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Postgraduate Medical Journal Dec 2000Guillain-Barré syndrome is an autoimmune disorder encompassing a heterogeneous group of pathological and clinical entities. Antecedent infections are thought to trigger... (Review)
Review
Guillain-Barré syndrome is an autoimmune disorder encompassing a heterogeneous group of pathological and clinical entities. Antecedent infections are thought to trigger an immune response, which subsequently cross reacts with nerves leading to demyelination or axonal degeneration. Both intravenous immunoglobulin treatment and plasma exchange have been found to be equally beneficial. Several factors are useful in predicting the outcome of these patients.
Topics: Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Infections; Prognosis; Vaccination
PubMed: 11085768
DOI: 10.1136/pmj.76.902.774 -
Guillain-Barre syndrome in North Indian children: Clinical and serial electrophysiological features.Neurology India 2019Guillain-Barre syndrome (GBS) is a common acquired polyneuropathy in children.
BACKGROUND
Guillain-Barre syndrome (GBS) is a common acquired polyneuropathy in children.
AIM
To describe the clinical and serial electrophysiological features along with short-term outcomes of children with GBS in north India.
SETTING AND DESIGN
This was a prospective study conducted at a tertiary care pediatric hospital in north India.
MATERIALS AND METHODS
Consecutive children, aged 2 to 18 years, with GBS, presenting within 4-weeks of onset of weakness, diagnosed on clinical and/or electrophysiological grounds, were enrolled. The enrolled children underwent a detailed clinical-assessment followed by nerve conduction studies. Repeat nerve conduction studies were performed after 2-weeks of the first study to determine changes in the electrophysiological subtype. The patients were followed up for 3 months.
RESULTS
Thirty-six children were studied. The mean age at presentation was 5.1 years [standard deviation (SD): 2.1]. The mean medical research council (MRC)-sum-score at admission was 24.1 (SD: 10.4). Thirty-three children (91%) had loss of ambulation, 24 (66%) had cranial nerve involvement, and 6 (16.6%) required ventilation. At presentation, 20 had acute motor axonal neuropathy (AMAN), 13 had acute inflammatory demyelinating polyneuropathy (AIDP), 2 had in-excitable nerves, and 1 had normal findings. Four children, initially diagnosed as AIDP, had AMAN with reversible conduction failure on the repeat study. The final classification was AMAN in 25 (69.4%; 95% confidence interval (CI), 51.9-83.7%) and AIDP in 9 children (25%; 95% CI, 12.1-42.2%). Only one patient was nonambulatory at a 3-month follow-up (n = 32). The Erasmus GBS outcome score was 2 in 2 (5.6%), 3 in 5 (13.9%), 4 in 26 (72.2%), and 5 in 3 (8.3%) patients.
CONCLUSIONS
The serial electrophysiological studies were helpful in establishing the final correct diagnosis.
Topics: Adolescent; Child; Child, Preschool; Electrophysiological Phenomena; Female; Guillain-Barre Syndrome; Humans; India; Male; Neural Conduction; Prospective Studies
PubMed: 31347543
DOI: 10.4103/0028-3886.263191 -
Journal of Neurology May 2017To describe the key diagnostic features of pediatric Guillain-Barré syndrome (GBS) and validate the Brighton criteria. Retrospective cohort study of all children...
To describe the key diagnostic features of pediatric Guillain-Barré syndrome (GBS) and validate the Brighton criteria. Retrospective cohort study of all children (<18 years) diagnosed with GBS between 1987 and 2013 at Sophia Children's Hospital, Erasmus MC, Rotterdam. Clinical information was collected and the sensitivity of the Brighton criteria was calculated. 67 children (35 boys) were included, with a median age of 5.0 years [interquartile range (IQR) 3.0-10.0 years]. Bilateral limb weakness was present at hospital admission in 93% of children, and at nadir in all patients. Children presented with tetraparesis in 70% or with paraparesis in 23%. Reduced reflexes in paretic limbs were observed at hospital admission in 82% and during follow-up in all children. The progressive phase lasted median 6 days (IQR 3-8 days) and less than 4 weeks in all children. A monophasic disease course was seen in 97%, including 5 children with a treatment-related fluctuation. Two children had a later relapse at 9 weeks and 19 weeks after onset. 77% of the children showed an elevated protein level in CSF. Nerve conduction studies showed evidence for a poly(radiculo)neuropathy in 91% of the children. 46 children had a complete data set, the sensitivity of the Brighton criteria level 1 was 72% (95% CI 57-84) and 96% (95% CI 85-99) for level 2 and 98% (95% CI 88-100) for level 3. The majority of the pediatric GBS patients presented in this cohort fulfilled the current diagnostic criteria.
Topics: Cerebrospinal Fluid Proteins; Child; Child, Preschool; Cohort Studies; Female; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Male; Muscle Weakness; Neural Conduction; Proteins; Reflex; Reproducibility of Results; Severity of Illness Index; Statistics, Nonparametric
PubMed: 28251358
DOI: 10.1007/s00415-017-8429-8 -
Journal of Neurology Apr 2021Presented herein is a severe case of SARS-CoV-2 associated Guillain-Barré syndrome (GBS), showing only slight improvement despite adequate therapy. To date, only few...
Presented herein is a severe case of SARS-CoV-2 associated Guillain-Barré syndrome (GBS), showing only slight improvement despite adequate therapy. To date, only few cases of GBS associated with this infection have been described. This case report summarizes the insights gain so far to GBS with this antecedent trigger. So far, attention has mostly focused on complications of the CNS involvement. Taking into account that GBS can cause a considerable impairment of the respiratory system, clinicians dealing with SARS-CoV-2 positive-tested patients should pay attention to symptoms of the peripheral nervous system. As far as we know from this reported case and the review of the current literature, there seems to be no association with antiganglioside antibodies or a positive SARS-CoV-2 RT-PCR in CSF. An obvious frequent occurrence of a bilateral facial weakness or bilateral peripheral facial diplegia should be emphasized.
Topics: COVID-19; Female; Guillain-Barre Syndrome; Humans; Middle Aged; SARS-CoV-2
PubMed: 32770414
DOI: 10.1007/s00415-020-10133-w -
Pharmacological Reports : PR 2010Guillain-Barré syndrome (GBS) is an autoimmune and post-infectious immune disease. The syndrome includes several pathological subtypes, the most common of which is a... (Review)
Review
Guillain-Barré syndrome (GBS) is an autoimmune and post-infectious immune disease. The syndrome includes several pathological subtypes, the most common of which is a multifocal demyelinating disorder of the peripheral nerves. In the present review, the main clinical aspects and the basic features of GBS are discussed along with approaches to diagnosis and treatment. Furthermore, the pathophysiology of GBS is reviewed, with an emphasis on the production of symptoms and the course of the disease.
Topics: Adrenal Cortex Hormones; Complement Inactivator Proteins; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Plasma Exchange
PubMed: 20508277
DOI: 10.1016/s1734-1140(10)70261-9 -
Neurosciences (Riyadh, Saudi Arabia) Jan 2018To evaluate all the coincidence cases of Guillain-Barre syndrome (GBS) and myasthenia gravis (MG). (Review)
Review
OBJECTIVE
To evaluate all the coincidence cases of Guillain-Barre syndrome (GBS) and myasthenia gravis (MG).
METHODS
We performed web-based research of the overlapping incidence of GBS and MG in studies occurring from 1982 to 2016 and restricted to the English language.
RESULTS
Among 15 cases, an elevated CSF protein level without pleocytosis was found in 10 cases (66.7%); reduced nerve conduction was found in 13 cases (86.6%); a positive repetitive nerve stimulation test occurred in 11 cases (73.3%); anti-AChR antibodies were found in 13 cases (86.6%); anti-GQ1b antibodies were found in 6 cases (40%); a positive edrophonium chloride test was present in 10 cases (66.7%); and a co-occurring thymoma or thymectomy occurred in 4 cases (26.6%). The MG co-occurred with acute inflammatory demyelinating polyneuropathy (AIDP) in 8 cases and with Miller Fisher Syndrome in 5 cases. Treatment in the assessed cases included pyridostigmine (10 cases), prednisolone (7 cases), intravenous immunoglobulin (9 cases), plasmapheresis (3 cases), combined intravenous immunoglobulin and plasmapheresis in one case, and immunosuppressive drugs in 2 cases (azathioprine). Functional outcome was mentioned in 13 patients. The prognosis was favorable in 8 of the 15 recorded patients (Hughes 0-1), and 2 cases resulted in death.
CONCLUSION
Although comorbidity of GBS and MG is extremely rare, early recognition of this combination of inflammation of peripheral nerves and the neuromuscular junction is of great importance for both initial treatment and a better prognosis.
Topics: Adolescent; Adult; Aged; Comorbidity; Female; Guillain-Barre Syndrome; Humans; Male; Middle Aged; Myasthenia Gravis
PubMed: 29455227
DOI: 10.17712/nsj.2018.1.20170209 -
Journal of Neurology Sep 2023Guillain-Barre syndrome (GBS) is an acute inflammatory polyradiculoneuropathy rarely observed during pregnancy.
BACKGROUND
Guillain-Barre syndrome (GBS) is an acute inflammatory polyradiculoneuropathy rarely observed during pregnancy.
METHODS
In this retrospective study, we analyzed the characteristics of pregnant women with GBS (pGBS) diagnosed in French University Hospitals in the 2002-2022 period and compared them with a reference group of same-age non-pregnant women with GBS (npGBS) identified in the same institutions & timeframe.
RESULTS
We identified 16 pGBS cases. Median age was 31 years (28-36), and GBS developed in the 1st, 2nd, and 3rd trimester in 31%, 31% and 38% of cases respectively. A previous infection was identified in six cases (37%), GBS was demyelinating in nine cases (56%), and four patients (25%) needed respiratory assistance. Fifteen patients (94%) were treated with intravenous immunoglobulins, and neurological recovery was complete in all cases (100%). Unscheduled caesarean section was needed in five cases (31%), and two fetuses (12.5%) died because of cytomegalovirus (CMV) infection (1 case) and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome (1 case). In comparison with a reference group of 18 npGBS women with a median age of 30 years (27-33), pGBS patients more frequently had CMV infection (31% vs 11%), had a prolonged delay between GBS onset and hospital admission (delay > 7 days: 57% vs 12%), more often needed ICU admission (56% vs 33%) and respiratory assistance (25% vs 11%), and more often presented with treatment-related fluctuations (37% vs 0%).
CONCLUSIONS
This study shows GBS during pregnancy is a severe maternal condition with significant fetal mortality.
Topics: Humans; Female; Pregnancy; Adult; Guillain-Barre Syndrome; Retrospective Studies; Cesarean Section; Cytomegalovirus Infections; Fetus
PubMed: 37294323
DOI: 10.1007/s00415-023-11808-w -
Journal of Infection in Developing... Nov 2023Hyperactivity immune responses to coronavirus disease 2019 (COVID-19) can lead to several manifestations in the human organ. One of the most affected organs is the...
INTRODUCTION
Hyperactivity immune responses to coronavirus disease 2019 (COVID-19) can lead to several manifestations in the human organ. One of the most affected organs is the respiratory system. Not only does it affect the respiratory system, but hyperactivity can also affect the neuromuscular and cerebrovascular systems, though it is scarce for both systems to be affected simultaneously.
CASE PRESENTATION
We presented a mild COVID-19 patient with a history of progressive general weakness and dysphagia on day seventh day after patient was first diagnosed with COVID-19, which continued with diplopia and shortness of breath. The patient experienced respiratory failure type 1 and was admitted to an intensive care unit. A head CT scan showed multiple lacunar infarcts in the nucleus lentiform, while the electromyography (EMG) showed Guillain-Barré syndrome (GBS) with the subtype acute inflammatory demyelinating polyneuropathy (AIDP). The patient was reported to have successful therapy with intravenous immunoglobulin (IVIG) for five days and physical rehabilitation for three months. General weakness disappeared after the therapy, and the patient could do regular daily activities.
CONCLUSIONS
Various neurological symptoms can manifest in COVID-19 patients. Acute progressive muscle weakness should be considered as an autoimmune and cerebrovascular disease induced by COVID-19. Early diagnosis and treatment can provide a better outcome for the patient.
Topics: Humans; COVID-19; Guillain-Barre Syndrome; SARS-CoV-2; Stroke, Lacunar; Immunoglobulins, Intravenous
PubMed: 38064394
DOI: 10.3855/jidc.17975 -
European Journal of Neurology Nov 2021In its initial stages, Guillain-Barré syndrome (GBS) is difficult to identify, because diagnostic criteria may not always be fulfilled. With this retrospective study,...
BACKGROUND AND PURPOSE
In its initial stages, Guillain-Barré syndrome (GBS) is difficult to identify, because diagnostic criteria may not always be fulfilled. With this retrospective study, we wanted to identify the most common electrophysiological abnormalities seen on neurophysiological examination of GBS patients and its variants in the early phases.
METHODS
We reviewed the clinical records of patients admitted to our Neurology Unit with a confirmed diagnosis of GBS. The study sample was divided in two subgroups according to whether the neurophysiological examination was performed: within 7 days (very early group) or within 7-15 days (early group). H reflex, F waves, and motor and sensory conduction parameters were judged abnormal if they were outside the normal range for at least two nerves. We evaluated neurophysiological findings in Miller-Fisher syndrome (MFS) separately.
RESULTS
The study sample comprised 36 patients. In GBS, the most frequent abnormal neurophysiological parameter was the bilateral absence of the H reflex, followed by F wave abnormalities. Motor conduction parameters were altered in less than 50% of patients, and even less common were sensory nerve action potential reduction and the "sural-sparing" pattern. In MFS, H reflex was absent bilaterally in 100% of patients, followed by a predominant peripheral sensory involvement, whereas motor conduction parameters were frequently normal.
CONCLUSIONS
Bilateral absence of the H reflex is the most sensitive parameter in early diagnosis of GBS and its variants.
Topics: Guillain-Barre Syndrome; Heart Rate; Humans; Miller Fisher Syndrome; Neural Conduction; Neurophysiology; Retrospective Studies
PubMed: 34233056
DOI: 10.1111/ene.15011 -
BMC Neurology Jul 2021Guillain-Barre syndrome (GBS) is an inflammatory polyradiculoneuropathy characterized by rapidly evolving weakness and areflexia, reaching nadir within 4 weeks. Data on...
BACKGROUND
Guillain-Barre syndrome (GBS) is an inflammatory polyradiculoneuropathy characterized by rapidly evolving weakness and areflexia, reaching nadir within 4 weeks. Data on the characteristic of GBS in Saudi Arabia are limited. This study aimed to describe the clinical, electrophysiological, and laboratory characteristics and outcome of a multicenter cohort of patients with GBS.
METHODS
This is a retrospective multicenter nationwide study. Patients who had GBS, identified through Brighton Criteria, between January 2015 and December 2019 were included. Data collected included demographics, clinical features, cerebrospinal fluid profile, reported electrophysiological patterns, treatment, and outcome. Reported GBS subtypes were compared using chi-square, Fisher's exact, or Mann-Whitney U tests, as appropriate.
RESULTS
A total of 156 patients with GBS were included (men, 61.5%), with a median age of 38 (interquartile range, 26.25-53.5) years. The most commonly reported antecedent illnesses were upper respiratory tract infection (39.1%) and diarrhea (27.8%). All but two patients (98.7%) had weakness, 64.1% had sensory symptoms, 43.1% had facial diplegia, 33.8% had oropharyngeal weakness, 12.4% had ophthalmoplegia, and 26.3% needed mechanical ventilation. Cytoalbuminological dissociation was observed in 69.1% of the patients. GBS-specific therapy was administered in 96.8% of the patients, of whom 88.1% had intravenous immunoglobulin, and 11.9% had plasmapheresis. Approximately half of the patients were able to walk independently within 9 months after discharge, and a third regained the ability to walk independently thereafter. Death of one patient was caused by septicemia. Acute inflammatory demyelinating polyradiculoneuropathy was the most commonly reported GBS subtype (37.7%), followed by acute motor axonal neuropathy (29.5%), and acute motor-sensory axonal neuropathy (19.2%).
CONCLUSION
The clinical and laboratory characteristics and outcome of GBS in the Arab population of Saudi Arabia are similar to the international cohorts. The overall prognosis is favorable.
Topics: Adolescent; Adult; Aged; Female; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Male; Middle Aged; Plasmapheresis; Prognosis; Respiration, Artificial; Retrospective Studies; Saudi Arabia; Treatment Outcome; Young Adult
PubMed: 34253174
DOI: 10.1186/s12883-021-02314-5