Electrophysiological observations in critically ill Guillain-Barre syndrome.
BACKGROUND
Respiratory muscle paralysis is a serious complication of Guillain-Barre syndrome (GBS). Factors that govern duration and recovery from respiratory paralysis are unclear.


OBJECTIVE
To correlate electrophysiological parameters in critically ill GBS with duration of mechanical ventilation and outcome at discharge.


METHODS
Data of a large cohort (n=93; M:F 59:34; mean age: 33.51+21.4 years) of critically-ill patients with GBS seen over one decade was retrospectively analyzed.


RESULTS
The duration of mechanical ventilation was <15 days (n = 38), 16-30 days (n = 24), and >30 days (n = 31). Majority of the patients had a demyelinating electrophysiology. Reduced amplitude or absent motor potentials correlated with requirement for longer duration of ventilation. Inexcitable sensory nerves were more common in patients who could be weaned off from the ventilator within 15 days. There was no relation between the conduction blocks in motor nerves and the duration of ventilation. Low amplitude of median nerve correlated with a poor outcome at hospital discharge as assessed by Hughes disability scale.


CONCLUSIONS
Distinct patterns of electrophysiological abnormalities are noted in patients and they correlate with the duration of mechanical ventilation. Future studies to unravel the underlying pathophysiological processes that govern the patterns of progression and recovery in the critically ill patients with GBS will pave way for the development of better and more potent therapies that will hasten recovery, when combined with the prevalent treatment modalities including plasmapheresis and intravenous immunoglobulin.
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Madhu
M
Nagappa
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Archana B
AB
Netto
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Arun B
AB
Taly
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Girish Baburao
GB
Kulkarni
Department of Neuroanesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
G S
GS
Umamaheshwara Rao
Department of Transfusion Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Sunder
S
Periyavan
Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Shivaji
S
Rao
D000328:Adult; D016638:Critical Illness; D018450:Disease Progression; D004594:Electrophysiology; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D012121:Respiration, Artificial; D012133:Respiratory Paralysis / Q000503:physiopathology*; D012189:Retrospective Studies; D013997:Time Factors; D015300:Ventilator Weaning