title: Guillain-Barré syndrome: clinical profile and management.
abstract: BACKGROUND
  Guillain-Barré syndrome (GBS) is a fulminant polyradiculoneuropathy that is acute, frequently severe and autoimmune in nature. Etiology of GBS is incompletely understood, prognosis is usually good with early detection and prompt treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and electrodiagnostic features of patients with GBS and mode of management, complications and prognostic factors.
  
  
  METHODS
  Data of 1,166 patients admitted with GBS or presented to outpatient department (previous medical records) with GBS between January 2003 and January 2014 were analyzed.
  
  
  RESULTS
  No difference in genders noted. Around 35% of patients are above 50 years of age. Poor control of diabetes with mean HbA1c of 8.1 ± 2.11 is found on analysis. Seasonal occurrence in GBS is prominent in winter 484 (41.50%) and mechanically ventilated were 449 (38.50%) patients. 48 (4.11%) deaths were attributed to GBS. Neurological analysis revealed cranial nerve involvement in 407 (34.90%) patients, facial palsy in 401 (34.39%) and ataxia in 88 (7.54%) patients. Most patients in plasma exchange group belonged to the lower socio-economic status. Mean cerebrospinal fluid (CSF) protein levels was (n=962) 113.8 ± 11.8 mg/dl. Conduction block determined indirectly by absent H-reflex was noted in 891 (90.64%) patients. No difference in complications and outcome is found in treatment regimens of intravenous immunoglobulin (IVIG) and plasma exchange.
  
  
  CONCLUSIONS
  Seasonal occurrence predominantly in winter is noted. Peak flow test may be a predictor of assessing requirement of mechanical ventilation and prognosis. Conduction block is the major abnormality noted in electrophysiological studies and proximal nerve segment assessing with Erb's point stimulation has high predictive value. IVIG treatment is more expensive but is associated with less duration of hospital stay.
authors.affiliation: Columbia Asia Hospital, Bangalore, India.
authors.forename: Sreenivasa Rao
authors.initials: SR
authors.lastname: Sudulagunta
authors.affiliation: K.S. Hegde Medical College, Mangalore, India.
authors.forename: Mahesh Babu
authors.initials: MB
authors.lastname: Sodalagunta
authors.affiliation: Baptist Hospital, Bangalore, India.
authors.forename: Mona
authors.initials: M
authors.lastname: Sepehrar
authors.affiliation: Dr.B.R. Ambedkar Medical College, Otolaryngology Department, Bangalore, India.
authors.forename: Hadi
authors.initials: H
authors.lastname: Khorram
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Shiva Kumar
authors.initials: SK
authors.lastname: Bangalore Raja
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Shyamala
authors.initials: S
authors.lastname: Kothandapani
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Noroozpour
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aheta Sham
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Nagendra
authors.initials: N
authors.lastname: Prasad
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Sony Parethu
authors.initials: SP
authors.lastname: Sunny
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Munawar Dhanish
authors.initials: MD
authors.lastname: Mohammed
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Rekha
authors.initials: R
authors.lastname: Gangadharappa
authors.affiliation: Dr.B.R. Ambedkar Medical College, Bangalore, India.
authors.forename: Ranjitha
authors.initials: R
authors.lastname: Nidsale Sudarshan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001259:Ataxia / Q000209:etiology; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003391:Cranial Nerves; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology; D004576:Electromyography; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000382:microbiology; D020275:Guillain-Barre Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D010951:Plasma Exchange; D012021:Reflex, Abnormal; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000453:epidemiology; D012189:Retrospective Studies; D012621:Seasons; D055815:Young Adult
chemical_list: D002556:Cerebrospinal Fluid Proteins; D016756:Immunoglobulins, Intravenous
keywords: Guillain-Barré syndrome; IVIG; acute inflammatory demyelinating polyradiculoneuropathy; autoimmune; conduction motor action potential; electromyography studies; immunoglobulin; plasma exchange