- and middle-income countries. J Peripher Nerv Syst 2023; 28:564-577. [PMID: 37698165 DOI: 10.1111/jns.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND AIMS Considerable variation in clinical practice for management of Guillain-Barré syndrome (GBS) has been observed worldwide. Diagnosis and treatment are challenging in low- and middle-income countries (LMIC) due to lack of facilities and treatment availability. We aimed to evaluate current clinical practice and limitations and to provide recommendation for GBS management in low-resource settings. METHODS We conducted an explanatory-sequential mixed-methods survey among neurologists and internists working in tertiary and secondary government hospitals in Bangladesh. There were two phases: (1) quantitative (cross-sectional survey to evaluate clinical practice and limitations); (2) qualitative (key informant interview to explain certain clinical practice and provide recommendations for GBS management in LMIC). Data were analyzed by frequencies, χ2 test and thematic analysis. RESULTS Among 159 physicians (65 neurologists and 94 internists), 11% and 8% physicians used Brighton and NINDS criteria respectively to diagnose GBS. Specific treatment protocols of GBS were used by 12% physicians. Overcrowding of patients, inadequate diagnostic facilities, high costs of standard therapy, and inadequate logistics and trained personnel for intensive care unit and rehabilitation services were considered major challenges for GBS management. In qualitative part, respondents recommended regular training for the physicians, development of cost-effective treatment strategies and appropriate patients' referral and management guideline considering existing limitations in health service delivery and socio-economic status of the country. INTERPRETATION Current study design and recommendations might be applied for other LMIC. Such data can assist policymakers to identify areas requiring urgent attention and take required action to improve GBS management in LMIC.
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Affiliation(s)
- Nowshin Papri
- Laboratory of Gut-Brain Axis, Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Laboratory of Gut-Brain Axis, Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
| | - Gulshan Ara
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
- Department of Nutrition, Sports and Exercise, University of Copenhagen, Copenhagen, Denmark
| | - Tamal Saha
- Laboratory of Gut-Brain Axis, Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
| | - Sonja E Leonhard
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus 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
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
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6
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Habib AA, Waheed W. Guillain-Barré Syndrome. Continuum (Minneap Minn) 2023; 29:1327-1356. [PMID: 37851033 DOI: 10.1212/con.0000000000001289] [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: 10/19/2023]
Abstract
OBJECTIVE This article summarizes the clinical features, diagnostic criteria, differential diagnosis, pathogenesis, and prognosis of Guillain-Barré syndrome (GBS), with insights into the current and future diagnostic and therapeutic interventions for this neuromuscular syndrome. LATEST DEVELOPMENTS GBS is an acute, inflammatory, immune-mediated polyradiculoneuropathy that encompasses many clinical variants and divergent pathogenic mechanisms that lead to axonal, demyelinating, or mixed findings on electrodiagnostic studies. The type of antecedent infection, the development of pathogenic cross-reactive antibodies via molecular mimicry, and the location of the target gangliosides affect the subtype and severity of the illness. The data from the International GBS Outcome Study have highlighted regional variances, provided new and internationally validated prognosis tools that are beneficial for counseling, and introduced a platform for discussion of GBS-related open questions. New research has been undertaken, including research on novel diagnostic and therapeutic biomarkers, which may lead to new therapies. ESSENTIAL POINTS GBS is among the most frequent life-threatening neuromuscular emergencies in the world. At least 20% of patients with GBS have a poor prognosis and significant residual deficits despite receiving available treatments. Research is ongoing to further understand the pathogenesis of the disorder, find new biomarkers, and develop more effective and specific treatments.
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Berrim K, Lakhoua G, Zaiem A, Charfi O, Aouinti I, Kastalli S, Daghfous R, El Aidli S. Guillain-Barré syndrome after COVID-19 vaccines: A Tunisian case series. Br J Clin Pharmacol 2023; 89:574-578. [PMID: 36398559 DOI: 10.1111/bcp.15601] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
As the COVID-19 vaccination campaign progresses worldwide, Guillain-Barré syndrome (GBS) vaccine-related cases have been reported. We carried out a retrospective, descriptive study of GBS patients following COVID-19 vaccine, submitted to the National Pharmacovigilance Center of Tunis during the period between March 2021 and May 2022. Our study aimed to identify epidemiological and clinical features of COVID-19 vaccine-associated GBS. We found 9 cases of GBS post COVID-19 vaccination; 5 of them were excluded due to the lack of information, whereas 4 cases were included in this study. Men represented 75% (3/4) of the cases. The most frequently reported vaccine type was ChAdOx1 nCoV-19 vaccine (n = 2 reports [50%]), Ad26.COV2.S vaccine and BNT162b2 vaccine in 1. The mean time interval from vaccination to symptom onset was 15.3 days. Clinical manifestations were different: classical GBS in two cases and GBS with unilateral facial palsy in the other 2 cases. All patients were treated with a course of intravenous immunoglobulin for 5 days. Three patients reported clinical improvement while one case (25%) showed treatment-related fluctuations. Our observations suggest that COVID-19 vaccines may be associated with GBS. Continuous surveillance and further studies are warranted to assess the significance of the association.
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Affiliation(s)
- Khouloud Berrim
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Ghozlane Lakhoua
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Ahmed Zaiem
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Ons Charfi
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Imen Aouinti
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Sarrah Kastalli
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Riadh Daghfous
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
| | - Sihem El Aidli
- National Pharmacovigilance Center, Tunis, 1006, Tunisia.,Research Unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis-El-Manar, Tunis, 1007, Tunisia
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Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:78-99. [PMID: 36322548 PMCID: PMC9714524 DOI: 10.7705/biomedica.6366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 12/04/2022]
Abstract
Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.
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Varol F, Yusuf Can Y, Sahin E, Sahin SB, Akyuz G, Aydin A, Kara M, Cam H. Successful treatment with therapeutic plasmapheresis of a pediatric patient with Guillain-Barré syndrome associated with neurobrucellosis. J Clin Apher 2022; 37:522-526. [PMID: 36151906 DOI: 10.1002/jca.22020] [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: 03/03/2022] [Revised: 07/06/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
Brucellosis is a multisystemic disease that can present with multiple signs and symptoms. Rarely, brucellosis can manifest as neurobrucellosis, with central or peripheral nervous system involvement. Guillain-Barré syndrome (GBS) is a post-infectious autoimmune disease that progresses rapidly, causing ascending muscle weakness, and is accompanied by areflexia/hyporeflexia. Regarding GBS etiology, it is thought to be an autoimmune disease, triggered by a previous bacterial or viral infection. There are a few Brucella-associated GBS case reports in the literature and in our opinion, only one of them is a pediatric patient. Herein we reported a case of GBS associated with neurobrucellosis, who was successfully treated with therapeutic plasmapheresis (TP) due to poor response to IVIG treatment.
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Affiliation(s)
- Fatih Varol
- Barre Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Yasar Yusuf Can
- Barre Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Ebru Sahin
- Barre Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Suleyman Berkay Sahin
- Barre Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Gulcan Akyuz
- Department of Pediatric Neurology, University of Health Science Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Ali Aydin
- Department of Pediatric Neurology, Van Training and Research Hospital, Istanbul, Turkey
| | - Manolya Kara
- Department of Pediatric Infectious Diseases, Istinye University Medical School, Istanbul, Turkey
| | - Halit Cam
- Barre Department of Pediatric Intensive Care, University of Health Science Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
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10
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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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11
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Faustino P, Coutinho M, Brum M, Medeiros L, Ladeira F. Outcomes in Guillain-Barré Syndrome following a second therapeutic cycle – A single-centre retrospective observational study. J Neurol Sci 2022; 441:120368. [DOI: 10.1016/j.jns.2022.120368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/05/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
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12
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Rajabally YA. Immunoglobulin and Monoclonal Antibody Therapies in Guillain-Barré Syndrome. Neurotherapeutics 2022; 19:885-896. [PMID: 35648286 PMCID: PMC9159039 DOI: 10.1007/s13311-022-01253-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 12/29/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy affecting 1-2 subjects per 100,000 every year worldwide. It causes, in its classic form, symmetric weakness in the proximal and distal limb muscles with common involvement of the cranial nerves, particularly facial weakness. Respiratory function is compromised in a case in four. Randomised controlled trials have demonstrated the benefit of therapeutic plasma exchange in hastening time to recovery. Intravenous immunoglobulin was subsequently shown to be as efficacious as plasma exchange in adult subjects. In children, few trials have shown the benefit of intravenous immunoglobulin versus supportive care. Pharmacokinetic studies suggested a relationship between increase in immunoglobulin G level post-infusion and outcome, implying administration of larger doses may be beneficial in subjects with poor prognosis. However, a subsequent trial of a second dose of immunoglobulin in such subjects failed to show improved outcome, while demonstrating a higher risk of thromboembolic side-effects. Monoclonal antibody therapy has more recently been investigated for GBS, after multiple studies in animal models, with different agents and variable postulated mechanisms of action. Eculizumab, a humanised monoclonal antibody against the complement protein C5, was tested in in two randomised, double-blind, placebo-controlled phase 2 trials. Neither showed benefit versus immunoglobulins alone on disability level at 4 weeks, although one study importantly suggested possible, clinically highly relevant, late effects on normalising function. A phase 3 trial is in progress. Preliminary results of a placebo-controlled ongoing study of ANX005, a humanised recombinant antibody against C1q inhibiting the complement cascade, have been promising.
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Affiliation(s)
- Yusuf A Rajabally
- Aston Medical School, Aston University, Birmingham, B4 7ET, UK.
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
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13
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Zang Q, Wang Y, Guo J, Long L, Zhang S, Cui C, Song D, Yu B, Tang F, Teng J, Miao W. Treatment of Severe Japanese Encephalitis Complicated With Hashimoto's Thyroiditis and Guillain-Barré Syndrome With Protein A Immunoadsorption: A Case Report. Front Immunol 2022; 12:807937. [PMID: 35069593 PMCID: PMC8777188 DOI: 10.3389/fimmu.2021.807937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
A severely comatose female patient was diagnosed with Japanese encephalitis (JE). Her condition was complicated by Hashimoto’s thyroiditis (HT) and Guillain-Barré syndrome (GBS). After antiviral, glucocorticoid, and immunoglobulin treatment, the patient’s consciousness was restored, and she could breathe spontaneously. Following this, new-onset, primarily demyelinating GBS developed, which progressed to demyelination combined with axonal injury. The patient was switched to protein A immunoadsorption (PAIA) therapy, and her Hughes score decreased rapidly, from 4 to 1 after 6 months. This patient is the first to receive PAIA combined with an antiviral-glucocorticoid-immunoglobulin regimen to treat encephalitis, meningitis, HT, and GBS caused by JE infection, thereby reflecting the importance of clinical application of PAIA in the treatment of immunological complications of JE.
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Affiliation(s)
- Qiuling Zang
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yating Wang
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junshuang Guo
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liyang Long
- Traditional Chinese Medicine Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Kaili, China
| | - Shuyu Zhang
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Can Cui
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dandan Song
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Boguang Yu
- Guangdong Provincial Key Laboratory of Hemoadsorption Technology, Guangzhou, China
| | - Fenlan Tang
- Guangdong Provincial Key Laboratory of Hemoadsorption Technology, Guangzhou, China
| | - Junfang Teng
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wang Miao
- Neuro-intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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14
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Alessandro L, Castiglione JI, Brand P, Bruno V, Barroso F. Treatment-related fluctuations in Guillain-Barré syndrome: clinical features and predictors of recurrence. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:516-522. [PMID: 35195232 DOI: 10.1590/0004-282x-anp-2021-0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND A treatment-related fluctuation (TRF) in a patient with Guillain-Barré syndrome (GBS) is defined as clinical deterioration within two months of symptom onset following previous stabilization or improvements with treatment. OBJECTIVE To investigate the clinical characteristics and factors that could increase the risk of relapse of GBS in patients with and without TRFs. METHODS Retrospective review of medical records of patients (>18 years) with GBS evaluated between January/2006 and July/2019. Demographic and clinical characteristics, ancillary studies, treatment received, and the clinical course of patients with and without TRFs were analyzed. RESULTS Overall, 124 cases of GBS were included; seven (5.6%) presented TRFs. GBS-TRF cases were triggered more frequently by infectious mononucleosis (28.57 vs. 8.55%; p=0.01). GBS-TRF were initially treated with plasmapheresis more frequently than those without TRF (14.29 vs. 1.70%; p=0.0349). Combined treatment (71.43 vs. 4.27%; p<0.001) and corticosteroids (42.86 vs. 1.71%; p<0.001) were more commonly used in the GBS-TRF group. GBS-TRF patients presented a higher median initial disability score (4 vs. 2; p=0.01). CONCLUSIONS Patients with GBS triggered by infectious mononucleosis and a high degree of initial disability have higher chances of developing TRFs. Although patients with TRF were treated with plasmapheresis more often, the total number was too low to suggest a link between plasma exchange and TRF.
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Affiliation(s)
- Lucas Alessandro
- Raul Carrea Institute for Neurological Research, Department of Neurology, Buenos Aires, Argentina
| | - Juan Ignacio Castiglione
- Raul Carrea Institute for Neurological Research, Department of Neurology, Buenos Aires, Argentina
| | - Patricio Brand
- Raul Carrea Institute for Neurological Research, Department of Neuromuscular, Buenos Aires, Argentina
| | - Veronica Bruno
- University of Calgary, Hotchkiss Brain Institute, Department of Clinical Neurosciences, Calgary, Alberta, Canada
| | - Fabio Barroso
- Raul Carrea Institute for Neurological Research, Department of Neuromuscular, Buenos Aires, Argentina
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15
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Lestayo O'Farrill Z, González-Quevedo A, Gutierrez-Gil J, Hernández-Cáceres JL, Sistach-Vega V. Proposal for the functional assessment of acute inflammatory neuropathy (FAAIN) in Guillain-Barré syndrome. Neurol Res 2022; 44:534-543. [PMID: 35168471 DOI: 10.1080/01616412.2021.2024725] [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: 10/19/2022]
Abstract
BACKGROUND Guillain Barré syndrome (GBS) functional assessment is necessary in clinical practice, research and clinical trials. Existing instruments are not sensitive to change and are not applicable to the current GBS clinical spectrum. OBJECTIVE To construct a functional assessment for acute inflammatory neuropathies (FAAIN-GBS), inclusive for current GBS spectrum that assesses extension and intensity separately. METHODS FAAIN-GBS subscales were constructed. Its structure and interpretation were defined. It was validated using data from medical record of 167 GBS patients admitted to the Institute of Neurology and Neurosurgery. Cronbach α was used for items reduction and reliability analysis. Bartlett sphericity test was performed. Exploratory factor analysis (EFA) of the main components, with varimax rotation, was applied to evaluate dimensionality and content validity. Hughes scale was used as gold standard for criterion validity. Sensitivity, specificity and area under the receiver operating characteristic curves (AUROC), were calculated. Construct validity was assessed by confirmatory factor analysis (CFA). RESULTS FAAIN-GBS is made up of two subscales (extension and intensity). The final score is obtained by averaging both dimensions. Internal consistency was acceptable (Cronbach 0.745). EFA showed three dimensions: intensity, spinal extension and cranial extension. Spearman correlation between FAAIN-GBS and Hughes scale was 0.463. Sensitivity (0.714) and specificity (0.986) values showed the good behavior of the scale; AUROC was 0.93. CONCLUSION FAAIN-GBS was constructed and a first step of validation was made, showing good internal consistency and validity. New prospective studies with large populations will be necessary to perfect this instrument that could be useful in neurological practice.
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Affiliation(s)
- Zurina Lestayo O'Farrill
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
| | - Alina González-Quevedo
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
| | - Joel Gutierrez-Gil
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
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16
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Kim JE, Min YG, Shin JY, Kwon YN, Bae JS, Sung JJ, Hong YH. Guillain–Barré Syndrome and Variants Following COVID-19 Vaccination: Report of 13 Cases. Front Neurol 2022; 12:820723. [PMID: 35153993 PMCID: PMC8833101 DOI: 10.3389/fneur.2021.820723] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022] Open
Abstract
Background Amidst growing concern about an increased risk of Guillain–Barré syndrome (GBS) following COVID-19 vaccination, clinical and electrodiagnostic features have not been fully characterized. Methods We retrospectively reviewed medical records of the patients diagnosed with GBS and its variants following COVID-19 vaccination at four referral hospitals during the period of the mass vaccination program in South Korea (February to October 2021). Results We identified 13 patients with GBS and variants post COVID-19 vaccination: AstraZeneca vaccine (Vaxzevria) in 8, and Pfizer-BioNTech vaccine (Comirnaty) in 5. The mean time interval from vaccination to symptom onset was 15.6 days (range 4–30 days). Electrodiagnostic classification was demyelinating in 7, axonal in 4 and normal in 2 cases. Clinical manifestations were diverse with varying severity: classical GBS in 8 cases, paraparetic variant in 3, Miller-Fisher syndrome in 1 and acute cervicobrachial weakness in 1. Four patients developed respiratory failure, and 2 of them showed treatment-related fluctuations. Conclusion Our observations suggest that COVID-19 vaccines may be associated with GBS of distinctive clinical features characterized by severe quadriplegia, disproportionately frequent bilateral facial palsy or atypical incomplete variants. Continuous surveillance and further studies using robust study designs are warranted to fully assess the significance of the association.
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Affiliation(s)
- Jee-Eun Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Young Gi Min
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Hanlym University Hospital, Seoul, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
- *Correspondence: Yoon-Ho Hong
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17
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Holtz B, Grimm A, Axer H. Patients' attitude towards vaccination after Guillain Barré syndrome. Health Sci Rep 2021; 4:e469. [PMID: 34984239 PMCID: PMC8691489 DOI: 10.1002/hsr2.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Guillain Barré syndrome (GBS) could be triggered by an infectious disease but by vaccination as well. Thus, suffering GBS may influence patients' attitudes towards vaccination. METHODS An anonymous questionnaire consisting of the Overall Neuropathy Limitations Score (ONLS), the short form-36 health survey (SF-36), and questions addressing patients' attitude towards vaccination was sent to members of a German GBS support group and to patients with GBS diagnosis who were treated at Jena University Hospital. RESULTS Ninety-seven questionnaires clearly stated GBS as a diagnosis and were included in the analysis. Although 19.6% of the GBS patients reported having no disability in the long-time follow-up, a considerable number of patients still had persistent neurological symptoms; 74.2% of the GBS patients reported being able to walk at least 10 m independently. However, 5.2% were restricted to wheelchair. The patients reached lower scores in all domains of quality of life compared to German controls. Moreover, patients showed a more critical attitude towards vaccination compared to a German representative survey. Fewer patients (58.8%) received a vaccination after suffering from GBS than before (77.3%). Every tenth patient believed that vaccination was the trigger for the GBS. 32% of the patients did not receive a vaccination in the last 5 years mainly because of the fear of adverse effects (32%) or disadvise of the general practitioners (25.8%). DISCUSSION Although the risk of relapse following immunization may be rather low, uncertainties and fears still impair the counseling of these patients by their medical practitioner.
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Affiliation(s)
- Ben‐Ole Holtz
- Department of NeurologyJena University HospitalJenaGermany
| | - Alexander Grimm
- Department of NeurologyTuebingen University HospitalTuebingenGermany
| | - Hubertus Axer
- Department of NeurologyJena University HospitalJenaGermany
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18
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Ramirez N, Ujueta D, Diaz LF, Folleco LE, Rodríguez A, Gaona I, Nava-Mesa MO. Guillain-Barré syndrome with bilateral facial diplegia secondary to severe acute respiratory syndrome coronavirus-2 infection: a case report. J Med Case Rep 2021; 15:558. [PMID: 34782002 PMCID: PMC8591425 DOI: 10.1186/s13256-021-03120-w] [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: 12/12/2020] [Accepted: 09/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background The new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to its similarity to the previous severe acute respiratory syndrome (SARS), is characterized by causing, in most patients, nonspecific symptoms similar to those of the common flu. It has been reported that many coronavirus disease 2019 (COVID-19) patients presented neurological symptoms that involve the central and peripheral nervous systems. In addition, there have been several reports of patients who presented Guillain–Barré syndrome related to COVID-19 , with sensory and motor compromise in the extremities.
Case presentation In this report, we describe a rare case of Guillain–Barré syndrome in a 50-year-old Hispanic male with bilateral facial palsy as the only neurological manifestation, following SARS-CoV-2 infection. A complete neurophysiological study showed severe axonal neuropathy of the right and left facial nerves. Conclusion Regardless of severity, clinicians must to be aware of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine if the infection induces an axonal, myelin, or mixed involvement of the peripheral nervous system. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-03120-w.
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Affiliation(s)
- Natalia Ramirez
- Department of Neurology, Fundación Cardioinfantil (FCI), 110131, Bogotá, Colombia
| | - David Ujueta
- Department of Neurology, Fundación Cardioinfantil (FCI), 110131, Bogotá, Colombia
| | - Luis Felipe Diaz
- Department of Neurology, Fundación Cardioinfantil (FCI), 110131, Bogotá, Colombia
| | | | - Andrea Rodríguez
- Departamento de Medicina Física y Rehabilitación,, Departamento de Neurofisiología, FCI, 110131, Bogotá, Colombia
| | - Ivan Gaona
- Department of Neurology, Fundación Cardioinfantil (FCI), 110131, Bogotá, Colombia
| | - Mauricio O Nava-Mesa
- Escuela de Medicina y Ciencias de la Salud, GI en Neurociencias-NeURos, Universidad del Rosario, 111221, Bogotá, Colombia.
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19
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Vita GL, Terranova C, Sframeli M, Toscano A, Vita G. Reworsening of Recurrent Guillain-Barré Syndrome Triggered by COVID-19 Infection. Open Neurol J 2021. [DOI: 10.2174/1874205x02115010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Guillain-Barré Syndrome (GBS) is an acute, immune-mediated, generalized polyradiculoneuropathy often triggered by a bacterial or viral infection, vaccination, or surgery. During the SARS-CoV-2 pandemic, some patients were reported with GBS associated COVID-19 infection.
Case Presentation:
We report, herein, a patient who had a recurrent GBS after forty years. Intravenous immunoglobulins (IVIg) induced improvement, but her condition worsened suddenly after twenty days, coinciding with a COVID-19 infection. A second IVIg cycle was administered, and she improved again.
Conclusion:
The take-home message is that in the current pandemic, any re-worsening or lack of improvement after appropriate treatment of GBS or possibly other autoimmune neurological diseases must be checked to determine if it is related to COVID-19 infection.
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20
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Jin M, Zhao L, Liu J, Geng W, Zhao Z, Li C, Xue J, Sun S. Association Between the Rate of Treatment Response and Short-Term Outcomes in Childhood Guillain-Barré Syndrome. Front Neurol 2021; 12:746389. [PMID: 34803884 PMCID: PMC8602365 DOI: 10.3389/fneur.2021.746389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction: Few studies have examined the association between the rate of treatment response and the outcome of pediatric Guillain-Barré syndrome (GBS). Therefore, our study aimed to identify treatment response in relation to the short-term outcomes of GBS. Further, we investigated its potential predictive value for prognosis. Methods: Our retrospective study included children diagnosed with GBS in the Pediatric Neurology Department of the Children's Hospital of Hebei Province from 2016 to 2020. According to the rate of response from the standard intravenous immunoglobulin (IVIg) treatment, patients were divided into two groups: rapid-response GBS (initial response within 7 days) and slow-response (initial response within 8-30 days). The GBS disability score (Hughes Functional Grading Scale) was used to assess the children's functional disability at nadir, 1 month, and 6 months after onset. Results: Among the 36 children included in the study, 18 (50%) and 18 (50%) were rapid and slow responders, respectively. Time from IVIg treatment to the initial response was significantly shorter in the rapid-response group (5 [3-6.25] days vs. 10.5[8.75-15] days in slow-response GBS, p < 0.001). Hughes score at 1 month was worse than the rapid responders (Fisher's exact test, p = 0.006). Survival analysis (Kaplan-Meier) with respect to regaining the ability to walk independently (Hughes Functional Grading Scale of 2) within 1 month after onset was significantly different among the two groups (log-rank test for trend, p = 0.024). The abnormal levels of cerebral spinal fluid proteins and autonomic dysfunction were more frequent in the slow-response group than those in the rapid group (p < 0.05). Conclusion: The rate of response to IVIg treatment was correlated with short-term outcomes in children with GBS and had predictive value for prognosis. The role of patient's initial responses to treatment could be significantly valuable in developing more effective and efficient treatment options.
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Affiliation(s)
- Mei Jin
- Department of Pediatrics, Hebei Medical University, Shijiazhuang, China
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Libo Zhao
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jing Liu
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Weijin Geng
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Ziwei Zhao
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Chunzhen Li
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jingru Xue
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Suzhen Sun
- Department of Pediatrics, Hebei Medical University, Shijiazhuang, China
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
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21
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Tagaloa E, Venter F, Liang L, Bhaika J, Aguirre D, Patel J, Nasrawi F. A Rare Case of Guillain-Barré Syndrome With Severe Pandysautonomia. J Investig Med High Impact Case Rep 2021; 9:23247096211019558. [PMID: 34027705 PMCID: PMC8150453 DOI: 10.1177/23247096211019558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Acute pandysautonomia is a rare disorder characterized by autonomic failure affecting sympathetic, parasympathetic, and enteric functions. We present a case of acute inflammatory demyelinating polyneuropathy (AIDP) with severe pandysautonomia in a young, otherwise healthy, female who presented with gastrointestinal symptoms and sensory demyelinating polyneuropathy, which progressively worsened and subsequently developed bladder dysfunction and orthostatic hypotension. We discuss the challenges with diagnostic workup as well as the challenges we encountered as part of the management.
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Affiliation(s)
| | | | - Li Liang
- Kern Medical Center, Bakersfield, CA, USA
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22
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Doherty L, Chaudhry V. Inpatient Diagnosis and Management of Neuromuscular Disorders. Semin Neurol 2021; 41:493-510. [PMID: 34619777 DOI: 10.1055/s-0041-1733794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although many neuromuscular conditions are evaluated on an outpatient basis owing to their chronic or progressive nature, more urgent evaluation and management is often required for the inpatient presenting with acute to subacute focal or generalized numbness or weakness. This review focuses on clinical pattern recognition and basic anatomic localization principles to aid in the identification of common, as well as some less frequently encountered, neuromuscular disorders in hospitalized patients. The characteristic clinical and diagnostic features, associated complications, and recommended treatments of key neuromuscular conditions with acute and subacute manifestations are discussed. These conditions can be life-threatening in some cases, such as in Guillain-Barré syndrome, owing to associated oropharyngeal weakness, respiratory failure, or marked dysautonomia. Prompt recognition of the clinical and pathologic features is therefore necessary to reduce associated morbidity and mortality.
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Affiliation(s)
- Leana Doherty
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Vinay Chaudhry
- Department of Neurology, Division of Neuromuscular Medicine, University of North Carolina School of Medicine Chapel Hill, North Carolina
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23
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Verboon C, Harbo T, Cornblath DR, Hughes RAC, van Doorn PA, Lunn MP, Gorson KC, Barroso F, Kuwabara S, Galassi G, Lehmann HC, Kusunoki S, Reisin RC, Binda D, Cavaletti G, Jacobs BC. Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study. J Neurol Neurosurg Psychiatry 2021; 92:1080-1088. [PMID: 34103340 PMCID: PMC8458059 DOI: 10.1136/jnnp-2020-325815] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the disease course in patients with mild Guillain-Barré syndrome (GBS) who were treated with intravenous immunoglobulin (IVIg) or supportive care only. METHODS We selected patients from the prospective observational International GBS Outcome Study (IGOS) who were able to walk independently at study entry (mild GBS), treated with one IVIg course or supportive care. The primary endpoint was the GBS disability score four weeks after study entry, assessed by multivariable ordinal regression analysis. RESULTS Of 188 eligible patients, 148 (79%) were treated with IVIg and 40 (21%) with supportive care. The IVIg group was more disabled at baseline. IVIg treatment was not associated with lower GBS disability scores at 4 weeks (adjusted OR (aOR) 1.62, 95% CI 0.63 to 4.13). Nearly all secondary endpoints showed no benefit from IVIg, although the time to regain full muscle strength was shorter (28 vs 56 days, p=0.03) and reported pain at 26 weeks was lower (n=26/121, 22% vs n=12/30, 40%, p=0.04) in the IVIg treated patients. In the subanalysis with persistent mild GBS in the first 2 weeks, the aOR for a lower GBS disability score at 4 weeks was 2.32 (95% CI 0.76 to 7.13). At 1 year, 40% of all patients had residual symptoms. CONCLUSION In patients with mild GBS, one course of IVIg did not improve the overall disease course. The certainty of this conclusion is limited by confounding factors, selection bias and wide confidence limits. Residual symptoms were often present after one year, indicating the need for better treatments in mild GBS.
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Affiliation(s)
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard A C Hughes
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Michael P Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Kenneth C Gorson
- Department of Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| | - Fabio Barroso
- Department of Neurology, Instituto de Investigaciones Neurológicas Raúl Carrea, FLENI, Buenos Aires, Argentina
| | | | - Giuliana Galassi
- Department of Neurology, University Hospital of Modena, Modena, Italy
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | | | - Ricardo C Reisin
- Department of Neurology, Hospital Britanico, Buenos Aires, Argentina
| | - Davide Binda
- Department of Neurology, University Milano-Bicocca, Monza, Italy
| | - Guido Cavaletti
- Department of Neurology, University Milano-Bicocca, Monza, Italy
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
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24
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Querol L, Lleixà C. Novel Immunological and Therapeutic Insights in Guillain-Barré Syndrome and CIDP. Neurotherapeutics 2021; 18:2222-2235. [PMID: 34549385 PMCID: PMC8455117 DOI: 10.1007/s13311-021-01117-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
Inflammatory neuropathies are a heterogeneous group of rare diseases of the peripheral nervous system that include acute and chronic diseases, such as Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The etiology and pathophysiological mechanisms of inflammatory neuropathies are only partly known, but are considered autoimmune disorders in which an aberrant immune response, including cellular and humoral components, is directed towards components of the peripheral nerve causing demyelination and axonal damage. Therapy of these disorders includes broad-spectrum immunomodulatory and immunosuppressive treatments, such as intravenous immunoglobulin, corticosteroids, or plasma exchange. However, a significant proportion of patients do not respond to any of these therapies, and treatment selection is not optimized according to disease pathophysiology. Therefore, research on disease pathophysiology aiming to reveal clinically and functionally relevant disease mechanisms and the development of new treatment approaches are needed to optimize disease outcomes in CIDP and GBS. This topical review describes immunological progress that may help guide therapeutic strategies in the future in these two disorders.
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Affiliation(s)
- Luis Querol
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain.
- Centro Para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain.
| | - Cinta Lleixà
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
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25
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Real-world treatment of adult patients with Guillain-Barré syndrome over the last two decades. Sci Rep 2021; 11:19170. [PMID: 34580356 PMCID: PMC8476500 DOI: 10.1038/s41598-021-98501-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 12/28/2022] Open
Abstract
This study investigated treatment characteristics of Guillain-Barré syndrome (GBS) in a real-world setting between 2000 and 2019. We analyzed clinical improvement between nadir and last follow-up in patients with severe GBS (defined as having a GBS disability scale > 2 at nadir) and aimed to detect clinical factors associated with multiple treatments. We included 121 patients (74 male; median age 48 [IQR 35-60]) with sensorimotor (63%), pure motor (15%), pure sensory (10%) and localized GBS (6%) as well as Miller Fisher syndrome (6%). 44% of patients were severely affected. All but one patient received at least one immunomodulatory treatment with initially either intravenous immunoglobulins (88%), plasma exchange (10%) or corticosteroids (1%), and 25% of patients received more than one treatment. Severe GBS but not age, sex, GBS subtype or date of diagnosis was associated with higher odds to receive more than one treatment (OR 4.22; 95%CI 1.36-13.10; p = 0.01). Receiving multiple treatments had no adjusted effect (OR 1.30, 95%CI 0.31-5.40, p = 0.72) on clinical improvement between nadir and last follow-up in patients with severe GBS. This treatment practice did not change over the last 20 years.
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Abnormal sweating and "skin flushing" as possible predictive factor for treatment related fluctuations in Guillain-Barré syndrome: a case series and a review of the literature. J Neurol Sci 2021; 428:117589. [PMID: 34325159 DOI: 10.1016/j.jns.2021.117589] [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: 01/21/2021] [Revised: 06/21/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022]
Abstract
Treatment related fluctuations (TRFs) in Guillain-Barré Syndrome (GBS) are described as one or more episodes of deterioration manifesting within two months after disease onset and following an initial improvement or stabilisation after treatment. They may be encountered in 8% to 16% of patients, but currently predictive factors of TRF occurrence and severity are poorly known. To this end, we evaluated the frequency and clinical features of TRFs in a cohort of GBS patients admitted to the Neurological unit of Sant'Andrea Hospital (La Spezia, Italy) from January 1st, 2003 to December 31st, 2017. Among the 98 GBS collected patients, five (5.1%) developed a TRF during disease course. Consistently with the literature, the majority of our GBS patients who developed a TRF did not report a preceding diarrhoea, had a predominant proximal weakness and all of them had sensory disturbances at the clinical onset. Interestingly, 80% of our TRF patients manifested since GBS onset an autonomic dysfunction with abnormal sweating and a peculiar 'skin flushing' in face, neck and chest. Two patients developed respiratory insufficiency at the TRF time, and they both died. We would advise to pay attention to GBS patients with particular 'skin flushing' in face, neck and chest and abnormal sweating, because these findings could be a red flag for TRF.
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Yıldırım M, Bektaş Ö, Botan E, Şahin S, Gurbanov A, Teber S, Kendirli T. Therapeutic plasma exchange in clinical pediatric neurology practice: Experience from a tertiary referral hospital. Clin Neurol Neurosurg 2021; 207:106823. [PMID: 34304066 DOI: 10.1016/j.clineuro.2021.106823] [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: 05/17/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to retrospectively evaluate the long-term efficacy, tolerability, and safety of therapeutic plasma exchange (TPE) in children with various neuroimmunological disorders. METHODS This analysis was a single-center, retrospective cohort study of pediatric patients with neuroimmunological events undergoing TPE procedures in a tertiary referral center. RESULTS There were 23 patients, 14 boys (60.9%), aged at diagnosis onset 8 months to 16.8 years. The main indications of TPE were Guillain-Barré syndrome (GBS, n = 8), autoimmune encephalitis (n = 5), febrile infection-related epilepsy syndrome (FIRES, n = 4), and acute disseminated encephalomyelitis (ADEM, n = 3). There was no life-threatening complication due to the TPE procedures. Eight (34.8%) of 23 patients experienced 13 (7%) complications in 186 TPE procedures, mostly electrolyte disturbances (n = 5). None of patients discontinued TPE due to complications. Two (8.7%) of 23 patients had marked improvement, 6 (26.1%) had moderate and 11 (47.8%) had mild improvement after TPE. The last follow-up visit revealed neurological sequelae in 12 (52.2%) patients. Therapeutic plasma exchange was found to be more effective on GBS, autoimmune encephalitis and myasthenia gravis, less effective on ADEM and FIRES. There was no correlation between improvement with TPE and clinical parameters, including age, sex, diagnosis, disease duration before TPE, presence of intubation, and length of stay in the intensive care unit and hospital. CONCLUSION Therapeutic plasma exchange was found to be effective and well-tolerated in children with various types of neuroimmunological disorder, with at least mild improvement in approximately 80% of the patients and no life-threatening complications.
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Affiliation(s)
- Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Edin Botan
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Süleyman Şahin
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Anar Gurbanov
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey.
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Li Z, Li X, Shen J, Chan MTV, Wu WKK. Miller Fisher syndrome associated with COVID-19: an up-to-date systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:20939-20944. [PMID: 33677662 PMCID: PMC7936860 DOI: 10.1007/s11356-021-13233-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/26/2021] [Indexed: 05/02/2023]
Abstract
Recently, during the pandemic infection of the novel SARS-CoV-2, some cases of Miller Fisher syndrome (MFS) have been reported. We want to summarize the main features of patients with MFS and COVID-19. A PubMed search was performed on 8 October to identify references reporting cases with MFS associated with COVID-19 from the first report of COVID-19 to 8 October 2020 using the following keywords: "Miller Fisher syndrome" AND "COVID-19" OR "SARS-CoV-2". A systematic review from the first report of coronavirus disease 2019 (COVID-19) to 8 October 2020 revealed 7 cases with Miller Fisher syndrome (MFS) associated with COVID-19. The 7 cases came from 5 countries but most of these patients were from Europe (85.7%), especially Spain. There are 5 cases of MFS diagnosed after the laboratory confirmation of SARS-CoV-2 infection. The mean onset time of MFS-associated neurological symptoms was 14.75 days after the diagnosis of COVID-19. However, the two remaining cases presented initially with MFS-associated neurological symptoms followed by the diagnosis of COVID-19. The most common symptoms of COVID-19-associated MFS were perioral paresthesias (57.1%), ataxia (57.1%), blurred vision (42.9), ophthalmoplegia (42.9), and generalized areflexia (42.9). However, more cohort and case-control studies are required to establish the epidemiological linkage.
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Affiliation(s)
- Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100042, China
| | - Xingye Li
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua University, Beijing, China
| | - Jianxiong Shen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100042, China.
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - William Ka Kei Wu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Shang P, Feng J, Wu W, Zhang HL. Intensive Care and Treatment of Severe Guillain-Barré Syndrome. Front Pharmacol 2021; 12:608130. [PMID: 33995011 PMCID: PMC8113987 DOI: 10.3389/fphar.2021.608130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Changchun, China
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Wei Wu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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Al Maawali SM, Al Shibani AY, Nadeem AS, Al-Salti AM. Guillain-Barre syndrome: demographics, clinical features, and outcome in a single tertiary care hospital, Oman. ACTA ACUST UNITED AC 2021; 25:369-374. [PMID: 33459285 PMCID: PMC8015598 DOI: 10.17712/nsj.2020.5.20200057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Guillain-Barre syndrome (GBS) is an acute autoimmune-mediated peripheral nervous system disease. Different studies from various geographical regions have reported considerable variability regarding its epidemiology, clinical features, and outcome. Our study aimed to document demographics, clinical features, and outcomes among GBS patients admitted to a single tertiary care hospital in Muscat, Oman. METHODS A retrospective data analysis of 44 GBS patients, who were admitted during a two-year period from January 2016 to December 2018 at Khoula hospital, was carried out. Demographics, antecedent illness, duration of symptoms, muscle power graded by the Medical Research Council scale (MRCs), sensory & autonomic involvements, nerve conduction study results, CSF study, need for ventilation, condition at discharge and subsequent follow-up status were obtained. RESULTS Ninety-one percent of the patients were Omanis, with male predominant 63.6% and the average age was 42.69 years. Quadriparesis was the predominant presenting complaint (61.3%) and AIDP was the commonest variant (52%). All patients received a single cycle of IVIg and (13.6%) patients admitted to the ICU for mechanical ventilation. The study showed good outcome and recovery in 18 months follow up. CONCLUSION The clinical presentation of GBS in the majority of patients in Oman is similar to those reported in previous studies, and most patients had favorable prognoses. Our results can be used as baseline data for understanding the characteristics of GBS in Oman and, consequently, for better management.
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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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Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune neuropathy that can cause motor, sensory, and autonomic symptoms. Although GBS primarily is a neuropathic disorder, multiple organ systems can be affected during the disease course, and older patients may be more vulnerable to systemic complications. Close clinical monitoring and early interventions using pharmacologic and nonpharmacological treatments may lead to an improved long-term outcome.
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Affiliation(s)
- Justin Kwan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 1D45, MSC 1140, 10 Center Drive, Bethesda, MD 20814, USA.
| | - Suur Biliciler
- Department of Neurology, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSE#466, Houston, TX 77030, USA
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Walgaard C, Jacobs BC, Lingsma HF, Steyerberg EW, van den Berg B, Doets AY, Leonhard SE, Verboon C, Huizinga R, Drenthen J, Arends S, Budde IK, Kleyweg RP, Kuitwaard K, van der Meulen MFG, Samijn JPA, Vermeij FH, Kuks JBM, van Dijk GW, Wirtz PW, Eftimov F, van der Kooi AJ, Garssen MPJ, Gijsbers CJ, de Rijk MC, Visser LH, Blom RJ, Linssen WHJP, van der Kooi EL, Verschuuren JJGM, van Koningsveld R, Dieks RJG, Gilhuis HJ, Jellema K, van der Ree TC, Bienfait HME, Faber CG, Lovenich H, van Engelen BGM, Groen RJ, Merkies ISJ, van Oosten BW, van der Pol WL, van der Meulen WDM, Badrising UA, Stevens M, Breukelman AJJ, Zwetsloot CP, van der Graaff MM, Wohlgemuth M, Hughes RAC, Cornblath DR, van Doorn PA. Second intravenous immunoglobulin dose in patients with Guillain-Barré syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial. Lancet Neurol 2021; 20:275-283. [PMID: 33743237 DOI: 10.1016/s1474-4422(20)30494-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Treatment with one standard dose (2 g/kg) of intravenous immunoglobulin is insufficient in a proportion of patients with severe Guillain-Barré syndrome. Worldwide, around 25% of patients severely affected with the syndrome are given a second intravenous immunoglobulin dose (SID), although it has not been proven effective. We aimed to investigate whether a SID is effective in patients with Guillain-Barré syndrome with a predicted poor outcome. METHODS In this randomised, double-blind, placebo-controlled trial (SID-GBS), we included patients (≥12 years) with Guillain-Barré syndrome admitted to one of 59 participating hospitals in the Netherlands. Patients were included on the first day of standard intravenous immunoglobulin treatment (2 g/kg over 5 days). Only patients with a poor prognosis (score of ≥6) according to the modified Erasmus Guillain-Barré syndrome Outcome Score were randomly assigned, via block randomisation stratified by centre, to SID (2 g/kg over 5 days) or to placebo, 7-9 days after inclusion. Patients, outcome adjudicators, monitors, and the steering committee were masked to treatment allocation. The primary outcome measure was the Guillain-Barré syndrome disability score 4 weeks after inclusion. All patients in whom allocated trial medication was started were included in the modified intention-to-treat analysis. This study is registered with the Netherlands Trial Register, NTR 2224/NL2107. FINDINGS Between Feb 16, 2010, and June 5, 2018, 327 of 339 patients assessed for eligibility were included. 112 had a poor prognosis. Of those, 93 patients with a poor prognosis were included in the modified intention-to-treat analysis: 49 (53%) received SID and 44 (47%) received placebo. The adjusted common odds ratio for improvement on the Guillain-Barré syndrome disability score at 4 weeks was 1·4 (95% CI 0·6-3·3; p=0·45). Patients given SID had more serious adverse events (35% vs 16% in the first 30 days), including thromboembolic events, than those in the placebo group. Four patients died in the intervention group (13-24 weeks after randomisation). INTERPRETATION Our study does not provide evidence that patients with Guillain-Barré syndrome with a poor prognosis benefit from a second intravenous immunoglobulin course; moreover, it entails a risk of serious adverse events. Therefore, a second intravenous immunoglobulin course should not be considered for treatment of Guillain-Barre syndrome because of a poor prognosis. The results indicate the need for treatment trials with other immune modulators in patients severely affected by Guillain-Barré syndrome. FUNDING Prinses Beatrix Spierfonds and Sanquin Plasma Products.
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Affiliation(s)
- Christa Walgaard
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands; Department of Immunology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Bianca van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands; Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Alexandra Y Doets
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Sonja E Leonhard
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Christine Verboon
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ruth Huizinga
- Department of Immunology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Judith Drenthen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Samuel Arends
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | | | - Ruud P Kleyweg
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Krista Kuitwaard
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands; Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | | | | | - Frederique H Vermeij
- Department of Neurology, Franciscus en Vlietland Hospital, Rotterdam, Netherlands
| | - Jan B M Kuks
- Department of Neurology, University Medical Center Groningen, Groningen, Netherlands
| | - Gert W van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Paul W Wirtz
- Department of Neurology, Haga Hospital, Den Haag, Netherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Cees J Gijsbers
- Department of Neurology, Franciscus en Vlietland Hospital, Rotterdam, Netherlands
| | | | - Leo H Visser
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Roderik J Blom
- Department of Neurology, Diakonessenhuis, Utrecht, Netherlands
| | - Wim H J P Linssen
- Department of Neurology, Onze Lieve Vrouwen Gasthuis-West, Amsterdam, Netherlands; Zaans Medical Center, Zaandam, Netherlands
| | | | | | | | - Rita J G Dieks
- Department of Neurology, Röpke-Zweers Hospital, Hardenberg, Netherlands
| | - H Job Gilhuis
- Department of Neurology, Reinier de Graaf Hospital, Delft, Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, Den Haag, Netherlands
| | | | | | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Harry Lovenich
- Department of Neurology, St Jans Hospital, Weert, Netherlands
| | | | - Rutger J Groen
- Department of Neurology, Haaglanden Medical Center, Den Haag, Netherlands
| | - Ingemar S J Merkies
- Department of Neurology, Spaarne Gasthuis, Haarlem, Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bob W van Oosten
- Department of Neurology, Amsterdam University Medical Centers, VUmc, Amsterdam, Netherlands
| | - W Ludo van der Pol
- Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Umesh A Badrising
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands; Department of Neurology, van Weel-Bethesda Hospital, Dirksland, Netherlands
| | - Martijn Stevens
- Department of Neurology, Tergooi Hospitals, Blaricum, Netherlands
| | | | | | | | - Marielle Wohlgemuth
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Richard A C Hughes
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands.
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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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Barnes SL, Herkes GK. Guillain–Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort. Intern Med J 2020; 50:1500-1504. [DOI: 10.1111/imj.14705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie L. Barnes
- Department of Neurology Concord Repatriation General Hospital Sydney New South Wales Australia
- Faculty of Medicine University of Notre Dame Sydney New South Wales Australia
- Department of Neurology Royal North Shore Hospital Sydney New South Wales Australia
| | - Geoffrey K. Herkes
- Department of Neurology Royal North Shore Hospital Sydney New South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
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Yang MC, Liu A. Surge of Miller Fisher variant and Guillain-Barré syndrome in two downtown Los Angeles community teaching hospitals. Clin Case Rep 2020; 8:2245-2250. [PMID: 33235769 PMCID: PMC7669403 DOI: 10.1002/ccr3.3132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022] Open
Abstract
Guillain-Barré syndrome (GBS) and Miller Fisher variant (MFv) cases spiked threefold in Los Angeles, with a high proportion of MFv cases. MFv is underdiagnosed when accompanying neurological symptoms are mild. This report emphasizes the seasonality of GBS and its relation to ganglioside antibodies.
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Affiliation(s)
- Michael C. Yang
- Department of Internal MedicineAdventist Health White MemorialLos AngelesCAUSA
| | - Antonio Liu
- Department of NeurologyAdventist Health White MemorialLos AngelesCAUSA
- Department of NeurologyCalifornia Hospital Medical CenterLos AngelesCAUSA
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Khaja M, Gomez GPR, Santana Y, Hernandez N, Haider A, Lara JLP, Elkin R. A 44-Year-Old Hispanic Man with Loss of Taste and Bilateral Facial Weakness Diagnosed with Guillain-Barré Syndrome and Bell's Palsy Associated with SARS-CoV-2 Infection Treated with Intravenous Immunoglobulin. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927956. [PMID: 33128540 PMCID: PMC7643409 DOI: 10.12659/ajcr.927956] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND This case report is of a patient who presented with loss of taste and facial weakness and was diagnosed with Guillain-Barre syndrome (GBS) and Bell's palsy, associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. GBS is a neurological emergency defined as acute inflammatory demyelinating polyneuropathy. The patient responded to intravenous immunoglobulin (IVIG) treatment. CASE REPORT We present the case of a 44-year-old Hispanic man who came for evaluation of bilateral facial weakness and lack of taste sensation. He had lower motor neuron facial weakness. His head computed tomography and brain magnetic resonance imaging scans did not show any pathological abnormalities. He tested positive for SARS-CoV-2 by a nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) test. Cerebrospinal fluid (CSF) analysis via lumbar puncture revealed elevated protein levels, no leukocytes, and a negative Gram stain. The CSF RT-PCR test for SARS-CoV-2 was negative. PCR tests of the CSF for other viral infections were negative. A diagnosis of GBS was made, and he was treated successfully with IVIG. After the fourth dose of IVIG, the patient was able to close his eyes, frown, show his teeth, and smile. CONCLUSIONS Our case is rare because the patient did not present with lower extremity weakness, but only with bilateral Bell's palsy. Physicians should be aware of GBS because it is a neurological emergency for which COVID-19 can be a risk factor. Early diagnosis and treatment of GBS can prevent neurological disability.
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Affiliation(s)
- Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Gabriella P Roa Gomez
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Yaneidy Santana
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Nolberto Hernandez
- Department of Medicine, BronxCare Health Center Affiliated with The Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Asim Haider
- Department of Medicine, BronxCare Health Center Affiliated with The Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Jose Luis Perez Lara
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System Affiliated with the Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Rene Elkin
- Department of Neurology, BronxCare Health Center Affiliated with The Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
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39
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Ipe TS, Meyer EK, Sanford KW, Joshi SK, Wong ECC, Raval JS. Use of therapeutic plasma exchange for pediatric neurological diseases. J Clin Apher 2020; 36:161-176. [PMID: 33063869 DOI: 10.1002/jca.21850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/10/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Abstract
Therapeutic plasma exchange is used to treat neurological diseases in the pediatric population. Since its first use in pediatric patients with hepatic coma in the form of manual whole blood exchange, therapeutic plasma exchange has been increasingly used to treat these disorders of the nervous system. This expansion is a result of improved techniques and apheresis instruments suitable for small children, as well as the recognition of its applicability to many diseases in the pediatric population. This review provides a historical overview of the use of therapeutic apheresis in children and highlights the most common applications for therapeutic plasma exchange to treat neurological disorders in children.
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Affiliation(s)
- Tina S Ipe
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Erin K Meyer
- American Red Cross, Columbus, Ohio, USA.,Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kimberly W Sanford
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarita K Joshi
- Department of Hematology/Oncology and Bone Marrow Transplant, University of Washington, Seattle, Washington, USA
| | - Edward C C Wong
- Department of Pediatrics and Pathology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA.,Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jay S Raval
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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40
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Facing acute neuromuscular diseases during COVID-19 pandemic: focus on Guillain-Barré syndrome. Acta Neurol Belg 2020; 120:1067-1075. [PMID: 32696312 PMCID: PMC7373212 DOI: 10.1007/s13760-020-01421-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
In December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia from Wuhan, China, aroused worldwide concern due to an escalating outbreak in all the countries in the world. Coronavirus belongs to a family of single-stranded RNA viruses, which includes severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV), that have caused human epidemics with high fatality. The spectrum of the novel coronavirus disease (SARS-Co-2 or COVID-19) ranges from asymptomatic infections to fatal pneumonia, and differs from other viral pulmonary infections. MERS-CoV is known to be potentially neuroinvasive. Extensive reports from China documented central and peripheral nervous system involvement in patients with COVID-19, and identified in angiotensin converting enzyme2 (ACE2), which is present in multiple human organs, the functional receptor for this virus. Guillain-Barré syndrome (GBS) has recently been associated to COVID-19 rising concern among physicians. This review summarizes the current state of knowledge on GBS during or after COVID-19 infection, attempting to clarify the pathophysiology of the associated respiratory dysfunction and failure.
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41
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López-Hernández JC, Colunga-Lozano LE, Garcia-Trejo S, Gomez-Figueroa E, Delgado-Garcia G, Bazán-Rodríguez L, Cervantes-Uribe R, Burgos-Centeno J, Fernandez-Valverde F, Vargas-Cañas ES. Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with Guillain-Barré syndrome, a single center experience. J Clin Neurosci 2020; 80:292-297. [PMID: 32674942 DOI: 10.1016/j.jocn.2020.04.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical characteristics of electrophysiological subtypes and prognostic factors of Mexican adults diagnosed with Guillain-Barré Syndrome (GBS) have not been described. MATERIALS AND METHODS A single center, ambispective, cohort study was performed (2015-2019). GBS was defined following the Asbury and Cornblath criteria. Electrodiagnosis was made according to Hadden criteria. Clinical, biochemical and electrodiagnostic parameters were described, compared and analyzed using a multivariate model. Only patients who completed a 3-month follow-up were included. RESULTS 137 GBS patients (92 males; mean age 46.6 ± 16.6).132 (96.3%) underwent an electrodiagnostic assessment.68 (51.5%) were classified as axonal GBS, with further classified into two groups: acute motor axonal neuropathy (AMAN) 45.4%, and acute motor and sensory axonal neuropathy (AMSAN) 8,6%. The following characteristics were lower in the AMAN group: Medical Research Counsel sumscore (MRC) 30.1 ± 16.3 vs 36.4 ± 14.4, unilateral facial palsy 10% vs 25.9% and albuminocytologic dissociation 41.3% vs. 71.7%.Multivariate analysis found AMAN as an independent predictor of an unfavorable outcome OR: 3.34 (p = 0.03) CONCLUSIONS: AMAN subtype is the most frequent presentation of GBS in Mexican adult patients and an independent predictor of inability to walk independently at 3 months after discharge.
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Affiliation(s)
| | | | - Sofia Garcia-Trejo
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Enrique Gomez-Figueroa
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Lisette Bazán-Rodríguez
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Roberto Cervantes-Uribe
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jorge Burgos-Centeno
- Department of Clincal Neuphysiology, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Edwin Steven Vargas-Cañas
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
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42
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Electrodiagnostic Testing of Large Fiber Polyneuropathies: A Review of Existing Guidelines. J Clin Neurophysiol 2020; 37:277-287. [DOI: 10.1097/wnp.0000000000000674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Patel K, Nussbaum E, Sico J, Merchant N. Atypical case of Miller-Fisher syndrome presenting with severe dysphagia and weight loss. BMJ Case Rep 2020; 13:13/5/e234316. [PMID: 32467120 DOI: 10.1136/bcr-2020-234316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 71-year-old man developed dysphagia, bilateral lower extremity muscle weakness and weight loss. He was admitted to the hospital after a failed formal swallow evaluation, nearly 3 weeks after symptom onset. In addition to dysphagia and weakness, physical examination was notable for hypophonia, dysarthria, diplopia, horizontal ophthalmoparesis, ptosis, ataxia and hyporeflexia. Cerebrospinal fluid was notable for albuminocytological dissociation and serum anti-GQ1b antibody titre was elevated (1:200). A diagnosis of Miller-Fisher syndrome (MFS) was made, and the patient was treated with intravenous immunoglobulin (0.4 g/kg/day) for 5 days, which resulted in resolution of symptoms. This is an atypical case of MFS, in that the presenting symptom was progressive dysphagia rather than the ophthalmoplegia and ataxia that are normally seen in MFS. Patients who present with dysphagia should receive a thorough neurological examination, with particular attention to extraocular movements, reflexes and gait stability, to rule out MFS as a potential cause.
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Affiliation(s)
- Kishan Patel
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Eliezer Nussbaum
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason Sico
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Neurology, VA Connecticut Health System, West Haven, Connecticut, USA
| | - Naseema Merchant
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA .,Internal Medicine, VA Connecticut Health System, West Haven, Connecticut, USA
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44
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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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45
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Shang P, Zhu M, Wang Y, Zheng X, Wu X, Zhu J, Feng J, Zhang HL. Axonal variants of Guillain-Barré syndrome: an update. J Neurol 2020; 268:2402-2419. [PMID: 32140865 DOI: 10.1007/s00415-020-09742-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
Axonal variants of Guillain-Barré syndrome (GBS) mainly include acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, and pharyngeal-cervical-brachial weakness. Molecular mimicry of human gangliosides by a pathogen's lipooligosaccharides is a well-established mechanism for Campylobacter jejuni-associated GBS. New triggers of the axonal variants of GBS (axonal GBS), such as Zika virus, hepatitis viruses, intravenous administration of ganglioside, vaccination, and surgery, are being identified. However, the pathogenetic mechanisms of axonal GBS related to antecedent bacterial or viral infections other than Campylobacter jejuni remain unknown. Currently, autoantibody classification and serial electrophysiology are cardinal approaches to differentiate axonal GBS from the prototype of GBS, acute inflammatory demyelinating polyneuropathy. Newly developed technologies, including metabolite analysis, peripheral nerve ultrasound, and feature selection via artificial intelligence are facilitating more accurate diagnosis of axonal GBS. Nevertheless, some key issues, such as genetic susceptibilities, remain unanswered and moreover, current therapies bear limitations. Although several therapies have shown considerable benefits to experimental animals, randomized controlled trials are still needed to validate their efficacy.
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Mingqin Zhu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Ying Wang
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xiangyu Zheng
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xiujuan Wu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jie Zhu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Shuangqing Road 83#, Beijing, 100085, China.
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46
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Sim BNH, Joseph JP. Forme fruste anti-GQ1b-negative Miller Fischer syndrome masquerading as posterior circulation stroke. J R Coll Physicians Edinb 2019; 49:304-306. [PMID: 31808458 DOI: 10.4997/jrcpe.2019.411] [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: 11/19/2022] Open
Abstract
Miller Fischer syndrome (MFS) is a variant of Guillain-Barré syndrome first described in 1956 and is characterised by the clinical triad of ophthalmoplegia, ataxia and areflexia. However, since its discovery, forme fruste and overlapping syndrome have been described. A forme fruste of MFS implies an attenuated form where not all of the clinical triad are present. In this report, a case of MFS is highlighted that was mistakenly treated as posterior circulation stroke, as well as the challenges faced in reaching the correct diagnosis and hence the appropriate treatment.
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Affiliation(s)
- Benjamin Ng Han Sim
- Neurology Department, Hospital Kuala Lumpur, 23, Jalan Pahang, 50586 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia,
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47
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Leonhard SE, Conde RM, de Assis Aquino Gondim F, Jacobs BC. Diagnosis and treatment of Guillain-Barré syndrome during the Zika virus epidemic in Brazil: A national survey study. J Peripher Nerv Syst 2019; 24:340-347. [PMID: 31746070 PMCID: PMC6972698 DOI: 10.1111/jns.12358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/16/2022]
Abstract
The Zika virus (ZIKV) epidemic in Brazil in 2015-2016 was followed by an increase in the incidence of patients with Guillain-Barré syndrome (GBS). With this national survey study, we aimed to gain a better understanding of how neurologists in Brazil are currently diagnosing and treating patients with GBS, and how this increase in incidence has impacted the management of the disease. The questionnaire consisted of 52 questions covering: personal profile of the neurologist, practice of managing GBS during and outside of the ZIKV epidemic, and limitations in managing GBS. All 3264 neurologists that were member of the Brazilian Academy of Neurology at the time of the study were invited to participate. The questionnaire was fully answered by 171 (5%) neurologists. Sixty-one percent of neurologists noticed an increase in patients with GBS during the ZIKV epidemic, and 30% experienced an increase in problems in managing GBS during this time. The most important limitations in the diagnosis and management of GBS included the availability of nerve conduction studies (NCS), beds in the Intensive Care Unit (ICU) and referral to rehabilitation centers. Most neurologists did not use a protocol for treating patients with GBS and the treatment practice varied. Increasing availability of NCS and beds in the ICU and rehabilitation centers, and the implementation of (inter)national guidelines, are critical in supporting Brazilian neurologist in their management of GBS, and are especially important in preparing for future outbreaks.
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Affiliation(s)
- Sonja E. Leonhard
- Department of NeurologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Rodrigo M. Conde
- Ribeirão Preto Medical SchoolUniversity of São Paulo (FMRP‐USP)Ribeirão PretoSão PauloBrazil
| | | | - Bart C. Jacobs
- Department of NeurologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of ImmunologyErasmus University Medical CenterRotterdamthe Netherlands
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48
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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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49
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What's happening in Without Borders. Neurology 2019; 93:486. [DOI: 10.1212/wnl.0000000000008110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Pitarokoili K, Gold R. Heterogeneous GBS course requires standardized guidelines. Nat Rev Neurol 2019; 15:561-562. [PMID: 31358946 DOI: 10.1038/s41582-019-0245-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ralf Gold
- Department of Neurology, Ruhr University, St Josef-Hospital, Bochum, Germany.
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