Autonomic involvement in Guillain–Barré syndrome: an update

Zaeem, Zoya; Siddiqi, Zaeem A.; Zochodne, Douglas W.

doi:10.1007/s10286-018-0542-y

Cited by 83 publications

(67 citation statements)

References 64 publications

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“…A single patient with Guillain-Barre syndrome was admitted to the ICU for autonomic dysfunction, suggesting that close monitoring for autonomic dysfunction is also essential to the care of these patients. 20 A majority of the neuromuscular disorders encountered in our ICU over the past 11 years have treatment options that, when initiated promptly, target the underlying pathophysiological process, thereby reducing the duration of illness, the length of hospital stay, and the need for intensive management. For example, the prompt initiation of intravenous immunoglobulin or plasma exchange in patients with Guillain-Barre syndrome hastens recovery in both adults and children.…”

Section: Discussionmentioning

confidence: 99%

Acute Neuromuscular Disorders in the Pediatric Intensive Care Unit

2019

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Background: The neuromuscular disorders encountered in the pediatric intensive care unit (PICU) encompass a broad spectrum of pathologies. These include acute disorders (eg, Guillain-Barre syndrome), acute-on-chronic disorders (eg, myasthenia gravis), progressive disorders (eg, muscular dystrophy), and disorders that develop in the PICU (eg, critical illness myopathy/polyneuropathy). Familiarity with the presenting features of these disorders is of paramount importance in facilitating timely diagnosis. Methods: We conducted a retrospective review of the medical records of patients admitted to the PICU or Intermediate Care Program (ICP) at a single tertiary children’s hospital from 2006 to 2017 with an acute or acute-on-chronic neuromuscular disorder. We did not include patients with a known progressive neuromuscular disorder or critical illness myopathy/polyneuropathy. Results: Twenty-four patients were admitted to the PICU/ICP with acute or acute-on-chronic neuromuscular disorders. Diagnosis and indication for ICU/ICP admission were Guillain-Barre syndrome (n = 6; respiratory failure: 3, respiratory monitoring: 2, autonomic instability: 1), myasthenia gravis (n = 5; airway clearance: 3, respiratory failure: 2), acute flaccid myelitis (n = 3; respiratory failure: 2, respiratory monitoring: 1), periodic paralysis (n = 3; intravenous potassium replacement), rhabdomyolysis (n = 3; monitoring for electrolyte derangements), infant botulism (n = 2; respiratory failure), chronic demyelinating polyneuropathy (n = 1; respiratory failure), and congenital myasthenic syndrome (n = 1; apnea). No patients were admitted to the PICU/ICP with a diagnosis of tick paralysis, acute intermittent porphyria, or inflammatory myopathy. Conclusions: Although acute and acute-on-chronic neuromuscular disorders are encountered relatively rarely in the PICU, familiarity with the presenting features of these disorders is important in facilitating timely diagnosis. This, in turn, enables the institution of effective management strategies, thereby avoiding complications associated with diagnostic delays.

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Section: Discussionmentioning

confidence: 99%

Acute Neuromuscular Disorders in the Pediatric Intensive Care Unit

2019

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“…Guillain‐Barre syndrome (GBS) is an autoimmune‐mediated length independent radiculoneuropathy that predominantly targets the somatic system, but also autonomic fibers. Autonomic disturbances predominantly affect the cardiovascular and gastrointestinal systems and are present in two‐thirds of patients 34,35 . Cardiac disturbances manifest in the form of over‐reactive or blunted cardiac vagal and cardiac adrenergic responses, with patients often exhibiting sinus tachycardia, dysrhythmias (sometimes potentially fatal arrhythmias), systemic hypertension, bradycardia, and/or blood pressure fluctuation.…”

Section: Autonomic Neuropathies With An Acute To Subacute Onsetmentioning

confidence: 99%

Autonomic neuropathies

et al. 2020

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Autonomic neuropathies represent a complex group of disorders that preferentially target autonomic fibers and can be classified as either acute/subacute or chronic in onset. Acute-onset autonomic neuropathies manifest with such conditions as paraneoplastic syndromes, Guillain-Barre syndrome, Sjögren syndrome, infection, or toxins/chemotherapy. When the presentation is acute, immune-mediated, and without a secondary cause, autoimmune autonomic ganglionopathy is likely, and should be considered for immunotherapy. Of the chronic-onset forms, diabetes is the most widespread and disabling, with autonomic impairment portending increased mortality and cardiac wall remodeling risk. Acquired light chain (AL) and transthyretin (TTR) amyloidosis represent two other key etiologies, with TTR amyloidosis now amenable to newly-approved gene-modifying therapies. The COMPASS-31 questionnaire is a validated outcome measure that can be used to monitor autonomic severity and track treatment response. Symptomatic treatments targeting orthostatic hypotension, among other symptoms, should be individualized and complement disease-modifying therapy, when possible.

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“…Autonomic dysfunction secondary to demyelination of autonomic nerve fibers is considered a hallmark feature of GBS, being present in at least two thirds of cases. 16 Blood pressure variability is particularly characteristic, occasionally culminating in either sustained severe systolic hypertension or cardiovascular collapse. 17 While malignant hypertension may in and of itself produce mental status changes, one condition to be particularly mindful of in GBS + CNS is posterior reversible encephalopathy syndrome (PRES).…”

Section: Autonomic Dysfunctionmentioning

confidence: 99%

Altered mental status in “Guillain‐Barré syndrome” –a noteworthy clinical clue

Mulroy

Anderson

2020

Ann Clin Transl Neurol

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Guillain-Barr e syndrome (GBS) is widely regarded as a "pure" peripheral nervous system disorder. However, this simplistic interpretation belies the fact that central nervous system involvement, often manifesting as derangements in mental status can occur as a complication of the "pure" form of the disorder, as part of GBS variants, as well as in a number of mimic disorders. Despite being common in clinical practice, there is no guidance in the literature as to how to approach such scenarios. Herein, we detail our approach to these cases.

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Autonomic involvement in Guillain–Barré syndrome: an update

Abstract: This review will summarize the current literature involving GBS and autonomic dysfunction in terms of presentation, management, and a brief discussion of prognosis. We also examine prospective approaches that may be helpful and update a proposed management plan.

Cited by 83 publications

References 64 publications

Acute Neuromuscular Disorders in the Pediatric Intensive Care Unit

Acute Neuromuscular Disorders in the Pediatric Intensive Care Unit

Autonomic neuropathies

Altered mental status in “Guillain‐Barré syndrome” –a noteworthy clinical clue

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