Diagnosis and treatment of Guillain‐Barré syndrome during the Zika virus epidemic in Brazil: A national survey study

Abstract

The Zika virus (ZIKV) epidemic in Brazil in 2015‐2016 was followed by an increase in the incidence of patients with Guillain‐Barré syndrome (GBS). With this national survey study, we aimed to gain a better understanding of how neurologists in Brazil are currently diagnosing and treating patients with GBS, and how this increase in incidence has impacted the management of the disease. The questionnaire consisted of 52 questions covering: personal profile of the neurologist, practice of managing GBS during and outside of the ZIKV epidemic, and limitations in managing GBS. All 3264 neurologists that were member of the Brazilian Academy of Neurology at the time of the study were invited to participate. The questionnaire was fully answered by 171 (5%) neurologists. Sixty‐one percent of neurologists noticed an increase in patients with GBS during the ZIKV epidemic, and 30% experienced an increase in problems in managing GBS during this time. The most important limitations in the diagnosis and management of GBS included the availability of nerve conduction studies (NCS), beds in the Intensive Care Unit (ICU) and referral to rehabilitation centers. Most neurologists did not use a protocol for treating patients with GBS and the treatment practice varied. Increasing availability of NCS and beds in the ICU and rehabilitation centers, and the implementation of (inter)national guidelines, are critical in supporting Brazilian neurologist in their management of GBS, and are especially important in preparing for future outbreaks.

Epidemiological and clinical aspects of Guillain-Barré syndrome and its variants

“…Recently, a nationwide increase in the incidence of GBS following the Zika virus epidemic in 2015 was reported 28 . However, this was not supported by maintenance of annual incidence during this period, in our study (Figure 2).…”

Guillain–Barré syndrome in low-income and middle-income countries: challenges and prospects

“…Variations in the incidence and outcomes of GBS can also be partly explained by income per capita 12 , 18 . Resource limitations in LMIC, including the limited availability of electrodiagnostic machines, hospital and intensive care unit (ICU) beds and rehabilitation clinics, can hamper the diagnosis and care of patients with GBS 5 . In addition, the lack of national guidelines (in most LMIC) and the high cost of treatment facilities complicate the management of patients with GBS versus their counterparts in high-income countries (HIC) — defined according to World Bank criteria as having an annual gross national income per capita of ≥US$3,995 (ref.…”

Guillain-Barré syndrome in times of pandemics

“…We expect limitations mainly in ICU beds and rehabilitation care, as this was also reported during the Zika virus outbreak in Brazil. 16 These limitations are especially important in low-resource countries that often have suboptimal or malfunctional healthcare systems, a lack of health professionals and are hot spots for outbreaks of emerging infectious diseases. 17 Here, we provide recommendations on how to safeguard good quality diagnosis and management of GBS during a pandemic.…”