A Study on the Clinical and Electrodiagnostic Profile of GBS and Its Correlation With Early Predictors of Prognosis

Abstract

BACKGROUND The purpose of this study is about the clinical profile with electrodiagnostic features of GBS in South Indian populations admitted at a tertiary care centre to correlate the clinical and electrodiagnostic features with disability of the disease and thereby to identify the poor prognostic clinical and nerve conduction features in a much earlier course of the disease. MATERIALS AND METHODS Cross-sectional study (prospective cum retrospective) done in patients with acute inflammatory demyelinating polyradiculopathy. Patients with other causes of weakness like hypokalaemic periodic paralysis, diphtheria, trauma, paraneoplastic condition and botulism were excluded. History for each patient was obtained through a questionnaire and further subject to thorough clinical examination. Apart from routine blood investigations, cerebrospinal fluid analysis and nerve conduction studies were also done for each patient. RESULTS In our study group of fifty patients with GBS, majority of patients belonged to the age group 20-40 years, comprising 66%. This correlates well with various GBS study groups conducted at NIMHANS, Kerala. The age and sex distribution did not seem to affect the outcome of the disease-death or degree of recovery with the p value being greater than 0.05. The commonest subtype of GBS in our study population was demyelinating type comprising 60% and with axonal variants comprising 30%. The Pong Kuohyo et al study group had 49% of the patients who were of demyelinating type. Cranial nerve involvement was present in 42% of the patients and the facial nerve paralysis was the most commonly observed palsy. Ito M Kuwabara et al found that the facial involvement is the most common, present in 70%. Dysautonomia was present in 36% of the patients in our study population and it was directly related to ventilator dependence and mortality. Mechanical ventilation was required in 24% of the patients and the average duration of ventilator dependence was 14.5 days. Decreased CMAP < 10% was present in 18% of the patients. It had higher significance with morbidity and mortality with p value of < 0.001. Statistical Method-Data was analysed using SPSS (Statistical Package for Social Science) package. CONCLUSION GBS is the commonest cause of acute flaccid quadriparesis in our country. Our study group of 50 patients showed that axonal variant of GBS with cranial nerve involvement, dysautonomia, dependence on mechanical ventilation and decreased CMAP on nerve conduction study to be associated with higher mortality and morbidity in comparison to other parameters. Early identification of the above-mentioned adverse clinical and electrodiagnostic profile can be helpful in initiating prompt treatment and thereby attenuating the morbidity and mortality.