Guillain-Barré Syndrome Research Articles

Immune-mediated neuropathies: pathophysiology and management

Immune-mediated neuropathies (IMN) are a heterogenous group of disorders affecting the peripheral nervous system, due to dysregulation of the immune system. It mainly includes Guillain-Barre syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy and so on. Most of these diseases can be clinically improved by appropriate immunotherapy, but some patients still have unsatisfactory results. Therefore, studying the pathophysiology of the occurrence and development of diseases can reveal the nature of diseases and provide a theoretical basis for the prevention, diagnosis and treatment of diseases. In this paper, the pathophysiological mechanism of various IMNs is described in detail, with emphasis on immunological mechanism, and the progress of diagnosis and treatment of various IMNs is briefly introduced.

Temporal trends and regional variations in mortality related to Guillain-Barré syndrome in the United States: a retrospective study from 1999 to 2020

Aim Guillain-Barré syndrome (GBS) is an autoimmune neurological disorder, with an estimated 6.4% increase in cases worldwide from 1990 to 2019. We aim to identify the GBS-related mortality trends in the US stratified by age, sex, race, and region. Methods We used data from the CDC-WONDER database to calculate crude (CMR) and age-adjusted mortality rates (AAMRs) per 1,000,000 people. We examined the temporal trends through annual percent change (APC) and the average annual percent change (AAPC) in rates using Joinpoint regression. Results From 1999 to 2020, a total of 10,097 GBS-related deaths occurred in the US. The AAMR decreased till 2014 (APC: −1.91) but increased back to initial levels by 2020 (APC: 3.77). AAMR was higher in males (1.7) than females (1.1), decreasing till 2015 for females and 2014 for males, but increasing thereafter only for females. Non-Hispanic (NH) American Indians or Alaska Natives displayed the highest AAMR (1.8) while NH Asians or Pacific Islanders displayed the lowest (0.6). AAMRs also varied by region (West: 1.5; South: 1.5; Midwest: 1.4; Northeast: 1.1). Rural regions exhibited a higher AAMR (1.7) than urban regions (1.3). Most deaths occurred in medical facilities (60.99%). The adults aged ≥85 years exhibited an alarmingly high CMR (14.0). Conclusions While the mortality rates for GBS initially declined till 2014, they climbed back up afterwards. Highest mortality was exhibited by males and NH American Indians or Alaska Natives, residents of rural regions, and adults ≥85 years. Equitable efforts are needed to reduce the burden on high-risk populations.

Mortality of Guillain Barre Syndrome and Myasthenic Crisis in Haji Adam Malik Central General Hospital Medan January 2021- December 2022

Introduction: Neuromuscular disorders are disorders of the neuro system that impact the muscular system. Among them are Guillain-Barré Syndrome and Myasthenic Crisis. Guillain-Barré syndrome is an autoimmune disorder of the nervous system that is polyradiculoneuropathic, characterized by weakness that radiates from the legs to the arms, torso, and face. Myasthenic crisis is a state of acute respiratory failure due to the exacerbation of Myasthenia Gravis. These two diseases are the most common types of neurodiseases found in hospital ICU patients. Objective: Determining the mortality rate of Guillain-Barré Syndrome and Myasthenic Crisis at Haji Adam Malik Central General Hospital Medan January 2021-December 2022. Methods : This study was a descriptive study with data obtained from medical records. The subjects were inpatients and outpatients with Guillain Barré Syndrome and Myasthenia Crisis, with as many as 129 patients. The subjects were selected by purposive sampling and met the inclusion and exclusion criteria. Results: A total of 40 Guillain-Barré Syndrome patients were studied, and 6 of them died. The majority were patients aged 36-50 years, and the male and female sexes were equally significant. A total of 89 patients with Myasthenic Crisis were studied, and 1 of them died, namely patients with the age category of 36-50 years and female. Conclusion: Guillain-Barré Syndrome mortality was 15%, and Myasthenic Crisis was 1.12% at Haji Adam Malik Center General Hospital Medan January 2021-December 2022. Keyword : Guillain-Barré Syndrome, Mortality, Myasthenic Crisis

Correlation of Clinical and Electrophysiological Criteria in the Diagnosis of Guillain-Barré Syndrome: A Prospective Observational Study.

There are many criteria for diagnosing Guillain-Barré syndrome (GBS), and the yield of these diagnostic criteria varies. Each criterion requires some laboratory data and nerve conduction studies (NCS). Although supportive laboratory data are reassuring when present in suspected cases of GBS, when absent, they can potentially cause further delay in diagnosis and treatment. There is no gold standard test for the diagnosis of GBS, and there are multiple diagnostic criteria for GBS to date. The aim of the study is to know the sensitivity of different criteria, clinical and electrophysiological, for the diagnosis of GBS and to study the clinical spectrum and electrophysiological spectrum of GBS in our cohort of patients. We studied a total of 43 cases who presented with one or more of the following symptoms: relatively symmetrical and progressive flail-type weakness of more than one limb, with or without ataxia and/or ophthalmoplegia, and were diagnosed with GBS according to clinical criteria at the time of admission to Government Stanley Medical College Hospital. GBS mimics were ruled out. In all patients, the demographic data, cerebrospinal fluid (CSF) analysis (if done), and electrophysiological findings fitting into the diagnostic criteria of National Institute of Neurological Disorders and Stroke (NINDS), Dutch, and Brighton criteria were recorded. The need for assisted mechanical ventilation, neurology intensive care unit (NICU) stay, any complications, and treatment outcome details were recorded in a structured proforma. Most of the patients in our study were in their fourth decade of life, with a mean age of 41.37 years, similar to previous studies from India. Men are more frequently affected compared to women, similar to what has been observed in most studies done previously worldwide. In our study, electrophysiological criteria by Dutch criteria (87.5%), Brighton criteria (87.5%), and NINDS criteria (85.6%) had low sensitivity compared to the clinical criteria. In the present study, electrophysiological criteria proposed by the NINDS, Dutch, and Brighton criteria are less sensitive compared to clinical criteria in diagnosing GBS at early stages. Clinical criteria alone may be useful in resource-poor countries and at peripheral healthcare systems where NCS are not always readily available.

Electrodiagnostic subtyping in Guillain-Barré syndrome patients in the International Guillain-Barré Outcome Study.

Various electrodiagnostic criteria have been developed in Guillain-Barré syndrome (GBS). Their performance in a broad representation of GBS patients has not been evaluated. Motor conduction data from the International GBS Outcome Study (IGOS) cohort were used to compare two widely used criterion sets and relate these to diagnostic amyotrophic lateral sclerosis criteria. From the first 1500 patients in IGOS, nerve conduction studies from 1137 (75.8%) were available for the current study. These patients were classified according to nerve conduction studies criteria proposed by Hadden and Rajabally. Of the 1137 studies, 68.3% (N = 777) were classified identically according to criteria by Hadden and Rajabally: 111 (9.8%) axonal, 366 (32.2%) demyelinating, 195 (17.2%) equivocal, 35 (3.1%) inexcitable and 70 (6.2%) normal. Thus, 360 studies (31.7%) were classified differently. The areas of differences were as follows: 155 studies (13.6%) classified as demyelinating by Hadden and axonal by Rajabally; 122 studies (10.7%) classified as demyelinating by Hadden and equivocal by Rajabally; and 75 studies (6.6%) classified as equivocal by Hadden and axonal by Rajabally. Due to more strictly defined cutoffs fewer patients fulfilled demyelinating criteria by Rajabally than by Hadden, making more patients eligible for axonal or equivocal classification by Rajabally. In 234 (68.6%) axonal studies by Rajabally the revised El Escorial (amyotrophic lateral sclerosis) criteria were fulfilled; in axonal cases by Hadden this was 1.8%. This study shows that electrodiagnosis in GBS is dependent on the criterion set utilized, both of which are based on expert opinion. Reappraisal of electrodiagnostic subtyping in GBS is warranted.

Interpretable Machine Learning Model for Predicting the Prognosis of Guillain-Barré Syndrome Patients.

Machine learning (ML) is increasingly used in medical predictive modeling, but there are no studies applying ML to predict prognosis in Guillain-Barré syndrome (GBS). The medical records of 223 patients with GBS were analyzed to construct predictive models that affect patient prognosis. Least Absolute Shrinkage and Selection Operator (LASSO) was used to filter the variables. Decision Trees (DT), Random Forest (RF), Extreme Gradient Boosting (XGBoost), k-nearest Neighbour (KNN), Naive Bayes (NB), Neural Network (NN). Light Gradient Boosting Machine (LGBM) and Logistic Regression (LR) were used to construct predictive models. Clinical data from 55 GBS patients were used to validate the model. SHapley additive explanation (SHAP) analysis was used to explain the model. Single sample gene set enrichment analysis (ssGSEA) was used for immune cell infiltration analysis. The AUCs (area under the curves) of the 8 ML algorithms including DT, RF, XGBoost, KNN, NB, NN, LGBM and LR were as follows: 0.75, 0.896 0.874, 0.666, 0.742, 0.765, 0.869 and 0.744. The accuracy of XGBoost (0.852) was the highest, followed by LGBM (0.803) and RF (0.758), with F1 index of 0.832, 0.794, and 0.667, respectively. The results of the validation set data analysis showed AUCs of 0.839, 0.919, and 0.733 for RF, XGBoost, and LGBM, respectively. SHAP analysis showed that the SHAP values of blood neutrophil/lymphocyte ratio (NLR), age, mechanical ventilation, hyporeflexia and abnormal glossopharyngeal vagus nerve were 0.821, 0.645, 0.517, 0.401 and 0.109, respectively. The combination of NLR, age, mechanical ventilation, hyporeflexia and abnormal glossopharyngeal vagus used to predict short-term prognosis in patients with GBS has a good predictive value.

Cytotoxic Lesion of the Corpus Callosum Caused by Dengue Virus Infection

ABSTRACT Dengue virus infection can cause a wide spectrum of clinical manifestations, ranging from mild fever to lethal dengue shock syndrome. Neurological manifestations include encephalitis, acute disseminated encephalomyelitis, Transverse myelitis, Guillain-Barre syndrome, and neuro-ophthalmic complications. We report a case of a 44-year-old male who was admitted to our hospital with high-grade fever, myalgia, retro-orbital pain, visual disturbances, and drowsiness. Hematological and serological parameters confirmed the diagnosis of dengue fever. Brain imaging demonstrated altered signal intensity in the splenium of the corpus callosum and eventually a diagnosis of a cytotoxic lesion of the corpus callosum (CLOCC) was made. The patient was managed conservatively and discharged 7 days after admission and imaging findings were resolved completely 3 weeks later.

Recurrent GBS in Children: A Case Report

Background: Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy characterized by rapidly progressing muscle weakness. GBS usually follows a monophasic course, but rarely it can recur after an asymptomatic period of several months to years. Limited cases of recurrent GBS have been reported in the literature. We present two cases of recurrent GBS encountered in a tertiary care hospital. This case report describes the clinical presentation, diagnostic workup, management, and outcomes of two children of GBS who experienced recurrence. By presenting the cases, we aim to increase awareness of this rare presentation of GBS among healthcare professionals and enabletimely recognition and better outcomes for children with recurrent GBS. J Com Med Col Teachers Asso Jan 2024; 28(1): 37-40

Expanding our understanding of Guillain-Barré syndrome: Recent advances and clinical implications.

Guillain-Barré syndrome (GBS) is a rare yet potentially life-threatening disorder of the peripheral nervous system (PNS), characterized by substantial clinical heterogeneity. Although classified as an autoimmune disease, the immune mechanisms underpinning distinct GBS subtypes remain largely elusive. Traditionally considered primarily antibody-mediated, the pathophysiology of GBS lacks clarity, posing challenges in the development of targeted and effective treatments. Nevertheless, recent investigations have substantially expanded our understanding of the disease, revealing an involvement of autoreactive T cell immunity in a major subtype of GBS patients and opening new biomedical perspectives. This review highlights these discoveries and offers a comprehensive overview of current knowledge about GBS, including ongoing challenges in disease management.

Antibodies in Autoimmune Neuropathies: What to Test, How to Test, Why to Test.

Autoimmune neuropathies are a heterogeneous group of immune-mediated disorders of the peripheral nerves. Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are the archetypal acute and chronic forms. Over the past few decades, pathogenic antibodies targeting antigens of the peripheral nervous system and driving peripheral nerve damage in selected patients have been described. Moreover, the detection of these antibodies has diagnostic and therapeutic implications that have prompted a modification of the GBS and CIDP diagnostic algorithms. GBS diagnosis is based in clinical criteria, and systematic testing of anti-ganglioside antibodies is not required. Nonetheless, a positive anti-ganglioside antibody test may support the clinical suspicion when diagnosis of GBS (GM1 IgG), Miller Fisher (GQ1b IgG), or acute sensory-ataxic (GD1b IgG) syndromes is uncertain. Anti-myelin-associated glycoprotein (MAG) IgM and anti-disialosyl IgM antibodies are key in the diagnosis of anti-MAG neuropathy and chronic ataxic neuropathy, ophthalmoplegia, M-protein, cold agglutinins, and disialosyl antibodies spectrum neuropathies, respectively, and help differentiating these conditions from CIDP. Recently, the field has been boosted by the discovery of pathogenic antibodies targeting proteins of the node of Ranvier contactin-1, contactin-associated protein 1, and nodal and paranodal isoforms of neurofascin (NF140, NF186, or NF155). These antibodies define subgroups of patients with specific clinical (most importantly poor or partial response to conventional therapies and excellent response to anti-CD20 therapy) and pathologic (node of Ranvier disruption in the absence of inflammation) features that led to the definition of the "autoimmune nodopathy" diagnostic category and to the incorporation of nodal/paranodal antibodies to clinical routine testing. The purpose of this review was to provide a practical vision for the general neurologist of the use of antibodies in the clinical assessment of autoimmune neuropathies.

Stroke and Guillain-Barre syndrome secondary to spotted fever –A case report

Rickettsial infection is an important differential diagnosis in prolonged febrile illness and in returned travellers.We report a 44-year-old male from Deraniyagala, Sri Lanka, with spotted fever Rickettsiosis presenting with stroke and Guillain-Barre syndrome. He presented with dysarthria, reduced sensorium, and acute renal failure on the background of a prolonged febrile illness over two weeks. Following admission there was rapid deterioration of consciousness due to renal failure requiring intubation and repeated haemodialysis. On brain imaging, there were bilateral basal ganglia and internal and external capsule infarctions. His serology was positive for spotted fever Rickettsial infection and there was rapid improvement following treatment with doxycycline. However, difficulty in weaning off from the ventilator due to poor respiratory effort and symmetrical flaccid quadriparesis with areflexia raised concerns of concomitant Guillain-Barre syndrome. Serial cerebrospinal fluid (CSF) studies showed the development of elevated CSF protein with cytoalbuminologic dissociation during his stay in the intensive care unit (ICU). A diagnosis of co-existing Guillain-Barre syndrome was supported by the neuro-physiological findings and marked motor improvement following therapeutic plasmapheresis. This unmasked the right-sided mild residual hemiparesis he suffered due to stroke.

Serious Adverse Events Following COVID 19 Vaccination in India: A Retrospective Study

Abstract Introduction: The aim of this study was to identify the type and detail the serious adverse events following COVID-19 vaccination in India. Materials and Methods: The descriptive study was conducted by extracting the data from the website by the Ministry of Health and Family Welfare, Government of India https://shorturl.at/imwJY. The variables analysed were types of vaccines, types of SAEFI, thromboembolic (TE) events, neurological manifestations and consistent causal association as per the World Health Organization. Data were entered into MS Excel and analysed using the SPSS software version 25. Results: Out of the total 1.9 billion doses of COVID-19 vaccines, 1527 cases of SAEFI were reported. Among these, 51.7% were coincidental and 30.8% were associated with vaccination. All the allergic reactions (58), anaphylaxis (50), TE events (342) and Guillain–Barre syndrome (41) had consistent causal association. Out of the 598 deaths, 2% of deaths had consistent causal association. In comparison of exposure to Covaxin, Covishield had high odds of death (odds ratio [OR] =1.5; 95% confidence interval [CI] =1.11–2.07), acute febrile illness (OR = 2.07; 95% CI = 1–4.3), TE events (OR = 1.58; 95% CI = 1.08–2.31) and cardiovascular events (OR = 2.03; 95% CI = 1.32–3.13). Conclusions: Compared to other countries, similar types of SAEFIs were reported from India but at a lower rate.

Role of prazosin in patients with Guillain-Barré syndrome with sympathetic overactivity: A cohort study.

In Guillain-Barré syndrome (GBS), patients with dysautonomia demonstrate sympathetic overactivity (SO). This study assessed the role of prazosin (α1-blocker) in the management of SO. This cohort study was conducted from January 2022 to September 2023. Thirty-two GBS patients with SO received prazosin (2.5-10 mg three times a day) (prazosin group). For comparison, we included historical controls that included 33 GBS patients having SO with similar baseline characteristics, including median age and disability, who did not receive prazosin, from a GBS registry of patients admitted during February 2018-December 2021. The primary endpoint was days to resolution of SO. Secondary endpoints were daily fluctuations in the systolic (SBP) and diastolic blood pressure (DBP), duration of hospital stay, in-hospital mortality, and disability at 3 months. The median ages of both the treatment and the control groups were 36 (IQR 25-49) years and 43 (66.2%) were males. The demographic and clinical parameters were comparable. Prazosin resulted in significantly earlier normalization of SO compared to the control group (median 15 vs. 20 days; p = .01). The mean fluctuations in the SBP and DBP at 15 days were significantly lower in the prazosin group. However, the duration of hospital stay and good recovery at 3 months were comparable. Three patients developed hypotension, while two patients died (ventilator-associated pneumonia) in the prazosin group. This study provides new evidence supporting the role of prazosin in SO, and needs randomized trials to confirm our findings.

Maternal and newborn outcomes in pregnancies complicated by Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is a rare autoimmune disorder that affects the peripheral nervous system. The purpose of our study was to evaluate maternal and fetal/neonatal outcomes among pregnancies complicated by GBS. We performed a retrospective cohort study using the Healthcare Cost and Utilization Project- National Inpatient Sample from the United States. ICD-9 codes were used to identify all pregnant women who delivered between 1999 and 2015 and had a diagnosis of GBS. The remaining women without GBS who delivered during that time period constituted the comparison group. The associations between maternal GBS and obstetrical and fetal/neonatal outcomes were evaluated using multivariate logistic regression, while adjusting for the confounding effects of maternal characteristics. Of 13,792,544 births included in our study, 291 were to women with GBS, for an overall incidence of 2.1/100,000 births. A steady increase in maternal GBS was observed over the study period (from 1.26 to 3.8/100,000 births, p=0.02). Further, women with GBS were more likely to have pregnancies complicated by preeclampsia, OR 1.69 (95 % CI 1.06-2.69), sepsis, 9.30 (2.33-37.17), postpartum hemorrhage, 1.83 (1.07-3.14), and to require a transfusion, 4.39 (2.39-8.05). They were also at greater risk of caesarean delivery, 2.07 (1.58-2.72) and increased length of hospital stay, 4.48 (3.00-6.69). Newborns of women with GBS were more likely to be growth restricted, 2.50 (1.48-4.23). GBS in pregnancy is associated with maternal and newborn adverse outcomes. These patients would benefit from close follow-up throughout their pregnancy and in the postpartum period.

Genotypic characterization and antimicrobial susceptibility of human Campylobacter jejuni isolates in Southern Spain.

Campylobacter jejuni is the main cause of bacterial gastroenteritis and a public health problem worldwide. Little information is available on the genotypic characteristics of human C. jejuni in Spain. This study is based on an analysis of the resistome, virulome, and phylogenetic relationship, antibiogram prediction, and antimicrobial susceptibility of 114 human isolates of C. jejuni from a tertiary hospital in southern Spain from October 2020 to June 2023. The isolates were sequenced using Illumina technology, and a bioinformatic analysis was subsequently performed. The susceptibility of C. jejuni isolates to ciprofloxacin, tetracycline, and erythromycin was also tested. The resistance rates for each antibiotic were 90.3% for ciprofloxacin, 66.7% for tetracycline, and 0.88% for erythromycin. The fluoroquinolone resistance rate obtained is well above the European average (69.1%). CC-21 (n = 23), ST-572 (n = 13), and ST-6532 (n = 13) were the most prevalent clonal complexes (CCs) and sequence types (STs). In the virulome, the cadF, ciaB, and cdtABC genes were detected in all the isolates. A prevalence of 20.1% was obtained for the genes wlaN and cstIII, which are related to the pathogenesis of Guillain-Barré syndrome (GBS). The prevalence of the main antimicrobial resistance markers detected were CmeABC (92.1%), RE-cmeABC (7.9%), the T86I substitution in gyrA (88.9%), blaOXA-61 (72.6%), tet(O) (65.8%), and ant (6)-Ia (17.1%). High antibiogram prediction rates (>97%) were obtained, except for in the case of the erythromycin-resistant phenotype. This study contributes significantly to the knowledge of C. jejuni genomics for the prevention, treatment, and control of infections caused by this pathogen.IMPORTANCEDespite being the pathogen with the greatest number of gastroenteritis cases worldwide, Campylobacter jejuni remains a poorly studied microorganism. A sustained increase in fluoroquinolone resistance in human isolates is a problem when treating Campylobacter infections. The development of whole genome sequencing (WGS) techniques has allowed us to better understand the genotypic characteristics of this pathogen and relate them to antibiotic resistance phenotypes. These techniques complement the data obtained from the phenotypic analysis of C. jejuni isolates. The zoonotic transmission of C. jejuni through the consumption of contaminated poultry supports approaching the study of this pathogen through "One Health" approach. In addition, due to the limited information on the genomic characteristics of C. jejuni in Spain, this study provides important data and allows us to compare the results with those obtained in other countries.

Prevalence and Prognostic Impact of Hyponatremia in Guillain-Barré Syndrome: A Systematic Review and Meta-Analysis.

This study aims to systematically review the existing literature and perform a meta-analysis to evaluate the prevalence of hyponatremia among Guillain Barre Syndrome (GBS) patients and its relationship with disease prognosis.We comprehensively searched PubMed, Embase, Medline, Web of Science, Science Direct, and the Cochrane Library databases from 1995 to 2024 for observational studies on the prevalence of hyponatremia in GBS. The meta-analysis followedthe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Heterogeneity among the included studies was calculated with the I2 for each analysis. We used the Comprehensive Meta-Analysis software (Version 3.3.070; Biostat, Englewood, USA). Eight observational studies met our inclusion criteria. The meta-analysis showed that the pooled prevalence of hyponatremia among GBS patients was 12% (95% CI: 0.107-0.149). The results exhibited high heterogeneity (I² = 99%), indicating significant variability among the studies. Hyponatremia rates reported in these eight studies ranged from 11.5% to 48% in GBS patients. The prevalence of hyponatremia was found to be 12% in GBS patients, which is relatively lower compared to some reports. Hyponatremia was found to be associated with prolonged hospital stay, mortality, and mechanical ventilation as poor prognostic factors. Further prospective studies are needed to elucidate the mechanisms underlying hyponatremia in GBS and to develop targeted interventions to address this issue.

Opisthotonic posturing in Guillian-Barre syndrome.

Here we report a child of Gullian Barre syndrome (GBS) with opisthotonic posturing and we subsequently detected Scrub typhus in him. An 11-year-old boy presented with progressive motor quadriparesis with transient bladder retention, bilateral facial weakness, diminished gag reflex, absent reflexes and his nerve conduction studies suggested Acute Motor Axonal Neuropathy (AMAN) GBS. His power gradually started recovering after one week. However, he had opisthotonus and signs of meningeal irritation. The child's CSF examination was consistent with GBS. His bacterial, fungal, tubercular microscopy and cultures and viral markers were negative. IgM for Borrelia and Leptospira and HIV ELISA were negative. IgM for scrub typhus, however, came out to be positive. Hence, we gave him azithromycin and he recovered almost completely in 3 months. To our knowledge there is no previous report of opisthotonic posturing in GBS patients. This could be due to radicular involvement in immune mediated etiology of GBS.

Acompanhamento de paciente diagnosticado com Síndrome de Guillain-Barré com lesão axonal do tipo sensitivo-motor (AMSAN)

Guillain-Barre syndrome (GBS) is a rare inflammatory disease of the peripheral nervous system, with a prevalence of 1-4 cases per 100,000 population. It is characterized by acute flaccid paralysis with ascending motor and sensory symptoms, and can be electrophysiologically classified into subtypes such as acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute sensory-motor axonal neuropathy (AMSAN). GBS, usually triggered by viral infections, can lead to serious complications like respiratory failure due to phrenic nerve palsy. The reported case study describes a patient with AMSAN, a severe and rare form of the disease, who presented with progressive weakness and areflexia, with a diagnosis confirmed by electroneuromyography and successful treatment with intravenous immunoglobulin. The prognosis is usually favorable with appropriate treatment, but may include complications and the need for prolonged rehabilitation.

Neurological complication of pregnancy: An experience from north east India

: The neurology of pregnancy is usually of two types, those that are pregnancy-specific and those that worsen during pregnancy and the post-partum period. Almost 20% of maternal mortality can be attributed to neurological causes which warrants us to identify the red flag sign for early and proper intervention. : A retrospective study of three years duration in North East India. All demographic, clinical, and neurological findings, routine investigation, and neurological investigation were recorded. Further analysis was done to find out the most common neurological pathology in pregnancy and classify them into pregnancy-specific, incidental, and preexisting neurological conditions. : A total number of 80 patients were included. The age ranged from 18 to 49 years with the maximum number of patients (forty-four) in the 20-30 age group. Guillain barre syndrome (GBS) seen in 21 patients (26%) which was the most common with maternal mortality and stillbirth. Eclampsia was seen in seventeen patients (21%) with three intra-uterine death and one maternal death noted. The other neurological disease was cerebral venous thrombosis (11%), seizure in isolation (six patients), and seizure with post-partum sepsis (five patients). Myelopathy was seen in four patients, carpal tunnel syndrome and cramps in six patients each, multiple sclerosis, tubercular meningitis (proven), thymoma-negative generalized myasthenia gravis, and arteriovenous malformation in one patient each. An in-depth knowledge of the various neurological diseases during pregnancy helps us to recognize them early and provide proper approaches and management to reduce harm to maternal and child health.

Retrospective, cross-sectional study of the determinants of acute flaccid paralysis among children in Pakistan.

Timely diagnosis of acute flaccid paralysis is very crucial in developing countries like Pakistan, because this will have significant impact on management. To assess the surveillance, aetiology and epidemiology of acute flaccid paralysis in a tertiary care hospital in Peshawar, Pakistan. This retrospective, observational study was conducted at the Paediatric Department of Lady Reading Hospital, Peshawar, in 2022. Data on all children aged 1 month to 15 years and diagnosed with acute flaccid paralysis were retrieved from the electronic medical records and patient files of the hospital. The data were analysed using SPSS version 27. Eighty-eight (1.34%) of the 6544 patients admitted to the paediatric ward met the inclusion criteria for acute flaccid paralysis; 63 (71.6%) of them were male, 25 (28.4%) female, mean age 6.68 ± 3.86 (mean ±SD) years. Guillain Barre Syndrome was diagnosed in 36 (40.9%) of them, meningoencephalitis in 26 (29.5%), septic arthritis in 6 (6.8%), and hypokalaemia paralysis and cerebrovascular accidents in 5 (5.7%). Three (3.4%) of the patients had post-diphtheria neuropathy and 1 (1.1%) had poliomyelitis. In-hospital mortality was 2.3% (2). Although acute flaccid paralysis is vaccine-preventable and its infectious aetiology is low, its surveillance in Pakistan should be continued to reduce occurrence and progress towards polio eradication.