Clinico-electrophysiological profile and predictors of functional outcome in Guillain-Barre syndrome (GBS).
BACKGROUND
Guillain-Barre syndrome (GBS) is an acute polyradiculoneuropathy with varied severity of presentation.


OBJECTIVE
To study the clinical and electrophysiological profile of patients with GBS and to determine the factors associated with poor functional outcome and need for mechanical ventilation.


METHODS
It was a hospital-based prospective observational study.


METHODS
90 patients with GBS diagnosed as per Asbury and Cornblath criteria were enrolled and followed up for 6 months. Various epidemiological, clinical and electrophysiological parameters were evaluated. Hughes motor scale was used to measure functional outcome. Factors associated with poor functional outcome and need for mechanical ventilation were determined.


RESULTS
90 patients (56 males; 34 females; mean age of 29.3±15.2 years) were enrolled in this study. Amongst these 6 (6.7%) patients died during in-hospital stay. Antecedent infection was present in 29 (32.2%), autonomic dysfunction in 31 (34.4%), bulbar palsy in 21 (23.3%), neck flexor weakness in 52 (57.8%). 60 cases (66.7%) were of axonal variety and 30 (33.3%) of demyelinating variety. On univariate analysis, predictors associated with poor functional outcome at 6 months were autonomic dysfunction (p=0.013), neck flexor weakness (p=0.009), requirement of ventilatory assistance (p=<0.001), MRC sum score<30 on admission (p=<0.001) and axonal pattern on electrophysiological assessment (p=<0.001). On multivariate analysis, MRC sum score<30 on admission (p=0.007) and axonal pattern on electrophysiological assessment (p=<0.001) were independently associated with poor functional outcome at 6 months. Factors associated with need for mechanical ventilation were presence of autonomic dysfunction (p=<0.001), cranial nerve palsy including facial palsy (p=<0.001) and bulbar palsy (p=0.002), neck flexor weakness (p=<0.001), low MRC sum score (<30) (p=0.001), and low proximal CPN CMAP amplitude to distal CPN CMAP amplitude ratio (p=0.042); none of them being significant on multivariate analysis.


CONCLUSIONS
Detailed evaluation of the clinical and electrophysiological profile may help in predicting the functional outcome and need for mechanical ventilation in patients with GBS.
Department of Neurology, King George's Medical University, Lucknow, UP 226003, India. Electronic address: drrajeshverma32@yahoo.com.
Rajesh
R
Verma
Tejendra Sukdeo
TS
Chaudhari
Tushar Premraj
TP
Raut
Ravindra Kumar
RK
Garg
D000200:Action Potentials / Q000502:physiology; D000293:Adolescent; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000209:etiology; D004185:Disability Evaluation; D018450:Disease Progression; D004558:Electric Stimulation; D005260:Female; D005500:Follow-Up Studies; D020275:Guillain-Barre Syndrome / Q000453:epidemiology / Q000451:nursing / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology*; D019370:Observation; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D016756:Immunoglobulins, Intravenous
Guillain–Barre syndrome; MRC (Medical Research Council) sum score; Mechanical ventilation; Molecular mimicry; Nerve conduction velocity; Predictors of outcome