Increased cerebrospinal fluid protein and motor conduction studies as prognostic markers of outcome and nerve ultrasound changes in Guillain–Barré syndrome

Abstract

ObjectiveOur study examined the prognostic role of increased cerebrospinal fluid protein and motor conduction studies on outcome and nerve ultrasound changes in Guillain–Barré syndrome (GBS). MethodsFifty post-GBS patients underwent clinical and nerve ultrasound examination, with a mean of 3.4years (SD=2.8) after disease onset. Outcome was measured using the Medical Research Council Sum Score (MRC), the Rasch-built Overall Disability Scale (R-ODS) and the Rasch-built fatigue severity scale (R-FSS). Ιn addition, the results of the motor conduction studies and cerebrospinal fluid (CSF) examination at disease onset were retrospectively evaluated. ResultsNo significant changes in outcome were noted between patients with (p-CSF) and without increased CSF protein (n-CSF). The p-CSF group showed significant lower cross-sectional area (CSA) values of the radial nerve in spiral groove (p<0.001) and higher values of the internerve-CSA variability (p<0.001) compared to n-CSF patients. GBS patients with axonal affection in motor studies (GBS-a) showed significantly lower values of the R-ODS and MRC sum scores (p>0.001), but not of the R-FSS Score (p=0.018). Sonographically the GBS-a patients showed significant lower values of the median and ulnar nerve in the upper arm (p<0.001). DiscussionAxonal affection in motor studies, but not increased CSF protein at disease onset, seems to be an infavourable prognostic factor for outcome in GBS. Both axonal affection and increased CSF protein have a minor prognostic role in the development of nerve ultrasound changes.