Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with guillain-barré syndrome, a single center experience

López-Hernández, Juan Carlos; Colunga‐Lozano, Luis Enrique; Galnares-Olalde, Javier Andrés; Vargas-Cañas, Edwin Steven

doi:10.1016/j.jocn.2020.12.016

Cited by 7 publications

(18 citation statements)

References 10 publications

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“…These differences between the Americas and the rest of the world may be related to differences in operational definitions and because in most Latin American countries, GBS reports mostly depend on passive epidemiological surveillance systems. The most common electrophysiological variant in Mexico is AMAN, probably associated with the increased incidence of Campylobacter jejuni gastrointestinal infections 9,10 ; despite this association, in Mexico, GBS has a seasonal distribution with a peak of axonal variants during the summer, while the AIDP variant is more frequent in winter, possibly associated to a higher incidence of respiratory infections 11 .…”

Section: Epidemiology and Potential Triggersmentioning

confidence: 99%

“…However, acute ataxic neuropathy and classic BBE may have prolonged distal compound muscle action potentials (CMAP) in motor nerves without fulfilling axonal pattern criteria 26 . Some studies report that the most frequent electrophysiological variant is AMAN, which presents some clinical and paraclinical differences compared to the AIDP variant (Table 2) 9,20 . Although AMAN is the most prevalent variant in Mexico, only 35% of cases have preceding diarrhea, while respiratory tract infections precede in 25%.…”

Section: Electrophysiological Variants and Criteriamentioning

confidence: 99%

“…Although AMAN is the most prevalent variant in Mexico, only 35% of cases have preceding diarrhea, while respiratory tract infections precede in 25%. On the other hand, AIDP is preceded by diarrhea in 44.4% of cases or a respiratory tract infection in 26% 9 . AIDP is usually less severe and carries a better prognosis than AMAN, which has a faster course associated with an increased risk for invasive mechanical ventilation requirement 10 .…”

Section: Electrophysiological Variants and Criteriamentioning

confidence: 99%

“…Small volume PLEX (total exchange of 140 mL/kg over 8 days) is a safe and feasible treatment in low-income countries where IVIg and PLEX are unavailable or unaffordable 10 . In Mexico, the decision between IVIg and PLEX depends on treatment availability, and recent studies report that only 63-75% of patients are so treated 3,4,9 .…”

Section: Therapeutic Considerationsmentioning

confidence: 99%

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Guillain-Barr� syndrome in Mexico: An updated review amid the coronavirus disease 2019 era

Galnares-Olalde¹,

López-Hernández²,

García‐Grimshaw³

et al. 2022

RIC

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Guillain-Barré syndrome (GBS) is the most frequent cause of acute flaccid paralysis and if not diagnosed and treated timely, a significant cause of long-term disability. Incidence in Latin America ranges from 0.71 to 7.63 cases/100,000 person-years.Historically, GBS has been linked to infections (mainly gastrointestinal by Campylobacter jejuni) and vaccines (including those against severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]); however, a trigger cannot be detected in most cases. Regarding SARS-CoV-2, epidemiological studies have found no association with its development. Acute motor axonal neuropathy is the most common electrophysiological variant in Mexico and Asian countries. Intravenous immunoglobulin or plasma exchanges are still the treatment cornerstones. Mortality in Mexico can be as high as 12%. Advances in understanding the drivers of nerve injury in GBS that may provide the basis for developing targeted therapies have been made during the past decade; despite them, accurate criteria for selecting patients requiring acute treatment, prognostic biomarkers, and novel therapies are still needed. The newly-developed vaccines against SARS-CoV-2 have raised concerns regarding the potential risk for developing GBS. In the midst of coronavirus disease 2019 and vaccination campaigns against SARS-CoV-2, this review discusses the epidemiology, clinical presentation, management, and outcomes of GBS in Mexico. (REV INVEST CLIN. 2022;74(3):121-30

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Section: Epidemiology and Potential Triggersmentioning

confidence: 99%

Section: Electrophysiological Variants and Criteriamentioning

confidence: 99%

Section: Electrophysiological Variants and Criteriamentioning

confidence: 99%

Section: Therapeutic Considerationsmentioning

confidence: 99%

See 2 more Smart Citations

Guillain-Barr� syndrome in Mexico: An updated review amid the coronavirus disease 2019 era

Galnares-Olalde¹,

López-Hernández²,

García‐Grimshaw³

et al. 2022

RIC

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“…Before this article, little was known about the frequency of BBE among clinical phenotypes of GBS in Latin American countries. Our group had previously reported a frequency of BBE/MFS overlap in 1.5% of patients 11 ; currently with more patients included in our GBS cohort. In our center, 1.7% of cases met criteria for BEE.…”

Section: Discussionmentioning

confidence: 87%

Frequency, clinical, and paraclinical characteristics of patients with Bickerstaff brainstem encephalitis in a tertiary-referral neurological center

Aguilar-Parra¹,

de-Saráchaga²,

Bazán-Rodríguez³

et al. 2022

RMN

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Background: Bickerstaff brainstem encephalitis (BBE) presents with consciousness impairment, ataxia, ophthalmoplegia, and areflexia. Objective: We aim to describe the clinical, paraclinical, and imaging features of patients with BBE from a tertiary-referral neurological center. Methods: A case series was conducted from an ambispective cohort of patients with Guillain-Barré syndrome (GBS) from 2016 to 2021. Subjects ≥ 18 years and who met Odaka et al. BBE criteria were eligible. Data collected included: age, gender, prior infection, Guillain-Barré disability score (GDS score), time from symptom onset to diagnosis, altered mental state, time from symptom onset to altered mental state, cranial nerve involvement, deep tendon reflexes, ataxia, invasive mechanical ventilation (IMV) requirement, treatment, inpatient delirium, length of stay (days), and protein levels in CSF analysis. Nerve conduction studies (NCS) were performed, as well as neuroimaging (brain magnetic resonance imaging [MRI] and F 18-fluorodeoxyglucose PET-CT). Antiganglioside antibodies panel including anti-GQ1b was solicited. Results: Four patients (1.7%) met the inclusion criteria. Two patients manifested stupor and two showed somnolence throughout the course of the disease. Three patients required IMV due to bulbar dysfunction. None of the NCS met the criteria for any GBS electrophysiological variant. One patient was positive for IgM GM2 antibodies. One patient underwent 18F-FDG PET-CT, showing generalized cortical hypometabolism. Conclusion: The frequency of BBE in our population is very low (1.7%). IgM GM2 is another anti-ganglioside antibody related to BBE. Imaging studies such as MRI frequently do not present abnormalities and [ F 18-FDG-PET scan might be a useful study to describe a metabolism pattern to aid the diagnosis of BBE.

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Predictors of Mechanical Ventilation in Guillain–Barré Syndrome with Axonal Subtypes

Michel-Chávez

Chiquete

Gulı́as-Herrero

et al. 2022

Can. J. Neurol. Sci.

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Background: The early clinical predictors of respiratory failure in Latin Americans with Guillain–Barré syndrome (GBS) have scarcely been studied. This is of particular importance since Latin America has a high frequency of axonal GBS variants that may imply a worse prognosis. Methods: We studied 86 Mexican patients with GBS admitted to the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a referral center of Mexico City, to describe predictors of invasive mechanical ventilation (IMV). Results: The median age was 40 years (interquartile range: 26–53.5), with 60.5% men (male-to-female ratio: 1.53). Most patients (65%) had an infectious antecedent (40.6% gastrointestinal). At admission, 38% of patients had a Medical Research Council (MRC) sum score <30. Axonal subtypes predominated (60.5%), with acute motor axonal neuropathy being the most prevalent (34.9%), followed by acute inflammatory demyelinating polyneuropathy (32.6%), acute motor sensory axonal neuropathy (AMSAN) (25.6%), and Fisher syndrome (7%). Notably, 15.1% had onset in upper limbs, 75.6% dysautonomia, and 73.3% pain. In all, 86% received either IVIg (9.3%) or plasma exchange (74.4%). IMV was required in 39.5% patients (72.7% in AMSAN). A multivariate model without including published prognostic scores yielded the time since onset to admission <15 days, axonal variants, MRC sum score <30, and bulbar weakness as independent predictors of IMV. The model including grading scales yielded lower limbs onset, Erasmus GBS respiratory insufficiency score (EGRIS) >4, and dysautonomia as predictors. Conclusion: These results suggest that EGRIS is a good prognosticator of IMV in GBS patients with a predominance of axonal electrophysiological subtypes, but other early clinical data should also be considered.

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Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with guillain-barré syndrome, a single center experience

Cited by 7 publications

References 10 publications

Guillain-Barr� syndrome in Mexico: An updated review amid the coronavirus disease 2019 era

Guillain-Barr� syndrome in Mexico: An updated review amid the coronavirus disease 2019 era

Frequency, clinical, and paraclinical characteristics of patients with Bickerstaff brainstem encephalitis in a tertiary-referral neurological center

Predictors of Mechanical Ventilation in Guillain–Barré Syndrome with Axonal Subtypes

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