Assessment of current diagnostic criteria for Guillain-Barr� syndrome

Asbury, Arthur K.; Cornblath, David R.

doi:10.1002/ana.410270707

Cited by 1,752 publications

(1,193 citation statements)

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“…Some of this variety may be attributed to retrospective analysis of nonstandardized clinical and electrophysiological data to describe subtypes of GBS. In our study, all included GBS patients fulfilled the NINDS‐criteria for the diagnosis of GBS 18. We performed subgroup analysis of our GBS cohort to compare the clinical and electrophysiological characteristics of patients with evidence of ZIKV infection versus recent C .…”

Section: Discussionmentioning

confidence: 99%

“…The patients were included in the study after the validation of the clinical diagnosis using the criteria defined by NINDS 18. Detailed, standardized information on demographic and clinical data were collected, including age, sex, place of residence (district of Bangladesh); clinical symptoms of preceding infections or other events; time and degree of maximum weakness; cranial, sensory, and autonomic nerve involvement; respiratory failure; and requirement for mechanical ventilation.…”

Section: Methodsmentioning

confidence: 99%

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Zika virus and Guillain–Barré syndrome in Bangladesh

GeurtsvanKessel

Islam

et al. 2018

Ann Clin Transl Neurol

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ObjectivePrevious studies have associated Guillain–Barré syndrome (GBS) with Zika virus (ZIKV) outbreaks in South America and Oceania. In Asia, ZIKV is known to circulate widely, but the association with Guillain–Barré syndrome is unclear. We investigated whether endemic ZIKV infection is associated with the development of GBS.MethodsA prospective study was conducted from 2011 to 2015 in Bangladesh. A total of 418 patients and 418 healthy family controls were included in the study. Patients were diagnosed with GBS prior to inclusion according to established criteria. Detailed information on the epidemiology, clinical presentation, electrophysiology, diagnosis, disease severity, and clinical course were obtained during a follow‐up of 1 year using a predefined protocol.Results ZIKV‐neutralizing antibodies were detected in our study from 2013 onwards. The prevalence of ZIKV‐neutralizing antibodies was not significantly higher in patients with GBS compared to healthy controls (OR 2.23, P = 0.14, 95% CI 0.77–6.53). Serological evidence for prior ZIKV infection in patients with GBS was associated with more frequent cranial, sensory, and autonomic nerve involvement compared to GBS patients with Campylobacter jejuni, the predominant preceding infection in GBS worldwide. Nerve‐conduction studies revealed that ZIKV antibodies were associated with a demyelinating subtype of GBS, while C. jejuni infections were related to an axonal subtype.InterpretationNo significant association was found between ZIKV infection and GBS in Bangladesh, but GBS following ZIKV infection was characterized by a distinct clinical and electrophysiological subtype compared to C. jejuni infection. These findings indicate that ZIKV may precede a specific GBS subtype but the risk is low.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Zika virus and Guillain–Barré syndrome in Bangladesh

GeurtsvanKessel

Islam

et al. 2018

Ann Clin Transl Neurol

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“…20 A patient was eligible for inclusion if their symptoms of weakness began within 2 weeks before the date of randomisation, if they were unable to walk 10 m across an open space without assistance (GBS disability score у3), and if they were willing to sign the informed Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial previous infection with C jejuni. With respect to electrophysiology, we assessed the compound muscle action potential (CMAP) of the ulnar nerve.…”

Section: Patientsmentioning

confidence: 99%

Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trial

Koningsveld¹,

Schmitz²,

Meché³

et al. 2004

The Lancet

332

197

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SummaryBackground Despite available treatment with intravenous immunoglobulin (IVIg), morbidity and mortality are considerable in patients with Guillain-Barré syndrome (GBS). Our aim was to assess whether methylprednisolone, when taken with IVIg, improves outcome when compared with IVIg alone.Methods We did a double-blind, placebo-controlled, multicentre, randomised study, to which we enrolled patients who were unable to walk independently and who had been treated within 14 days after onset of weakness with IVIg (0·4 g/kg bodyweight per day) for 5 days. We assigned 233 individuals to receive either intravenous methylprednisolone (500 mg per day; n=116) or placebo (n=117) for 5 days within 48 h of administration of first dose of IVIg. Because age is an important prognostic factor, we split treatment groups into two age-groups-ie, younger than age 50 years, or 50 years and older. Our primary outcome was an improvement from baseline in GBS disability score of one or more grades 4 weeks after randomisation. Analysis was by intention to treat.Findings We analysed 225 patients. GBS disability scores increased by one grade or more in 68% (76 of 112) of patients in the methylprednisolone group and in 56% (63 of 113) of controls (odds ratio [OR] 1·68, 95% CI 0·97-2·88; p=0·06). After adjustment for age and degree of disability at entry, treatment OR was 1·89 (95% CI 1·07-3·35; p=0·03). Side-effects did not differ greatly between groups.Interpretation We noted no significant difference between treatment with methylprednisolone and IVIg and IVIg alone. Because of the relevance of prognostic factors and the limited side-effects of methylprednisolone, the potential importance of combination treatment with the drug and IVIg, however, warrants further investigation.

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“…It is important to highlight that the present population-based analysis is based on a simplified case definition for GBS. All 25 children in the hospital study in whom GBS was diagnosed on the basis of National Institute of Neurological Disorders criteria ( 7 ) were also detected through population-based surveillance and fulfilled the simplified GBS case definition. Future studies, however, should include a validation of the case definition used here.…”

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confidence: 99%