Abstract
Objectives: To assess the epidemiology of different electrophysiological subtypes of Guillain-Barre syndrome (GBS) and investigate the factors affecting the prognosis of the acute motor axonal neuropathy (AMAN) subtype in northern China.Methods: According to the National Institute of Neurological Disorders and Stroke diagnostic criteria for GBS, 104 consecutive GBS patients were recruited from the Department of Neurology of the Second Hospital of Hebei Medical University, China from 2014 to 2018.Results: Based on nerve conduction studies (NCSs), AMAN was the most common subtype in Northern China, accounting for 58 patients (55.8%). AMAN patients had significantly higher prevalence of antecedent diarrhea, longer duration of hospitalization, and slightly slower recovery than those with acute inflammatory demyelinating polyneuropathy (AIDP), but there was no statistical difference in disease severity or short-term prognosis between AMAN and AIDP. Based on multivariate regression analysis, AMAN patients with antecedent diarrhea (OR = 0.16, 95% CI: 0.03–0.756, p = 0.021) or conduction blocks (CBs) (OR = 0.033, 95% CI: 0.001–0.787, p = 0.035) had dramatically better short-term prognosis. Decreased compound action potential with distal stimulation (dCMAP) amplitude was associated with significant slower speed of recovery(OR = 8.31, 95% CI: 2.55–27.10, p = 0.02).Conclusion: AMAN is still the most common subtype of GBS in northern China. A decline in dCMAP amplitude is predictive factor of a slow recovery and poor outcome of GBS. Diarrhea and CBs may be the factors for better short-term prognosis in AMAN patients in Northern China.
Highlights
Guillain-Barré syndrome (GBS) is the most common and severe acute paralytic neuropathy, characterized by progressive weakness and diminished or absent deep tendon reflexes
Regarding the NCSs results, there was no statistical difference in dCMAP amplitude between acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN), while the distal motor latency (DML) of AIDP was significantly longer (p < 0.001), the motor nerve conduction velocity of AIDP was dramatically slower (p < 0.001)
The patients with the AMAN subtype had significantly longer hospital stays than those with AIDP (p = 0.01), there were no significant differences between the AIDP and AMAN subtypes in mechanical ventilation at admission (p = 0.42) or discharge (p = 1.00), Hughes Functional Grading Scale (HFGS) score at admission (p = 0.94) or discharge (p = 0.54), second cycle of intravenous immunoglobulin (IVIg) treatment (p = 0.18), or combination with intravenous steroids treatment (p = 0.59)
Summary
Guillain-Barré syndrome (GBS) is the most common and severe acute paralytic neuropathy, characterized by progressive weakness and diminished or absent deep tendon reflexes. GBS consists of two major subtypes, acute inflammatory demyelinating polyneuropathy (AIDP), and acute motor axonal neuropathy (AMAN). In Europe and the United States, GBS is dominated by AIDP, but in the north of China, especially in Hebei Province, AMAN is thought to be the most common subtype [1]. Prognostic Factors of GBS in Northern China in different regions has been reported differently. There are many studies on the factors associated to GBS outcomes [2,3,4], but these studies include all electrophysiological types, with most patients belonging to the AIDP subtype. This study aimed to investigate the clinical characteristics and the response to intravenous immunoglobulin (IVIg) of the AIDP and AMAN subtypes and explore the prognostic factors in AMAN subtype in Northern China
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