Barre Syndrome Research Articles

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Gullian Barre Syndrome among Nursing Officers Multispeciality Hospitals at Bangalore

ABSTRACTBackgroundGrowing evidence suggests a close association between circulating micronutrient levels and neuroimmune diseases. Nevertheless, the causal relationship between them remains unclear. Furthermore, due to confounding factors, many micronutrients implicated in these diseases remain unidentified. This study aimed to determine the causal relationship between circulating micronutrients and neuroimmune diseases through genetic association analysis, and to analyze the regulatory role of circulating micronutrients in neuroimmune diseases.MethodIn this study, we used a two‐sample mendelian randomization (MR) analysis to explore the causal relationship between micronutrients levels and neuroimmune disease. Fourteen micronutrients were screened from a published genome‐wide association study (GWAS). Neuroimmune diseases include multiple sclerosis (MS), Guillain–Barre syndrome (GBS), acute disseminated encephalomyelitis (ADEM), acute poliomyelitis (AP), sequelae of poliomyelitis (SP), optic neuritis (ON), and myasthenia gravis (MG). Data on these seven neuroimmune diseases came from the FinnGen database and included 5523 cases and 2,860,006 controls. The inverse variance weighting (IVW) method was used as the main MR analysis method, and sensitivity analysis was performed to determine MR hypotheses.ResultsThrough MR analysis and sensitivity testing, we identified significant causal relationships between four neuroimmune diseases and micronutrient levels. Specifically, MS was causally associated with magnesium levels (OR: 0.467, 95% CI: 0.269–0.809, p = 0.007), ADEM with folate levels (OR: 0.022, 95% CI: 0.001–0.957, p = 0.047), ON with vitamin B6 levels (OR: 0.382, 95% CI: 0.187–0.778, p = 0.008), and MG with iron levels (OR: 0.194, 95% CI: 0.043–0.867, p = 0.032). Sensitivity analysis showed that there was no level pleiotropic or heterogeneity in our study results.ConclusionThis study established the causal relationship between micronutrients and neuroimmune diseases. These findings provide new insights into the etiology of neuroimmune diseases and provide a theoretical basis for micronutrient regulation, prevention, and treatment of neuroimmune diseases.

PurposeThis study aimed to investigate the cumulative incidence of adverse events of special interest (AESI) among Iranians who were vaccinated with COVID-19 vaccines, including Sinopharm, Sputnik V, AZD1222, and COVIran Barekat.MethodsUsing World Health Organization guidelines, this cohort event monitoring (CEM) study was conducted to assess the adverse events of COVID-19 vaccines, in seven cities in Iran. A total of 89783 participants (31690 Sinopharm, 20195 Sputnik V, 23780 AZD1222, and 14118 CoVIran Barekat) who were 18 or older were followed up for 17 weeks (25 weeks for AZD1222) after receiving the first dose of vaccine by weekly phone contacts or self-reporting in a web application. Furthermore, all hospitalized cases were investigated for causes of admission by classification committees.ResultsA total of 11 cases (cumulative incidence: 12.3 per 100,000) of AESIs were recorded. All of the AESI cases were observed among 2080 hospitalized cases. The AESIs included five cases of coagulation disorders (three after AZD1222 and two after Sinopharm vaccination), and three cases of generalized seizure (one after Sputnik V, and two cases after AZD1222). In addition, two cases of Guillain–Barre syndrome, and Sub-acute Thyroiditis were detected after receiving Sputnik V, and one individual developed pericarditis after receiving COVIran Barekat.ConclusionWe found around one AESI among every 8,000 vaccinated Iranian people. The incidence of AESIs after COVID-19 vaccines was relatively rare and the studied vaccines can be considered safe. AZD1222 had a higher incidence of AESIs. Coagulation disorders, and generalized seizure were the main and most common AESIs.

ABSTRACTPeople with cystic fibrosis (CF) typically experience chronic respiratory infections, but neurological sequelae are rare. Guillain–Barre Syndrome (GBS) is classically precipitated by a respiratory or gastrointestinal infection, although other rarer aetiologies exist. This case series outlines four adults with CF who developed GBS. The association with acute and chronic respiratory infections in people with CF is explored, as well as other potential precipitants. An autoimmune phenomenon in the context of chronic systemic inflammation or a possible contributory role of dysfunctional CFTR protein is also considered.

Brain death as a presentation of fulminant Guillain Barré syndrome is rare with only twenty cases reported in the literature. This condition should be treated immediately despite high mortality as survivors recover with early treatment and supportive care. A 15-year-old boy with a history of recovery from Guillain Barré syndrome nine months ago, presented with coma, respiratory paralysis, fixed and dilated pupils. CT angiogram of the brain confirmed adequate cerebral perfusion, nerve conduction studies detected sensory motor axonal polyneuropathy and stool biofire was positive for Campylobacter jejuni. His prolonged hospital stay on life support systems was complicated with dysautonomia, shock, respiratory failure and ventilator associated pneumonia. Prompt treatment with endotracheal intubation, ventilation, intravenous immunoglobulins, supportive therapy and physiotherapy enabled the patient to recover and gradually regain motor power. At day 90, he was on tracheostomy and standing with support. Reviewing the literature, there are sporadic case reports of fulminant Guillain Barre syndrome recovering with rigorous and prolonged treatment. Clinicians should be vigilant about this variant as timely treatment could save lives and instill hope in distressed families. Dysautonomia, cranial nerve involvement, ventilator dependency and sepsis contribute to high mortality. This case report is unique as it highlights the trials and tribulations of management of this rare variant of Guillain Barre syndrome with emphasis on the necessity to maintain life sustaining measures and prolonged treatment in affected patients. The clinical course and treatment response was documented daily till the patient was on the road to recovery.

Abstract OBJECTIVE: Therapeutic plasma exchange (TPE) is a technique in which pathogenic substances such as autoantibodies, immune complexes, and toxins are removed from the plasma. The blood is passed through an apheresis machine and the filtered plasma is removed and replaced with a fluid such as plasma or albumin. Our aim was to describe our experience with TPE treatment in various neurologic and nonneurologic diseases at our institution. MATERIALS AND METHODS: A retrospective analysis of TPE procedures was done for 1 year from January 2020 to February 2021 in a tertiary care teaching hospital. A total of 37 procedures were performed in 17 patients between 3 and 65 years of age. RESULTS: Guillain‒Barre syndrome was the main indication for TPE accounting to 41.17%, followed by myasthenia gravis, autoimmune encephalitis, optic neuritis, and systemic lupus erythematosus. TPE was performed on a rare indication, a case of dengue hemorrhagic fever with septic shock and multisystem inflammatory syndrome which had a better outcome. Overall incidence of adverse reactions was 17.64%. CONCLUSION: Our results show that TPE is a safe and effective treatment alternative to intravenous immunoglobulin. It also shows TPE is safe in children. However, there is a need for a large trial for detailed evaluation.

Guillain-Barre syndrome is an autoimmune disease that provokes neural illness causing acute paralysis neuropathy. This syndrome appears after some bacterial infections produced by Campylobacter jejuni, Streptococcus pyogenes, S. pneumoniae, Haemophilus influenciae, E. coli and current studies showed the appears of this syndrome after SARS-CoV-2 infection. In this study, a in silico analysis was carry out in which to determinate bacterial epitopes than produce the molecule mimicry phenomena and that can produce the immune system activation against this epitope. A conserved amino acid sequence has been encountered with the highest probability to activate the immune system against this bacterial epitope, human gliomedin and ryanodine 3 type receptor. More studies needed to demonstrate in vivo the molecular mimicry in Guillain-Barre syndrome patients.

Abstract Medium and small arteries are affected by anti-neutrophilic cytoplasmic antibody-associated vasculitis (AAV), a systemic necrotizing inflammatory illness, that commonly causes peripheral neuropathy in the form of mononeuritis multiplex. There are three types of clinical subtypes in AAV, (1) microscopic polyangitis (MPA); (2) granulomatosis with polyangitis; (3) eosinophilic granulomatosis with polyangitis. We are presenting one case of fulminant neuropathy with AAV mimicking Guillain–Barre Syndrome, which is a rare occurrence. Rapid and early differentiation between the two conditions is important. In our case, we could not initiate the treatment due to suspected sepsis, which was later on found to be caused by the acute inflammatory response of systemic vasculitis. Once the diagnosis was clear, it was already late, and we lost the patient. The presence of a systematic inflammatory response, multiple organ dysfunctions, thrombocytosis, and normal procalcitonin can differentiate the two conditions, and emergent plasmapheresis would have been life-saving.

Background and Aim: Guillain-Barre syndrome (GBS) described as a syndrome manifesting clinically as an acute inflammatory polyradiculoneuropathy (AIDP) with concomitant, symmetrical muscular weakness with absent or diminished deep tendon reflexes. Autonomic dysfunction (AD) is frequent and clinically important complication of GBS, which potentially contributes to adequate sickness and even mortality. The present study aimed to determine the frequency of AD in GBS patients. Patients and Method: This cross-sectional study investigated 100 patients presenting with new onset Guillain Barre Syndrome in the department of Neurology, Mayo Hospital, Lahore from October 2024 to April 2025. Patients aged 18-65 years of either gender presented with new onset GBS were enrolled. Diagnosis of GBS was established through clinical assessment and supported by relevant investigations, including cerebrospinal fluid analysis and nerve conduction studies. Demographic information and illness duration recorded. All patients were evaluated for the presence of autonomic dysfunction (AD) using a standardized operational definition. Data analysis done using SPSS version 27. Results: The overall mean age was 37.82±4.62 years. Among the 100 patients diagnosed with Guillain-Barre syndrome, autonomic dysfunction (AD) seen in 38% of cases. The most common manifestations of AD included fluctuation in blood pressure (26%), cardiac arrhythmia (18%), and urinary retention (12%). AD seen more often in patients over 40 years of age and in patients with severe motor weakness. No significant gender-based differences in the frequency of AD observed. Conclusion: Autonomic dysfunction (AD) represents a frequent and significant complication in Guillain-Barre syndrome, affecting over one-third of affected individuals. Timely recognition and monitoring of autonomic symptoms are vital, as they play an important role in determining clinical outcomes and are associated with high risks of morbidity and mortality.

Objective: To evaluate the clinical profile and outcome of Guillian Barre Syndrome (GBS) in children admitted in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics of National Institute of Child Health, Karachi, Pakistan. Period: July 2024 to December 2024. Methods: A total of 45 children aged between 1 month up to 16 years, presenting and admitted with GBS were analyzed. Demographical and clinical characteristics of children were noted. Children were treated as per standard institutional protocols. Final outcome was recorded as survived or expired. Effect modifiers were controlled through stratification, and post-stratification chi-square/fisher’s exact test was applied taking p<0.05 as significant. Results: In a total of 45 children, 27 (60.0%) were males. The mean age was 6.27±2.49 years. The mean duration of symptoms was 3.6±2.7 days. The most common presentations were weakness of limbs, and fever, documented in 38 (84.4%), and 24 (53.3%) patients, respectively. Nerve conduction velocity evaluation revealed AMSAN as the most common GBS subset, found in 32 (71.1%) patients. Mortality was observed among 10 (22.2%) children, while the remaining 35 (67.8%) children improved and discharged successfully. Mortality was significantly associated with admission in PICU at the time of enrollment (p<0.001), need for ventilatory support (p<0.001), and inotropic support (p<0.001). Conclusion: Lower limb weakness and fever emerged as the most common initial symptoms, with AMSAN being the predominant subtype. Mortality was significantly associated with PICU admission, need for ventilatory support, and inotropic support.

Guillain-Barré Syndrome (GBS) has variable severity, inconsistent therapy response, and uncertain recovery. Intravenous immunoglobulins (IVIG) are used to treat this immune-mediated disorder. The authors investigated serial IgG levels and outcomes in IVIG-treated GBS patients. This prospective observational study from July 2019 and December 2021 in a tertiary pediatric referral hospital included children ≤12 y with GBS diagnosis. Children with recurrent GBS or chronic neuromuscular disorders were excluded. All patients received IVIG (2g/kg). Serum IgG levels were measured at enrolment, 2 wk, 4 wk, and 3 mo. IgG levels and change in IgG levels from baseline were correlated with outcome. The authors hypothesize that IgG levels before and after therapy may affect functional status outcomes [Medical Research Council (MRC) sum score, GBS disability score]. Seventy patients, median age 6.5 y, were enrolled. Acute motor axonal neuropathy predominated in nerve conduction studies (n = 46, 66%). Admission, 2 wk, 4 wk, and 3 mo median IgG levels were 10.1, 17.9, 13.0, and 9.9g/L. At 2 wk, higher IgG levels and increments were associated with better functional status. Higher ΔIgG at 2 wk correlated with a shorter hospital stay (r = -0.381, p = 0.001). Lower levels of IgG (16.01 vs. 20.56, p = 0.006) and ΔIgG (6.83 vs. 10.03, p = 0.041) at 2 wk were associated with inability to walk independently at 3 mo. The increase in serum IgG after IVIG therapy weakly correlates with GBS outcomes in children. A second IVIG dose for non-responders did not improve outcomes at 3 mo, suggesting unknown factors causing severe disease and poor recovery that need further studies.

Efficacy and safety of efgartigimod in patients with neurological autoimmune diseases.

BACKGROUND Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy that results in ascending paralysis, autonomic dysfunction, and neuromuscular impairment. OBJECTIVES This case highlights the presentation, diagnosis, and therapeutic management of Acute Motor Axonal Neuropathy (AMAN), a severe GBS variant. MATERIAL AND METHODS: A 73-year-old male patient case report, Cerebrospinal fluid (CSF) analysis showed mild pleocytosis with albuminocytologic dissociation, and MRI findings revealed an incidental posterior fossa arachnoid cyst. RESULT A 73-year-old male presented with gait ataxia, progressive limb weakness, and numbness. Cerebrospinal fluid (CSF) analysis showed mild pleocytosis with albuminocytologic dissociation, and MRI findings revealed an incidental posterior fossa arachnoid cyst. The patient underwent plasmapheresis (five cycles) along with neuro-rehabilitative therapy to remove pathogenic circulating autoantibodies and enhance recovery. Following plasmapheresis and physiotherapy, the patient demonstrated substantial neurological improvement, with restored motor function, preserved bulbar reflexes, and safe oral intake. CONCLUSION The critical role of early immunomodulatory intervention, particularly plasmapheresis and rehabilitation, in managing GBS variants like AMAN. Multidisciplinary care, close outpatient monitoring, and structured rehabilitative support are essential in optimizing functional outcomes and minimizing recurrence risks.

Reviewer Comment on Li et al. “Systematic Review: Mental Health Outcomes in Guillain–Barre Syndrome and Chronic Inflammatory Demyelinating Polyneuropathy”

The COVID-19 pandemic has raised concerns about various neurological complications, including Guillain-Barré syndrome (GBS). Understanding the characteristics and incidence of GBS during this period is crucial for clinical management and public health response. This study aims to analyze the characteristics of GBS cases reported at an Iranian referral center during the COVID-19 pandemic and assess the relationship between GBS, COVID-19 infection, and vaccination. We conducted a retrospective analysis of GBS cases referred to our center between 2018 and 2023. Clinical data, including demographic information, neurophysiological subtypes, COVID-19 and vaccination associated cases and outcomes were collected and analyzed. The frequency of GBS admission during pandemic compared with previous years. Characteristics of COVID-19 associated GBS and those vaccinated for COVID-19 was compared. A total of 334 patients were included to study. Our analysis revealed a notable increase in GBS cases during the pandemic. The incidence of vaccine-related GBS was significantly lower than that of GBS related to COVID-19 infection. Additionally, GBS patients diagnosed with COVID-19 presented more severe symptoms compared to those who developed GBS after vaccination. Although the incidence of GBS increased during the COVID-19 pandemic at our center, it remains a rare complication of both COVID-19 and its vaccination. These findings highlight the need for ongoing surveillance of neurological complications during infectious disease outbreaks and vaccination campaigns.

Guillain Barre Syndrome in an Elderly: A Disease of a Different Breed

Guillain-Barré Syndrome (GBS) is an acute neuropathy characterized by varying prognoses. To identify predictive biomarkers, we conducted a prospective observational study involving 110 GBS patients. We focused on assessing the levels of two proteins associated with neurogeneration, namely CNTF (ciliary neurotrophic factor) and TIMP1 (tissue inhibitor of metalloproteinase 1), in the cerebrospinal fluid (CSF) of GBS patients. Measurements were taken prior to and following the second week of illness. We found that the increase in CNTF and TIMP1, as determined by the ratio of post-2nd week CNTF levels to pre-2nd week CNTF levels, exhibited a positive correlation with improvements in the Medical Research Council (MRC) sum score at both 4 weeks and 6 months. Based on these findings, we conclude that both CNTF and TIMP1 can serve as valuable prognostic biomarkers in GBS.

ObjectivesTo study the profile of patients with Guillian Barre Syndrome (GBS) admitted to our Neuro ICU over one year duration.Materials and methodsThis is a retrospective observational study on patients with GBS admitted to our Neuro ICU, over a one year period from January 2024 to December 2024. We retrieved case records of eight patients admitted with GBS over one year. We collected demographic data, details of specific treatment such as plasmapheresis, IVIG, Rituximab etc. ICU interventions such as Intubation, mechanical ventilation, RRT, Vasopressor supports, tracheostomy and nutrition were recorded. We also recorded Pain, CAUTI, CLABSI, VAP, Pressure ulcer, Phlebitis and Sepsis events. We assessed patient and family's emotional and mental status subjectively. In December, the presenting author called all discharged patients over phone and documented the details.ResultsIn 2024, nine patients with GBS were admitted to our ICU. 5 male and 4 female patients, Age range 20 to 62 years.1,2 Four patients received IVIG, seven underwent plasmapheresis and two patients received Rituximab. Eight patients improved and got discharged, four each to Rehab and home. Average length of ICU stay was 12 days. 3 patients required invasive mechanical ventilation and one patient NIV. Two patients required tracheostomy and prolonged ventilatory support. We had one CAUTI and one VAP. Almost all patients were anxious and required reassurance during ICU stay. The patients on ventilator in particular were difficult to manage. We faced challenges with position change, pain, mobilization and nutrition. On December 10th 2024, we called all the survivors. 2 patients were able to get back to their job, six patients are still in rehabilitation. A 62 year old female was intubated and developed severe autonomic dysfunction during Plasmapheresis and had cardiac arrest. She could not be resuscitated. Every patient we cared for, had unique background, presentation and challenges. We needed a multidisciplinary approach. Nursing care was very labour and time intensive. But, when recovery was good, it was also very satisfying.ConclusionGBS Patients are challenging to care for. One size does not fit all. Continuous quality care, emotional and social support is crucial. Support has to continue post ICU discharge to optimize Rehabilitation.

Background. Leptospirosis is an acute, naturally focal zoonotic infection caused by various serogroups of Leptospira, with a wide range of transmission mechanisms. The relevance of this infectious disease in modern medicine remains high not only in Ukraine but worldwide, with an estimated 350,000 to 500,000 severe cases reported annually. The clinical course can range from mild to severe, involving multiple organs and systems, potentially leading to disability or even death. Complications affecting the nervous system are of particular clinical significance, occurring in only 10–15% of cases, yet they can result in serious outcomes. Cases involving the development of Guillain–Barré syndrome are extremely rare, highlighting the scientific and clinical importance of analyzing such cases. The presented case is notable for the development of secondary Guillain–Barré syndrome with profound peripheral tetraparesis, bilateral facial nerve palsy, central-type pelvic organ dysfunction, severe pain and amyotrophic syndromes, as well as impaired gait and loss of self-care ability. Purpose – to describe a rare clinical case of Guillain–Barré syndrome associated with leptospirosis caused by the Leptospira Hebdomadis serovar. Materials and methods. This paper presents the findings from clinical observation and diagnostic studies of Guillain–Barré syndrome associated with leptospirosis in a patient treated at the infectious disease and neurology departments of the Volyn Regional Clinical Hospital. Results. The patient was diagnosed with a severe form of leptospirosis, complicated by the development of secondary Guillain–Barré syndrome. The diagnosis of leptospirosis was confirmed via microagglutination and lysis testing, which yielded a positive result at a serum dilution of 1:400 with the Hebdomadis serovar. Despite a comprehensive therapeutic approach, the patientʼs condition rapidly deteriorated, marked by progressive neurological deficits, including ascending symmetrical weakness with areflexia and autonomic dysfunction. These symptoms indicated a rapidly advancing involvement of the nervous system characteristic of Guillain–Barré syndrome. The clinical features of leptospirosis and its impact on the nervous system were assessed based on the patientʼs complaints, neurological examination, and diagnostic test results. Conclusions. This report describes the first documented case in the literature of Guillain–Barré syndrome associated with the Leptospira Hebdomadis serovar. The uniqueness of the case lies in the development of severe neurological impairment due to delayed medical intervention. This case underscores the importance of early diagnosis and heightened physician awareness regarding potential neurological complications of infectious diseases.

The acute polyneuropathy known as Guillain-Barré syndrome (GBS) has varying degrees of weakness and peaks in severity in four weeks. Usually, the illness has a monophasic phase and is preceded by an infection. Immunoglobulin (IVIg) and plasma exchange (PE) both works well for GBS. Surprisingly, steroids by themselves don't work. The primary treatment is typically IVIg, mostly for logistical reasons. Miller-Fisher syndrome (MFS), acute motor axonal neuropathy (AMAN), which is more common in Asia and Japan, and acute inflammatory demyelinating polyneuropathy (AIDP), which is the most common form in the western world, are subtypes of GBS. There are overlap syndromes as well (GBS-MFS overlap). A secondary worsening occurs in around 10% of GBS patients within the first 8 weeks following IVIg treatment. It is necessary to administer IVIg repeatedly to address such a treatment-related fluctuation (TRF). Approximately 5% of people who are first diagnosed with GBS end up having acute onset chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (A-CIDP). It is yet unknown if IVIg is also beneficial for individuals with MFS or GBS patients who are still able to walk (referred to as "mildly affected GBS potients"). GBS is still a serious illness even with modern treatment; roughly 25% of patients need artificial ventilation for a few days to months, 20% are still unable to walk after six months, and 3–10% pass away. Furthermore, a lot of patients experience chronic concerns including pain, exhaustion, or other issues that can last for months or even years. Making a diagnosis can sometimes be quite difficult when pain is present before weakening syndrome (GBS) is a rare appears.