Clinical Variants and Evaluation of Clinical Severity of Guillain Barre Syndrome in a Tertiary Care Hospital of Nepal

Abstract

Background Guillain Barre Syndrome(GBS) is an acute, frequently severe, and fulminant polyradiculoneuropathy that is autoimmune in nature. Our aim is to evaluate the grading of disability and outcome among different variants of GBS. Methods All consecutive patients recruited prospectively in the study were of age ≥16 years and were being admitted in department of Neurology of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 2016 March to 2017 February. All demographic, historical and clinical data were collected. Nerve conduction study, cerebrospinal fluid analysis along with clinical features were evaluated to assess the diagnostic certainty of Brighton Criteria. Overall disability sum score (ODSS) and GBS disability score were assessed in all patients. The study protocol was approved by the Institutional Review Boards. Results A total of 46 patients were included: male patients being predominant (70% vs 30%), mean age= 36.5±16.2, range = 16 - 80 years. Thirty-two patients (70%) were an axonal variant, acute motor axonal neuropathy being more common (18 patients), and 14 patients were acute motor and sensory axonal neuropathy. Fourteen patients (30%) were demyelinating type, out of which 11 patients had both motor and sensory features, and only 3 patients were pure motor demyelinating type. Axonal variants were found to have higher ODSS during nadir (p=0.024) and discharge(p=0.004), and also higher GBS disability score during nadir (p=0.012) and discharge (p=0.021). Acute motor axonal neuropathy (AMAN) had higher GBS disability score than acute inflammatory demyelinating polyneuropathy (AIDP) at nadir (p=0.034) and discharge (p=0.039). Conclusions Axonal neuropathy variants are predominant among the Nepalese population and are clinically severe than demyelinating variants. Further, prospective study of longer duration to include larger number of patients will be needed.