Guillain-Barré Syndrome Subtypes Research Articles

Clinical profile and outcome of Guillain Barre syndrome in a tertiary care hospital

Background: Guillain Barre syndrome (GBS) is a progressive symmetric muscular weakness with absent or depressed deep tendon reflexes. Wide spectrum of disease severity can be seen ranging from a mild disease to quadriparesis, cranial nerve involvement and autonomic instability. Methods: Hospital based observational study is planned for GBS patients admitted to Cheluvamba hospital, a tertiary care hospital in South India, for a period of 2.5 years from Jan 2020 to August 2022.Results: 30 patients (12 males; 18 females; mean age of 7.7 years) were enrolled in this study. Among which 11 were in age group of 0-5 (36%), 10 were in the age group of 6-10 (33%), 7 were in age group of 10-15 (23%), 2 were in age group 16 and above (6.6%). Type of paralysis was paraparesis in 14 (46%) children quadriparesis in 15 (50%) children and one child had no limb involvement. In associated dysfunctions, autonomic dysfunction was seen in 1 (4.5%), bulbar palsy in 3 (13.6%). One child presented with features of Miller Fischer variant of GBS which are ophthalmoplegia and ataxia. Among 30 children 22 were recovered and discharged, 3 children died, and 5 children left against medical advice.Conclusions: The clinical characteristics, subtype of GBS, and outcome vary according to geographic area. This study is directed to find the clinical pattern and outcome of the same in tertiary care hospital in south India.

Disease profile of Guillain-Barré syndrome among Indian patients receiving intravenous immunoglobulin: a real-world observational study

<p class="abstract"><strong>Background:</strong> Objectives of the study were to evaluate the real-world usage pattern of intravenous immunoglobulin (IVIg) for the treatment of patients with Guillain‐Barré syndrome (GBS), and to understand the disease characteristics and demographic patterns of these patients.</p><p class="abstract"><strong>Methods:</strong> This real-world, retrospective, analysis included data of patients with GBS who received IVIg treatment at various centers across India. The study data was collected between April 2021 and March 2022. </p><p class="abstract"><strong>Results:</strong> A total of 3064 patients with GBS who received IVIg treatment were included. The mean (SD) age of the patients was 48.97 (14.97) years, and majority of the patients were men (68.8%). Acute inflammatory demyelinating polyneuropathy (AIDP) was the most common subtype of GBS (60.5%), followed by acute motor axonal neuropathy (AMAN; 11.6%), and acute motor sensory axonal neuropathy (AMSAN; 3%). The majority (>94%) of patients received IVIg therapy as first-line treatment. A large proportion of the patients (n=2402, 78.4%) were given the standard dose of 2 g/kg bodyweight (given over 5 days) and 97.1% (n=2974) of the total study population received IVIg regimen over the standard protocol of 5 days.</p><p class="abstract"><strong>Conclusions:</strong> In the clinical spectrum of GBS, AIDP was the most common subtype. IVIg was used at generally recommended dose and duration in patients with GBS.</p>

Triggers of Guillain-Barré Syndrome: Campylobacter jejuni Predominates.

Guillain-Barré syndrome (GBS) is a rare immune-mediated acute polyradiculo-neuropathy that typically develops after a previous gastrointestinal or respiratory infection. This narrative overview aims to summarise and discuss current knowledge and previous evidence regarding triggers and pathophysiology of GBS. A systematic search of the literature was carried out using suitable search terms. The most common subtypes of GBS are acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). The most common triggers of GBS, in three quarters of cases, are previous infections. The most common infectious agents that cause GBS include Campylobacter jejuni (C. jejuni), Mycoplasma pneumoniae, and cytomegalovirus. C. jejuni is responsible for about a third of GBS cases. GBS due to C. jejuni is usually more severe than that due to other causes. Clinical presentation of GBS is highly dependent on the structure of pathogenic lipo-oligosaccharides (LOS) that trigger the innate immune system via Toll-like-receptor (TLR)-4 signalling. AIDP is due to demyelination, whereas in AMAN, structures of the axolemma are affected in the nodal or inter-nodal space. In conclusion, GBS is a neuro-immunological disorder caused by autoantibodies against components of the myelin sheath or axolemma. Molecular mimicry between surface structures of pathogens and components of myelin or the axon is one scenario that may explain the pathophysiology of GBS.

Recurrence of a Rare Subtype of Guillain-Barré Syndrome Following a Second Dose of the Shingles Vaccine

Guillain-Barré Syndrome (GBS) is an acute, immune-mediated polyneuropathy. The exact cause of GBS remains unknown, however, it commonly develops post-infection. Since the 1950s, various vaccines have been attributed to causing the syndrome, yet no definitive relationship has ever been determined. In 2021, the Food and Drug Administration (FDA) placed a black-box warning for Shingrix, a non-live recombinant vaccine against the varicella-zoster virus, regarding a possible risk of acquiring GBS post-vaccination in adults aged 65 and older. We report the recurrence of a rare subtype of GBS in a 61-year-old patient following the second dose of Shingrix. This case highlights the difficulty of diagnosing and treating recurrent GBS. It also raises awareness that Shingrix may be related to the development of GBS in younger patients. This case also emphasizes the importance of differentiating GBS from other polyneuropathies.

Elevated monocyte to high-density lipoprotein cholesterol ratio correlates with clinical severity in acute inflammatory demyelinating polyradiculoneuropathy patients.

While monocyte to high-density lipoprotein cholesterol ratio (MHR) has been reported to be associated with nervous system lesions, the role of MHR has not been determined in patients with Guillain-Barré Syndrome (GBS). The purpose of our study was to explore the role of MHR in patients with GBS. A total of 52 GBS patients were involved in the study retrospectively, including patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor sensory axonal neuropathy (AMSAN). We used Hughes Functional Grading Scale (HFGS) score to evaluate functional status in GBS patients. Among patients with different subtypes of GBS, MHR was significantly elevated in those with demyelination compared to patients without demyelination (p < 0.001); AIDP patients had an increased MHR compared with AMAN or AMSAN patients (p = 0.001; p = 0.013). There was a positive correlation between MHR and HFGS score (r = 0.463, p = 0.006) in AIDP patients, but not in AMAN or AMSAN. Multiple linear regression analysis revealed that MHR was independently associated with HFGS score (beta = 0.405, p = 0.013) in AIDP patients. Our study suggests that MHR as an inflammatory marker is elevated in patients with AIDP compared to AMAN or AMSAN patients, while MHR has a positive correlation with clinical severity in AIDP patients, suggesting that MHR may provide an additional information to reflect the pathophysiology of AIDP.

Role of the Neutrophil to Lymphocyte Ratio in Guillain Barré Syndrome: A Systematic Review and Meta-Analysis.

In this study, we conducted a systematic review and meta-analysis regarding the role of the neutrophil to lymphocyte ratio (NLR) in Guillain Barré syndrome (GBS). The most recent update to the search was on July 18, 2022, through the databases of Web of Science, PubMed, Embase, and Scopus. The Newcastle-Ottawa scale was used for quality assessment of included studies. Finally, 14 studies were included in the review, and among them, ten studies were included in the meta-analysis. Our results showed that NLR levels were significantly increased in the patients with GBS compared with healthy controls (SMD = 1.05; 95%CI = 0.59 to 1.50, P < 0.001). After treatment, NLR levels were decreased to the extent that they became similar to healthy controls (SMD = −0.03, 95%CI = −0.29 to 0.22, P = 0.204). Moreover, NLR was a stable predictor of outcome or response to treatment in such patients (SMD = 1.01, 95%CI = 0.65 to 1.37, P < 0.001); the higher the NLR, the worse the outcome. In addition, patients who underwent mechanical ventilation had higher levels of NLR compared to those who did not (SMD = 0.93, 95%CI = 0.05 to 1.82, P = 0.03). However, NLR levels were not different among distinct GBS subtypes, so it could not distinguish among them. In conclusion, our analysis indicates that the NLR levels are highly elevated in patients with GBS. Therefore, the NLR has the potential to be used as a biomarker to inform diagnosis, prognosis, or treatment responses in GBS, and future studies are warranted.

Children with Guillain-Barre Syndrome: A Comparison between AIDP and AMAN variants among Patients admitted in a Tertiary Care Hospital

Background: Guillain-Barre syndrome (GBS) is the leading cause of acute flaccid paralysis in children. This study was aimed to compare the clinical spectrum and shortterm outcome of children with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) subtypes of GBS in children. Methods: The study was a prospective cohort study done in a tertiary neurology hospital for 3 years. Children under 18 years of age fulfilling the Brighton diagnostic criteria for GBS were enrolled in the study. Based on the nerve conduction study, patients were subclassified as AIDP, AMAN, AMSAN, and others. Finally, a comparison was done in children with AIDP and AMAN subtypes. Results: A total of 102 children have fulfilled the Brighton diagnostic criteria of GBS during that study period. Among them, 83 children were included in the final analysis as NCS findings suggestive of AIDP and AMAN were found in 29(28.43%) and 54(52.94%) of cases respectively. No patient died in this cohort and follow-up was done at 3 months after discharge. A comparison of clinical data between the two groups revealed similar clinical features in most of the cases. The mean age difference between the two groups was statistically significant and AIDP was found to be more frequent in the 1-5 years age group. There was a significant association between gastroenteritis and AMAN subtypes. On symptom analysis, pain and tingling sensation were found predominantly in AMAN subtypes. Children having AMAN variants developed respiratory distress more than AIDP. Assisted ventilation were needed in 14.45% of cases and the majority of them were from the AMAN group. The mean duration of hospital stay and the mean disability scores at three months after discharge were significantly higher in the AMAN group. Conclusions: AMAN was the commonest GBS subtypes in children. AIDP was more frequent in the younger age group. Children with AMAN appeared to have higher short-term morbidity and slower recovery than those with AIDP. Bang. J Neurosurgery 2022; 11(2): 94-100

Outcome of Guillain-Barré syndrome following intravenous immunoglobulin compared to natural course.

Intravenous immunoglobulin (IVIg) is recommended in Guillain-Barré syndrome (GBS), but its efficacy may vary in different subtypes. We report the outcomes of patients with GBS following IVIg treatment compared to the natural course (NC). We also compare the effect of IVIg treatment in different subtypes of GBS. From a cohort of 528 GBS subjects, we have extracted 189 patients who received IVIg and compared their outcomes with 199 age- and peak disability-matched patients who did not receive IVIg, plasmapheresis, or corticosteroid. Disability was assessed using the 0-6 Guillain-Barré Syndrome Disability Scale (GBSDS). Clinical and neurophysiological subtypes were recorded. The primary outcome was functional disability at 6 months, which was categorized as complete (GBSDS ≤ 1), partial (GBSDS 2-3), or poor (GBSDS &gt; 3). The secondary outcomes were in-hospital death, duration of hospitalization, and mechanical ventilation. In-hospital death (2.6% vs. 2%, p=0.74) and 3-month poor recovery (20.7% vs. 18%) were similar in the IVIg and NC groups. At 6 months, however, a lesser proportion of patients in the IVIg group had poor recovery (2.2% vs. 8.3%, p=0.026). The outcomes of IVIg and NC were compared in 72 acute motor axonal neuropathy (AMAN) and 256 acute inflammatory demyelinating polyradiculoneuropathy (AIDP) patients. IVIg therapy did not alter the outcome in AMAN but resulted in a lesser proportion of poor recovery at 6 months in AIDP (0.8% vs. 6.6%, p=0.03). IVIg is beneficial in AIDP variants of GBS but not in the AMAN subtype. A customized treatment may be cost-effective until a randomized controlled trial is conducted in AMAN.

COVID-19 and Guillain-Barré syndrome: A single-center prospective case series with a 1-year follow-up.

Single reports of Guillain-Barré syndrome (GBS) have been reported worldwide during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. While case reports are likely to be biased toward uncommon clinical presentations, systematic assessment of prospective series can highlight the true clinical features and spectrum. In this prospective, observational study, we included all consecutive patients who developed GBS. In patients with SARS-CoV-2 infection as antecedent, the time-gap between the infection and GBS onset had to be ≤30 days. The referral was a neurological University Research Hospital, in the Italian Region more severely involved by the pandemic, and hospitalizing both COVID+ and non-COVID neurological diseases. Clinical, laboratory, cerebrospinal fluid, and electromyographic features of GBS diagnosed between March 2020 and March 2021 were compared to a retrospective series of GBS diagnosed between February 2019 and February 2020 (control population). Nasopharyngeal swab was still positive at GBS onset in 50% of patients. Mild-to-moderate COVID-related pneumonia, as assessed by X-ray (6 patients) or X-ray plus computerized tomography (2 patients) co-occurred in 6 of 10 patients. GBS diagnosed during the pandemic period, including 10 COVID-GBS and 10 non–COVID-GBS, had higher disability on admission (P = .032) compared to the GBS diagnosed between February 2019 and 2020, possibly related to later hospital referral in the pandemic context. Compared to non–COVID-GBS (n = 10) prospectively diagnosed in the same period (March 2020–2021), post–COVID-GBS (n = 10) had a higher disability score on admission (P = .028), lower sum Medical Research Council score (P = .022) and lymphopenia (P = .025), while there were no differences in GBS subtype/variant, severity of peripheral involvement, prognosis and response to treatment. Cerebrospinal fluid search for SARS-CoV-2 RNA and antiganglioside antibodies were negative in all COVID+ patients. Temporal clustering of cases, coinciding with the waves of the pandemic, and concomitant reduction of the incidence of COVID-negative GBSs may indicate a role for SARS-CoV-2 infection in the development of GBS, although the association may simply be related to a bystander effect of systemic inflammation; lack of prevalence of specific GBS subtypes in post–COVID-GBS also support this view. GBS features and prognosis are not substantially different compared to non–COVID-GBS.

Peripheral Neuropathy and Myopathy Associated with COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease (COVID-19) were reported to originate from Wuhan, China, in December 2019, spreading rapidly worldwide. With the emergence of this pandemic, an increasing number of cases of Guillain-Barré syndrome (GBS) have been reported following this infection. Most patients had a demyelinating subtype of GBS. The time interval between infectious and neuropathic symptoms, absence of cerebrospinal fluid pleocytosis, and negative polymerase chain reaction test result support a postinfectious mechanism. Skeletal muscle injury presents as muscle pain and elevated serum creatine kinase level in patients with COVID-19. Some patients developed several myopathic manifestations, including new-onset inflammatory myopathy. Muscle injury is caused by direct SARS-CoV-2 infection or through parainfectious mechanisms such as type I interferonopathy.

Guillain–Barré Syndrome

Background: Guillain–Barré syndrome (GBS) is an immune-mediated acute polyradiculoneuropathy with different subtypes, clinical features, and demographics. Nerve conduction study is important in differentiating axonal and demyelinating form of GBS. Diagnosis of various subtypes is essential as they have different pathophysiology and prognosis. Objective: The study was aimed to evaluate the different subtype spectrum of GBS in our patient population cohort and to look for the clinical features, demographics, and electrophysiological profile variations among the patients with GBS. Materials and Methods: We evaluated clinical spectrum and electrodiagnostic parameters of the admitted patients in Department of Neurology of our tertiary care center between September 2019 and April 2022 with clinical diagnosis of GBS. It was a quantitative descriptive cross-sectional study. Results: Out of 49 study participants, 63.82% patients had axonal form while 36.2% of patients had acute inflammatory demyelination polyneuropathy by applying Hadden criteria. Statistically lower single breath count (SBC) (median 10.5; P &lt; 0.0001) at admission was observed in ventilated patients compared to nonventilated patients of GBS. Conclusion: Axonal form is the most common subtype of GBS in our study cohort. SBC at admission could be an important bedside tool to predict requirement of ventilatory support in admitted patients of GBS.

Association Between A-Waves and Outcome in Pediatric Guillain-Barré Syndrome.

IntroductionTo examine the importance of abundant A-waves in electrophysiological classification and prognosis of pediatric Guillain-Barré Syndrome (GBS).MethodsA single-center and retrospective study enrolling 65 children-patients, aged 16 years and younger, with clinically diagnosed GBS between 2013 to 2020. Hughes grade was used to assess functional disability at nadir, 1 month, and 6 months after symptom onset. Patients were divided into 2 groups according to the presence of abundant A-waves. Clinical features and prognosis between the 2 groups were compared.ResultsThe distal motor latency of the median nerve in patients with GBS with A-waves (9.18 ms) was more prolonged than that of patients with GBS without A-waves (4.1 ms). An electrophysiological variant of these two groups was also statistically different (p = 0.006). The short-term prognosis of patients with AIDP with A-waves was worse than patients with AIDP without A-waves (χ2 = 5.022, p = 0.025), and univariable logistic regression analysis showed statistically significant (OR: 5.844, 95% CI 1.118–30.553; p = 0.036).ConclusionA-waves were strongly associated with demyelination and poor short-term prognosis of AIDP in children. We proposed an electrophysiological marker for early prediction of outcome in the AIDP subtype of GBS, applicable for clinical practice and future treatment administration.

P.101 A-waves on electrodiagnostic studies in axonal and demyelinating cases of Guillain-Barré Syndrome (GBS)

Background: A-waves are lesser-known late responses of debated clinical significance, seen in routine motor nerve conduction studies (NCS). They are proposed to be a sensitive marker of demyelination and an early finding in acute demyelinating polyradiculoneuropathy (AIDP). We hypothesized that the presence and distribution of A-waves are discriminative markers in differentiating AIDP from axonal variants of Guillain-Barré Syndrome (GBS). Methods: We identified patients diagnosed with demyelinating and axonal forms of GBS at the Montreal Neurological Institute between 2016 and 2021. Clinical and electrophysiological data including raw NCS responses were retrospectively reviewed for 28 AIDP and 9 axonal GBS cases. Results: 20 of 28 AIDP cases had at least one A-wave in non-tibial nerves compared to 2 of 9 axonal cases. Among patients with NCS available within 2 weeks of symptom onset, 13 of 14 AIDP cases had non-tibial A-waves, compared to 0 of 6 axonal cases. Eight of 14 AIDP cases had one or more nerves with multiple A-waves within 2 weeks, compared to 0 of 6 axonal cases. Conclusions: In patients with GBS, the presence of A-waves in non-tibial nerves and of nerves with multiple A-waves are early indicators of the demyelinating variant. Early identification of GBS subtype is valuable for prognostication.

Impact of Antecedent Infections on the Antibodies against Gangliosides and Ganglioside Complexes in Guillain-Barré Syndrome: A Correlative Study.

Background and Aims:Guillain-Barré Syndrome (GBS), an immune-mediated neuropathy, is characterized by antibodies against gangliosides/ganglioside complexes (GSCs) of peripheral nerves. Antecedent infections have been reported to induce antibodies that cross-react with the host gangliosides and thereby have a pivotal role in conferring an increased risk for developing GBS. Data pertaining to the impact of various antecedent infections, particularly those prevalent in tropical countries like India on the ganglioside/GSC antibodies is sparse. We aimed at exploring the association between six antecedent infections and the profile of ganglioside/GSC antibodies in GBS.Methods:Patients with GBS (n = 150) and healthy controls (n = 50) were examined for the serum profile of antibodies against GM1, GM2, GD1a, GD1b, GT1b, and GQ1b and their GSCs by ELISA. These antibodies were correlated with immunoreactivities against Campylobacter jejuni, Japanese encephalitis (JE), dengue, influenza, zika, and chikungunya infections.Results:The frequencies of antibodies against six single gangliosides (P < 0.001) and their GSCs (P = 0.039) were significantly higher in patients as compared to controls. Except for GT1b-antibody which was more frequent in axonal GBS, none of the other ganglioside/GSC antibodies correlated with the electrophysiological subtypes of GBS. Antecedent JE infection was significantly associated with increased frequency of antibodies against GD1a, GD1b, GT1b, and GQ1b. Antibodies against GSCs were not influenced by the antecedent infections.Interpretation:This study for the first time shows an association between antecedent JE infection and ganglioside antibodies in GBS. This finding reinforces the determining role of antecedent infections on ganglioside antibody responses and the subsequent immunological processes in GBS.

Çocuklarda nadir görülen bir Guillan Barre sendromu alt türü: Akut aksonal motor nöropati

Guillan Barre Sendromu en sık görülen akut, immün aracılı demiyelinizan poliradikulonöropatidir. Guillan Barre Sendromu klinik ve elektrofizyolojik bulgularına göre alt türlere ayrılır. Bu alt türlerden birisi olan akut aksonal motor nöropati çocuklarda çok nadir görülür. Bu çalışmada ayaklarında ve ellerinde uyuşma, gözlerini tam olarak kapatamama, peltek konuşma, ıslık çalamama şikâyeti ile başvuran ve fizik muayenesinde hiperrefleksi saptanan akut aksonal motor nöropati tanılı on altı yaşındaki erkek olguyu sunuyoruz.

Outcomes of patients presenting with Guillain-Barre Syndrome at a tertiary care center in India

BackgroundThe Guillain-Barre Syndrome (GBS), also known as acute idiopathic polyneuritis, is a critical acquired condition associated with preceding nonspecific infection or triggering factors like trauma, surgery, or vaccination. GBS is currently the most frequent cause of acute flaccid paralysis in India. This study evaluates the short-term and in-hospital outcomes in different subtypes of GBS.MethodsA prospective observational study was conducted at V.S. Hospital, Ahmedabad, from September 2015 to December 2017. Patients above the age of 12 were included. Patients having other underlying neurological conditions, as well as immunodeficiency disorders, were excluded. The patients were classified into different subtypes of GBS, and functional outcomes were recorded on admission and discharge according to Hughes Scoring System. All statistical analyses were performed by using SPSS software.ResultsOut of 50 patients, 35 (70%) were males. The mean age was of 37.18 +/− 18.35 years. 25 (50%) patients had a preceding infection. 88% of patients presented with cranial nerve (CN) involvement had a Hughes Score of >/= 3 (p = 0.0087). They had less improvement of Hughes Score on discharge (0.13 +/− 0.04) as compared to the patients without cranial nerve involvement (0.38 +/− 0.08) (p = 0.008). Respiratory involvement was associated with a higher Hughes Score (p = 0.005) on admission. 85% of patients diagnosed with an axonal subtype of GBS had a Hughes Score of >/= 3 (p = 0.06) compared to 74% patients with demyelinating subtype. Axonal subtype required double period (11 +/− 2.34) to show improvement as compared to demyelinating subtype (6 +/− 1.2) (p = 0.020). Irrespective of the subtypes, in two different treatment cohorts (PLEX vs IVIG), there was no difference in short term functional outcomes measured by improvement in the Hughes scores (p = 0.89).ConclusionsEarly cranial nerve and respiratory involvement in patients presenting with GBS are associated with poor outcomes warranting immediate critical care involvement. In our study, amongst all the subtypes, axonal had poor clinical outcomes. Further clinical trials on the Indian subpopulation will help us evaluate the impact of different treatment modalities on this disease.

Clinical predictors and electrodiagnostic characteristics in patients with Guillain-Barré syndrome with respiratory failure: a retrospective, matched case-control study.

BackgroundRespiratory failure is a common complication of Guillain-Barré syndrome (GBS). This study aimed to determine the clinical predictors and electrodiagnostic (EDx) characteristics in patients with Guillain-Barré syndrome (GBS) with respiratory failure.MethodsThe retrospective study included 29 confirmed GBS cases with respiratory failure and age- (±5 years) and sex-matched controls (1:1). The dependent t-test and McNemar–Bowker test were used to analyse the continuous and categorical data, respectively. In addition, a multiple logistic regression analysis was used to analyse the predictive factors for respiratory failure.ResultsAmong both cases and controls, the majority were male (72.4%), and the average age was 50.9 years. The data showed that patients with respiratory failure had higher GBS disability scores, lower motor power (≤3) of the hip flexors and ankle dorsiflexors, and experienced facial and bulbar palsy. In the multivariate analysis, the significant predictive factors were bulbar palsy (AOR 10.4 [95% CI [2.6–41.4]) and motor power of hip flexors ≤ 3 (AOR 31.4 [95% CI [3.1–314.5]). Patients with respiratory failure had lower compound muscle action potential amplitude of the ulnar and tibial nerves. The median, ulnar, and tibial nerve conduction studies were more likely to reflect inexcitability. The GBS subtypes in GBS patients with and without respiratory failure were not significantly different.ConclusionsBulbar palsy and motor power of the hip flexors ≤ 3 were significant predictors for respiratory failure. The GBS subtypes in patients with and without respiratory failure were not significantly different.

Guillain-Barré Syndrome During the COVID-19 Pandemic and Pre-pandemic Periods

Background: Guillain-Barré Syndrome (GBS) is an autoimmune disease that may occur after infections. As Coronavirus Disease 2019 (COVID-19) may bring about GBS, it is important to assess the effect of the COVID-19 pandemic on this disease Objectives: This study aimed to compare the distribution and characteristics of GBS during and before the COVID-19 pandemic in an academic referral hospital in the north of Iran. Materials &amp; Methods: This retrospective study assessed GBS distribution and characteristics during the COVID-19 pandemic period (from March 2020 to the end of February 2021) and before the pandemic (from March 2019 to the end of February 2020) on 5340 patients referred to the Neurology Ward of Poursina Hospital of Guilan Province, in Iran. Results: There was no significant difference between GBS distribution during (0.03%) and before (0.04%) the COVID-19 pandemic (P=0.413). There were also no differences between the two periods regarding the gender (P=0.659) and age (P=0.417) of the patients. The most common subtype of GBS during the COVID-19 pandemic was Acute Motor and Sensory Axonal Neuropathy (AMSAN) (71.4%). In both periods, the most common type of treatment was intravenous administration of immune globulin. There was no significant difference between the two periods (P=0.838) regarding the patients’ treatment response. Conclusion: The distribution of GBS, its subtypes, type of treatment, and response to treatment were not different between the two study periods.

A Rare Case of Acute Motor Axonal Neuropathy and Acute Transverse Myelitis Overlap Syndrome

Previous studies show few cases of concomitant Guillain-Barré syndrome (GBS) and acute transverse myelitis (ATM), also described as GBS and ATM overlap syndrome. We experienced a patient who presented with acute progressive leg weakness and hyperreflexia at initial stage, but was followed by areflexia. The spine magnetic resonance imaging revealed radiological findings of ATM and nerve conduction studies showed electrodiagnostic findings of acute motor axonal neuropathy, known as GBS subtype. The response to treatment with intravenous immune globulin was good.

Acute Motor Axonal Neuropathy Accompanied with Delayed Facial Diplegia

Facial nerve palsy is one of major accompanying features in Guillain-Barré syndrome (GBS). In most of the cases, facial weakness develops simultaneously with other symptoms such as motor weakness, sensory change and other cranial neuropathies. However, facial palsy also occurs after the nadir of neurological deficits or even after the beginning of limb weakness improvement, called delayed facial palsy (DFP). DFP has been reported in Miller Fisher syndrome, but it rarely found from the acute motor axonal neuropathy subtype of GBS. Recently, we experienced a patient who diagnosed acute motor axonal neuropathy accompanying with delayed facial diplegia.