Clinical Profile and Treatment Outcome of Guillain-Barre Syndrome: A Three Year Tertiary Care Experience from Kerala

Guillain–Barre syndrome (GBS) is an acute onset, usually monophasic immune-mediated disorder of the peripheral nervous system. The term GBS is often considered to be synonymous with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), but with the increasing recognition of variants over the past few decades, the number of diseases that fall under the rubric GBS have grown to include axonal variants and more restricted variants, such as Miller Fisher syndrome (MFS) [Table 1].[1] Table 1 Guillain–Barre syndrome—clinical variants Epidemiology The reported incidence rates for GBS are 1–2 per 100,000 population.[2–4] The lifetime likelihood of any individual acquiring GBS is 1:1000.[5] The subtypes of GBS have different incidence rates in different parts of the world. In Europe and North America AIDP is dominant contributing to 90% of the cases. In contrast in China and Japan AMAN being the most common subtype.[6,7] The picture is intermediate when we look at other population. In Indian series the incidence of AIDP and AMAN are virtually equal although AMAN is more common in younger patients.[8] There seems to be a slight preponderance of AIDP in studies by Gupta et al[9] and by Meena et al (unpublished data from NIMS, Hyderabad). Available Indian literature indicates a peak incidence between June–July and Sept–October.[10] In western countries, GBS is common in the 5th decade,[11] but in India it occurs more commonly at a younger age.[10,12] GBS is equally common in men and women and can occur at any age. There is a male preponderance among the hospitalized population.[10,12]

To compare the clinical profile and short-term outcome of children with axonal and demyelinating subtypes of childhood Guillain Barré syndrome (GBS). This is a prospective observational study conducted in a tertiary care teaching hospital in North India. Consecutive children with Guillain Barré syndrome were recruited to compare the clinical profile and short term outcome among the subtypes. Among 9847 children admitted to the emergency, 95 had acute flaccid paralysis; 57 of whom had GBS. Electrophysiological studies were completed in 57; of whom 20 had acute inflammatory demyelinating polyneuropathy (AIDP); 19 had acute motor axonal neuropathy (AMAN); 12 had non-reactive nerves; five were unclassifiable; 1 had acute motor sensory axonal neuropathy (AMSAN). More children in AMAN group had preceding gastroenteritis (4 vs. 2), while AIDP group had upper respiratory infections (12 vs. 7). Ataxia was only seen in AIDP subtype while wrist drop, foot drop and hyperreflexia were seen only with AMAN subtype. Respiratory muscle involvement (6 vs. 3) and artificial ventilation (5 vs. 2) was more in AMAN. At discharge, children with AIDP were less likely to be non-ambulant (12 vs. 6, p = 0.036). Mean disability scores at hospital discharge (4.9 ± 1.2 vs. 4 ± 0.9, p = 0.015) and at last follow-up (0.7 ± 1.01 vs. 0.05 ± 0.2, p = 0.016) were higher in AMAN. Children with AIDP were more likely to achieve normalcy on follow-up (19 vs. 12, p = 0.023). Children with AMAN appear to have a more severe clinical course; higher short-term morbidity; and slower recovery than those with AIDP.

Journal Article Guillain–Barré syndrome and Campylobacter jejuni infection Get access R.D.M. Hadden, R.D.M. Hadden Department of Neuroimmunology, Guy's, King's and St Thomas' School of Medicine, London, UK Search for other works by this author on: Oxford Academic Google Scholar N.A. Gregson N.A. Gregson Department of Neuroimmunology, Guy's, King's and St Thomas' School of Medicine, London, UK Search for other works by this author on: Oxford Academic Google Scholar Journal of Applied Microbiology, Volume 90, Issue S6, 1 June 2001, Pages 145S–154S, https://doi.org/10.1046/j.1365-2672.2001.01363.x Published: 01 June 2001

Background Our study aimed to determine the profile of Guillain–Barré syndrome (GBS) in the Philippines, compare the outcomes who received intravenous immunoglobulin (IVIg) and therapeutic plasma exchange (TPE), and determine the factors related to hospital stay and late motor recovery. Methods We conducted a retrospective cohort study of adult GBS patients admitted to the Philippine General Hospital from 2009 to 2019. Results We included 105 patients with confirmed GBS diagnoses. The median age was 43 years (interquartile range 32 to 56); the female-to-male ratio was 1.62:1; the predominant variant was acute inflammatory demyelinating polyneuropathy (n = 40, 38.1%). The difference in outcomes of patients in the IVIg (n = 44) and TPE (n = 24) groups (walking with aid/GBS-disability scores/ventilator dependency at 1 month, duration dependent on the ventilator, intensive care unit stay, and hospital stay) were not statistically significant, except for mild disability at 1 month (p = 0.009). Pneumonia, urinary tract infection, and dysautonomia were significantly related to a prolonged hospital stay. No predetermined variables were associated with late motor recovery. After adjusting for age and sex, the cumulative hazard risk for late motor recovery was 0.69 (95% CI 0.27–1.74). Conclusion Our study presented the first comprehensive information regarding the features and outcomes of GBS patients in the Philippines. Abbreviations AIDP – Acute inflammatory demyelinating polyneuropathy; AMAN – Acute motor axonal neuropathy; AMSAN – Acute motor and sensory axonal neuropathy; GBS – Guillain–Barré syndrome; GBS-DS – Guillain–Barré syndrome disability scale; ICU – Intensive care unit; IVIg – Intravenous immunoglobulin; MFS – Miller–Fisher syndrome; PGH – Philippine General Hospital; TPE – Therapeutic plasma exchange.

Introduction: Guillain–Barré syndrome (GBS) is an acute autoimmune disorder affecting peripheral nerves, with acute inflammatory demyelinating polyneuropathy (AIDP) and axonal variants—acute motor axonal neuropathy (AMAN) and acute motor and sensory axonal neuropathy (AMSAN)—being the main forms. These subtypes differ in pathophysiology, clinical presentation, and prognosis. Objective: The aim of this study was to compare the functional clinical outcomes between patients diagnosed with GBS axonal variants (AMAN/AMSAN) vs. AIDP. Methods: This is a retrospective cohort study of patients hospitalized with AIDP, AMAN, and AMSAN GBS in the Brazilian public healthcare system between February 2020 and February 2024. Results: In total, 55 patients were included, 67.27% AIDP and 32.72% axonal variants (55.55% AMAN; 44.44% AMSAN). AIDP aged 3–79 y (median 51 y; IQR 32–61), while axonal aged 23–73 y (median 46 y; IQR 30–63). Males predominated—54.05% in AIDP; 61.11% in axonal. When comparing prognostic scores, EGOS ≥ 7, was observed in 55.55% of axonal vs. 29.72% AIDP (OR 2.95; p < 0.03857). EGRIS ≥ 3 in 61.11% axonal vs. 18.9% AIDP (OR 2.90; p < 0.04001). Orotracheal intubation occurred in 22.22% axonal vs. 24.32% AIDP (OR 1.77; p < 0.2279). Hughes ≥ 3 at discharge: 83.33% axonal vs. 56.75% AIDP (OR 3.81; p < 0.02859). Mortality was 11.1% in axonal vs. 1.35% AIDP (OR 13.8; p < 0.01323). Conclusion: Axonal variants of GBS are associated with a significantly worse prognosis compared to AIDP. These findings highlight the need for early identification of the GBS subtype, as axonal forms may require more intensive monitoring, earlier respiratory support, and tailored rehabilitation strategies. Recognizing these prognostic differences is essential for improving clinical management and outcomes in GBS.

Guillain-Barré Syndrome (GBS) remains a significant contributor to acute flaccid paralysis in pediatric patients worldwide. Despite its impact, studies focusing on pediatric GBS requiring intensive care unit (ICU) management are limited. This study aimed to address this gap by exploring the clinical and outcome characteristics of pediatric GBS necessitating ICU care. This retrospective observational study, spanning a decade, analyzed the records of 75 pediatric GBS patients admitted to the Neuro-ICU of a tertiary care center in South India. Data included demographics, prodromal symptoms, clinical features, investigations, treatment modalities, and outcomes. The majority (55/75) of patients were male, with a median age of 12 years. The highest incidence of GBS requiring ICU admission was in the monsoon season. Prodromal symptoms were observed in 56%. Most patients (93.33%) presented with typical GBS symptoms, and 40% had respiratory distress on ICU admission. Acute motor axonal neuropathy (AMAN) was the most common subtype. Approximately 80% required mechanical ventilation, with a median duration of 22.5 days. No in-hospital mortality was recorded. At discharge, most patients had a GBS disability score of 4, improving to 2 at a median follow -up of 228 days. Pediatric GBS patients requiring ICU care exhibit distinctive characteristics, including a higher prevalence of AMAN subtype, seasonal clustering, and favorable outcomes with intensive treatment. The absence of in-hospital mortality underscores the effectiveness of prompt ICU admission and dedicated Neuro-intensive care.

P-PN008. Electrophysiological subtypes of Guillain-Barré syndrome (GBS) cases at tertiary general hospital, Myanmar

Introduction. Guillain Barre Syndrome (GBS) is a post infectious polyneuropathy involving mainly motor but sometimes sensory and autonomic nerves. It is an acquired disease of the peripheral nerves that is characterized by rapidly progressing paralysis, areflexia and albumino-cytological dissociation in CSF. Methodology: Prospective, descriptive, observational, hospital based study was carried out to find out the clinico-epidemiological features of GBS including existing treatment modalities and its outcome. All cases fulfilled the criteria for AFP (Acute flaccid Paralysis) surveillance was included. Cases were reviewed for full medical history and examinations. To confirm the diagnosis, necessary investigations were carried out and combined with clinical symptoms. Results: Thirty patients were included in the study during study period. Among them 90% were diagnosed as GBS, 7.4% patients of GBS were associated with hypokalemic paralysis, 7.4% diagnosed as transverse myelitis and 3.7% diagnosed as idiopathic neuropathy. Different types of GBS were classified as AIDP (Acute inflammatory demyelinating polyneuropathy) 62.96%, AMAN (Acute motor axonal neuropathy) - 25.52%, AMASAN (Acute motor and sensory axonal neuropathy) - 3.3% and MFS (Miller fisher's syndrome) - 6.6% according to NCV result. Male female ratio is 1.7:1.0. There was 14.8% patients had relapse within 5 year. Associated diseases were URTI, pneumonia, sore throat and diarrhea. Facial Nerve palsy was commonest cranial nerve involvement.Sixty percentage of patients presented with sensory symptoms. There was transient bowel and bladder involvement in 20% of the cases. 69.2% patients became bed ridden at the nadir. There was albumin-cytological dissociation in 80% case. Majority of patients improved with supportive treatment alone, 19.5% patient required ventilator support among them 40% died. 7.4% of cases expired during treatment. Half of the patients fully recovered within 3 months. Conclusion: GBS is the commonest cause of AFP, AIDP being commonest subtype in our setting. We have to improve our existing treatment facilities and extend to different centers to detect and treat GBS. Most of the patients improve with supportive treatment alone. Ventilator support indicates grave prognosis. Key words: GBS (Gullein Barre Syndrome); AFP (Acute flaccid Paralysis); AIDP (Acute inflammatory demyelinating polyneuropathy; AMAN (Acute motor axonal neuropathy); AMASAN (Acute motor and sensory axonal neuropathy); MFS (Miller fisher's syndrome). DOI: 10.3126/jnps.v31i2.4065 J Nep Paedtr Soc 2010;31(2):93-97

S32. Outcome Guillain–Barré of syndrome in tertiary care centers in Thailand (extended study)

To determine electrophysiological pattern and predictors of functional outcomes of patients with Gullain Barre Syndrome (GBS) at a tertiary care hospital. Observational study. Shifa International Hospital, Islamabad, Pakistan from January 2016 to July 2020. A total of 62 patients with GBS of all age groups, gender, locations and those with no other primary diagnosis such as poliomyelitis, botulism, hysterical paralysis, toxin neuropathy and diabetic neuropathy were included. Functional outcome using modified Rankin Scale (mRS) and HUGHES score were recorded at presentation, on discharge and 6-month follow-up. Results of this study were analyzed using SPSS version 20. There were 69% males with mean age of 31 ± 21years. The frequency of different GBS variants were 53% acute inflammatory demyelinating polyneuropathy (AIDP), 29% acute motor axonal neuropathy (AMAN), 11% acute motor and sensory axonal neuropathy (AMSAN) and pure sensory and atypical GBS were 2% each. The frequency of various antecedent events was recorded in 33 patients, including respiratory tract infection in 9 (14%) and diarrhea/vomiting in 13 (21%) patients. AIDP and AMSAN had a good prognosis where 31 (77%) patients out of the 40 fully recovered with HUGHES score 0-2 after 6 months. AMAN had poor prognosis as 2 (12%) patients died in the Hospital. Majority (n=32, 52%) of the patients were treated with plasmapheresis. In this study population, AIDP was the most common variant with good prognosis and AMAN variant had the worst prognosis. Key Words: Guillain Barre syndrome (GBS), Acute inflammatory demyelinating polyneuropathy (AIDP), Acute motor axonal neuropathy (AMAN), Peripheral neuropathy, Lower limb weakness, Acute motor and sensory axonal neuropathy (AMSAN), Sensory neuropathy, Autoimmune disease.

To study the clinical characteristics and effects of immunoglobulin treatment in children with the different types of Guillain-Barré syndrome (GBS). Data of 108 patients hospitalized for GBS were retrospectively analyzed; 75 cases in this group were given acute high dose of gamma globulin (IVIG) 400 mg/(kg·d) intravenously for 5 d. Clinical and electrophysiological data and information on treatment and recovery of the children were collected during the follow-up and were analyzed. According to the clinical and electrophysiologic findings, 32 patients manifested acute inflammatory demyelinating polyradiculoneuropathy (AIDP), 34 had acute motor axonal neuropathy (AMAN), 3 had acute motor and sensory axonal neuropathy (AMSAN), 4 were inexcitable, 2 were unclassified. The clinical progress of the AMAN was faster than the AIDP group. Except for sensory nerve involvement, there was no significant difference in the clinical feature and severity. The mean time of the muscle strength began to recover was (5.59±3.63) days in the AIDP group and (7.21±4.68) days in the AMAN group after IVIG treatment. The time of the AIDP group was shorter than the AMAN group, but the difference was not statistically significant (t=-1.5702, P>0.05). The mean time of the muscle strength increased one grade was (8.88±4.39) days in the AIDP group and (12.67±8.35) days in the AMAN group. The difference was statistically significant (t=-2.3689, P<0.05). No patients in this group died. Follow-up data showed that the complete recovery time was not significantly different (t=0.2041, P>0.05). The clinical progress of the AMAN was faster than the AIDP group. Besides sensory nerve involvement, there was no significant difference in the clinical feature and severity. The AIDP group's clinical recovery was faster than AMAN's after the immunoglobulin treatment. The two groups were not significantly different in long-term prognosis.

The purpose of this study was to assess the electrophysiological subtypes and prognosis of Guillain-Barré syndrome (GBS) in northeastern China. Ninety-nine patients with GBS were recruited between 2006 and 2010 and retrospectively reviewed. Sixty-seven percent of patients had acute inflammatory demyelinating polyneuropathy (AIDP). Patients with acute motor axonal neuropathy (AMAN) had more severe symptoms at onset of GBS, and intravenous immunoglobulin (IVIg) was less effective in these patients. The prognosis may have been associated with the severity of the illness and did not differ between AMAN and AIDP patients. Abnormal motor nerve conduction studies (NCS) of the lower limbs and sensory NCS of the upper limbs with normal sural sensory nerve studies were the main electrophysiological features of AIDP. AIDP is the main subtype of GBS, and it has specific electrophysiological characteristics in northeastern China. The prognosis of patients with AMAN was similar to that of patients with AIDP. Moreover, IVIg was more effective in patients with AIDP.

Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy, which has various clinical presentations and both axonal and demyelinating forms. The original description of "ascending paralysis" encompasses the most common varieties: the primary demyelinating form, acute inflammatory demyelinating polyneuropathy (AIDP), and some of the axonal forms, acute motor axonal neuropathy (AMAN) and acute motor and sensory axonal neuropathy (AMSAN). However, there are now well-documented acute "monophasic" polyneuropathies that have a different clinical phenomenology than that described originally by Guillain, Barré, and Strohl: Miller Fisher syndrome, pure sensory neuropathy/neuronopathy, pandysautonomia, and oropharyngeal variant. Here the authors review both typical GBS (AIDP, AMAN, and AMSAN), and variant syndromes with a focus on clinical and diagnostic features, pathologic findings, pathogenesis, and treatment.

Objective: To explore the classification, clinical features, the short-term efficacy of intravenous immunoglobulin (IVIg) for Guillain-Barré syndrome(GBS) and look for predictors of acute motor axonal neuropathy (AMAN) during pregnancy. Methods: The clinical data of 45 hospitalized pregnant patients with GBS recruited from October 2008 to October 2017 at the Tianjin Medical University general hospital, Handan City First Hospital and Nankai University Affiliated Tianjin Fourth Central Hospital, were collected and analyzed retrospectively, and patients were divided into the acute inflammatory demyelinating polyneuropathies (AIDP) group and the AMAN group. The clinical features and efficacy of IVIg were compared between the two groups. Logistic regression analysis was used to analyze the predictors of AMAN. Results: There were 25 cases in the AIDP group and 20 cases in the AMAN group. AIDP usually started with distal limb weakness (P=0.001), and AMAN often started with limb weakness (P=0.001) and mostly accompanied by dyspnea (P=0.042). AIDP was often associated with paresthesia (P=0.001) and autonomic dysfunction (P=0.007). The response days of active treatment in the AIDP group and the AMAN group were (1.6±0.5)d and (2.3±0.8)d (P=0.022), the improvement days were (3.6±0.8)d and (5.9±1.0)d (P=0.000), the basic cure days were (7.7±1.3)d and (9.0±0.8)d (P=0.002), the cure days were (12.3±1.1)d and (12.8±0.9)d (P=0.148). Multivariate Logistic regression analysis revealed that preceding diarrhea (OR=13.750; 95% CI 1.386-136.387), limb weakness(OR=12.000;95% CI 2.359-61.048) and limb weakness with dyspnea (OR=10.000; 95% CI 1.048-95.457) were significantly associated with the AMAN-type GBS. Conclusions: AIDP and AMAN are the main types of pregnancy complicating GBS. Most patients present with a single and benign course of disease. IVIg is generally safe and effective. Preceding diarrhea, limb weakness and limb weakness with dyspnea are the predictors of AMAN-type pregnancy complicating GBS.

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