Guillain-Barré syndrome: Clinical profile and Consensus to revise Hughes grade 5

Abstract

Background: Guillain-Barré Syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy and an important cause of acute flaccid paralysis (AFP) worldwide. Respiratory insufficiency requiring ventilator occurs in 30% of patients that prolong the hospital stay, leading to morbidity and mortality. There had been relatively few studies of Guillain-Barre syndrome in adults from South India. Aim: To evaluate clinical profile, epidemiological, laboratory, and electro diagnostic features of patients with GBS in adults. Settings and design: A prospective study was conducted over a period of 4 years at ESIC Superspeciality Hospital, Hyderabad. Materials and methods: Total 36 patients were identified and data was collected. We studied the epidemiological, clinical, electrophysiological features and their outcome. We subdivided Hughes grade 5 into 5A and 5B based on the requirement of ventilator. Statistical Analysis: Data obtained in the study were subjected to statistical analysis with Statistical Package for Social Sciences (SPSS) version 18. Bivariate analysis was done using chi-square test. Results: Of 36 GBS patients, 21(58.3%) were males; the mean age was 35 years. Antecedent infection was found in 23(63.8%). Majority 12 (33%) were in Hughes grade 4, 10 (27.7%) were in Hughes grade 5A. 97.2% had limb weakness. A significant association was found between low Medical research sum score (MRC) and respiratory failure. Most predominant neurophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 12 (33.3%). Duration of illness was less than 1week in 19 (52.7%) of cases. Asymmetry was observed in 5 (13.8%) and recurrence of Guillain-Barre Syndrome seen in 2 (5.5%) cases. Complete recovery was noted at 6 months in 34 (94.4%) cases. Conclusion: Early diagnosis of respiratory failure and prompt intervention improves patient outcome. Further large sample studies are required to assess respiratory failure and subdivision of Hughes grade 5.

Clinical Profile, Electrodiagnostic Variations, Treatment and Outcome in Guillain-Barré Syndrome: Prospective Study of 78 Patients

“…11,12,15,16 In our study majority >90% patients were treated with Plasmapharesis while in majority of the previous studies 11,12,14,15,17 >90% patients with GBS treated with IVIg. In our study complete recovery were observed in about 56% patients while in other studies 11,12,14,17 >70% patients with GBS were recovered completely. Early arrival (<1 week) to hospital, initiation of treatment in form of plasmapharesis or IVIg and intensive care helped to achieve complete recovery in our study.…”

“…The mean age was 34 years. Sex ratio showed a slight male preponderance in most of the studies [11][12][13][14][15][16][17] Preceding events prior to the illness in present study is observed in forty two patients (53%) had preceding illness. (Table 1) In most of previous studies shows antecedent event in >50% patients.…”

“…The study was an attempt to identify the clinical and epidemiological profile of GBS in adults and compared with previous clinical studies. [11][12][13][14][15][16][17] ( Table 2). Most of the studies were conducted either in children or both adults and children.…”

“…(Table 1) In most of previous studies shows antecedent event in >50% patients. [11][12][13][14][15]17 Majority of the patients >97% in all studies have shown limb weakness. [11][12][13][14][15]17 As compared to other studies in present study there were more number of patients with autonomic dysfunction (39.74%) and respiratory distress (42.3%).…”

“…[11][12][13][14][15]17 Majority of the patients >97% in all studies have shown limb weakness. [11][12][13][14][15]17 As compared to other studies in present study there were more number of patients with autonomic dysfunction (39.74%) and respiratory distress (42.3%). Amita bhargav et al 12 and Sandhya Manorj et al 17 observed albuminocytogenic dissociation in about 80% patients while in our study it was around 50.41%.…”