Influence of critical illness on axonal loss in Guillain-Barré syndrome.
In this study we sought to determine whether axonal damage in severe Guillain-Barré syndrome (GBS) was secondary to critical illness polyneuropathy (CIP) in the intensive care unit (ICU) by reviewing comorbidities in patients who had initial and follow-up electromyographic (EMG) studies. Patients were classified as demyelinating (EMG-D) or axonal (EMG-A) according to findings on the second EMG. A critical illness (CI) score, derived from components of the APACHE II score, assessed the severity of critical illness in the ICU. Forty-one patients were admitted to the ICU and had a follow-up EMG. Of these, 28 (68%) developed an EMG-A pattern. There was no difference in the timing of the second EMG (mean, 23 days) between the two groups. The mean CI score (10.7 for EMG-A vs. 9.2 for EMG-D, P = 0.47) and frequency of sepsis (89% vs. 77%, P = 0.36) were similar between the groups. Mean strength (0-100, Medical Research Council scale) and Hughes disability scores for the EMG-A group were significantly worse at admission, nadir, and discharge. EMG-A patients had significantly more days on the ventilator (25 vs. 11), in the ICU (26 vs. 15), and in the hospital (29 vs. 18). Sixty-eight percent of patients with GBS in the ICU developed axon loss, but this was not related to the usual precipitants of CIP.
Ho
Doreen
D
Department of Neurology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA.
Thakur
Kiran
K
Gorson
Kenneth C
KC
Ropper
Allan H
AH
D000200:Action Potentials / Q000502:physiology; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D018450:Disease Progression; D004568:Electrodiagnosis; D004576:Electromyography; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D010525:Peripheral Nerves / Q000473:pathology / Q000503:physiopathology; D011115:Polyneuropathies / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D015300:Ventilator Weaning / Q000706:statistics & numerical data; D014855:Wallerian Degeneration / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D055815:Young Adult