Clinico- Electrophysiological and CSF Profile and Predictors of Functional Outcome in Guillaine-Barre Syndrome- A Prospective Study

Abstract

BACKGROUND Guillain-Barre syndrome (GBS) is a rare, immune mediated disorder which is associated with demyelination of peripheral nervous system and progressive muscle weakness, with an annual global incidence of approximately 1–2 per 100,000 person-years. GBS has an unpredictable clinical course with up to 30% of patients requiring assisted ventilation during the course of their illness. Recent advances in the eld of critical care has successfully improved the outcome of GBS. Successful management mandates anticipation, prompt recognition of modiable risk factors and optimal treatment of neuromuscular respiratory failure in GBS. There is limited Indian data with regards to the early determinants and outcome of severely affected GBS patients. Knowledge of early predictors can substantially improve patient care and provides essential data for triage at an early stage in the course of the illness. OBJECTIVE 1. To study the clinical, electrophysiological prole, progression and outcome of GBS in a tertiary care hospital. 2. To determine the factors associated with the poor functional outcome, including the need for mechanical ventilation. MATERIALS AND METHODS This was a single centre, prospective study with 50 patients with GB syndrome, conducted from from 1st June 2021 to 30th May 2022 for a period of 1 year at Gauhati Medical College and Hospital. Their clinical, electrophysiological, CSF parameters were analysed. Hughes grading, EGRIS, mEGOS, MRC sum score were used. Any clinical deterioration and need for mechanical ventilation were noted carefully. Patients were followed up at 3 months and 6 months at assess their outcome. The mean age of the patients was 30.5 RESULTS years with a male female ratio of 1.3:1. AIDP was the most prevalent subtype found in 23(46%) patients followed by AMAN in 14(28%), AMSAN in 9(18%) and 4(8%) cases were unclassied. 32(64%) had severe disease with Hughes score ≥ 4 and 28(56%) had MRC score <40 at presentation. Respiratory distress was found in 17(34%) of patients, and out of which 10(20%) required mechanical ventilation. During the study 2(4%) patients died of complications. At 3 months, 30(60%) patients had complete recovery, 12(24%) had partial recovery and 6(12%) had poor recovery. At 6 months, 35(70%) had good recovery, 9(18%) had partial recovery and 4(8%) had poor recovery. Delayed CONCLUSION presentation, early peak of illness, prolonged Hospital stay, bulbar weakness, neck exor weakness, bilateral facial weakness, quadriparesis, respiratory distress, need for mechanical ventilation, autonomic dysfunction; high Hughes grading, low average single breath count along with high EGRIS, mEGOS, MRC sum score, high CSF protein, albumin-cytological dissociation, presence of F-wave abnormalities and Non stimulable nerves or Inexcitable nerves on NCS, AMAN subtype and systemic complications are associated with poor outcome. The overall outcome of GBS is favourable.