1
|
He L, Zhang Z, Tan Y. Systemic lupus erythematosus complicated by severe Guillain-Barré syndrome: case report and literature review. Front Immunol 2025; 16:1551448. [PMID: 40416954 PMCID: PMC12098485 DOI: 10.3389/fimmu.2025.1551448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Accepted: 04/21/2025] [Indexed: 05/27/2025] Open
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous chronic autoimmune disease characterized by immune-mediated multiple organ injuries in the setting of autoimmunity to nuclear antigens. In rare cases, it can complicated by the damage of peripheral nervous system, manifesting as Guillain-Barré syndrome (GBS). Severe GBS as the initial presentation is highly infrequent and associated with high disability and mortality rates, highlighting the importance of early detection, diagnosis, and treatment. Herein, we reported a successfully treated case of severe SLE-GBS in a 38-year-old male. Furthermore, we summarize the clinical characteristics of severe SLE-GBS reported thus far and propose the possibility of using medium-to-high dose corticosteroids in the acute progression stage of SLE-GBS. This report provides valuable insights for the analysis of disease characteristics and guidance for diagnosis and treatment of such cases.
Collapse
Affiliation(s)
| | | | - Ying Tan
- Department of Neurology, Huzhou Central Hospital, the Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang, China
| |
Collapse
|
2
|
Winkel A, Sanders L, Seiderer L, Cook M, Roberts L. Early Electrophysiology in Suspected Acute Guillain-Barré Syndrome: A Prospective Study of Comprehensive Testing. J Clin Neurophysiol 2025; 42:357-364. [PMID: 39322988 DOI: 10.1097/wnp.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
PURPOSE Electrophysiologic changes in early Guillain-Barré Syndrome (GBS) can be nondiagnostic. Improved testing paradigms may improve hyperacute treatment. METHODS This work prospectively evaluated consecutive patients admitted to a metropolitan teaching hospital in Melbourne, Australia, with suspected acute GBS. We performed extensive neurophysiology at three different time points. Novel tests, including cutaneous silent periods, long latency reflexes, and contraction-induced H reflexes, were assessed. RESULTS Twenty-three participants were studied, including 13 cases of acute GBS. In total, 69% of acute cases of GBS were accurately diagnosed on the first nerve conduction study using published neurophysiologic criteria, with serial studies rarely altering the GBS subtype classification. Antidromic and orthodromic upper limb sensory studies were diagnostically equivalent. A sural sparing pattern was seen in 77% of cases of GBS at the first test. Long latency reflexes and contraction-induced H reflexes testing were abnormal in most participants but were limited by muscle weakness in some. Cutaneous silent periods testing was unobtainable in approximately 50% of cases because of weakness and did not discriminate from mimic disorders. CONCLUSIONS Abnormalities of long latency reflexes and contraction-induced H reflexes may be helpful where initial electrophysiology is nondiagnostic but are nonspecific. Cutaneous silent periods testing seems of limited value. Comprehensive testing provides diagnostic certainty in most cases of GBS from the very first study.
Collapse
Affiliation(s)
- Antony Winkel
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia; and
- Department of Neurosciences, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Lauren Sanders
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia; and
| | - Linda Seiderer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia; and
| | - Mark Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia; and
| | - Leslie Roberts
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia; and
| |
Collapse
|
3
|
Yao X, Qiao B, Shan F, Zhang Q, Song Y, Song J, Wang Y. Elevated Serum Amyloid A2 and A4 in Patients With Guillain-Barré Syndrome. J Clin Neurol 2025; 21:213-219. [PMID: 40308016 PMCID: PMC12056137 DOI: 10.3988/jcn.2024.0469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 01/13/2025] [Accepted: 02/05/2025] [Indexed: 05/02/2025] Open
Abstract
BACKGROUND AND PURPOSE Guillain-Barré syndrome (GBS) is an autoimmune-mediated disorder characterized by demyelinating or axonal injury of the peripheral nerve. Our aim is to determine whether serum amyloid A (SAA) is a biomarker of demyelinating injury and disease severity in patients with GBS. METHODS This study retrospectively enrolled 40 patients with either the demyelinating or axonal GBS and sex- and age-matched controls with other neurological diseases as well as healthy subjects. The demographic and clinical features at entry were collected. The serum levels of the SAA isoforms SAA1, SAA2, and SAA4 were determined in the patients with GBS and the controls using the enzyme-linked immunosorbent assay and analyzed for the associations between levels of different SAA isoforms and the clinical features of the patients. RESULTS The levels of SAA2 and SAA4 were significantly higher in patients with GBS than in both the other neurological disease controls and the healthy subjects (p<0.05 for all). The level of SAA1 did not differ between patients with GBS and the controls. The level of SAA2 was considerably higher in GBS patients with antecedent infection than in those without infection (p=0.020). The levels of different SAA isoforms were not associated with the disease severity or other clinical features of patients with GBS (p>0.05 for all). CONCLUSIONS Increased levels of SAA2 and SAA4 may only represent the acute inflammatory status and so cannot be utilized as biomarkers of the disease severity or demyelinating injury in patients with GBS.
Collapse
Affiliation(s)
- Xiaoying Yao
- Medical Research Center, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Baojun Qiao
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Fangzhen Shan
- Medical Research Center, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Qingqing Zhang
- Medical Research Center, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Yan Song
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Jin Song
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Yuzhong Wang
- Medical Research Center, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China.
| |
Collapse
|
4
|
Ansari B, Gholipoor Khotbesara M, Basiri K. Relationship between sympathetic skin response and RR interval variation with the prognosis of Guillain-Barre syndrome patients. Neurol Res 2025; 47:333-338. [PMID: 40116534 DOI: 10.1080/01616412.2025.2476514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Accepted: 02/28/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an inflammatory disorder causing severe disability and death. The sympathetic skin response (SSR) and RR interval variability are non-invasive tests that measure autonomic dysfunction. The aim of this study was to investigate the relationship of SSR and RR interval variation with prognosis in patients with GBS in Isfahan, Iran. METHODS This cross-sectional study analyzed 32 patients with GBS in Iran between 2023 and 2024. Patients underwent EMG-NCV during their hospitalization, measuring SSR and RR interval variation. Patients' GBS disability scores were calculated and recorded on the day of hospital discharge and one month after. Gender distribution, types of GBS, intubation status, length of ICU and ward stay, GBS disability scores, and plasmapheresis volume are also compared. RESULTS In 19 patients (59.3%), both SSR and RR interval variability were abnormal. There were no statistically significant differences between patients with and without autonomic dysfunction (AD) for the variables compared. There were no significant differences between groups with normal and abnormal SSR and between groups with normal and abnormal RR interval variation. Age and intubation status significantly affect GBS disability scores at discharge and one month after discharge, while gender does not significantly impact any outcomes. Many variables, such as age, gender, type of GBS, intubation status, and lengths of stay, do not show significant differences between the compared groups based on AD, SSR, and RR interval variability. CONCLUSIONS The study highlights the lack of correlation between AD, SSR, and RR interval variation in patients with GBS.
Collapse
Affiliation(s)
- Behnaz Ansari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, Isfahan Neuroscience Research Center, AL-Zahra Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Keivan Basiri
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, Isfahan Neuroscience Research Center, AL-Zahra Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| |
Collapse
|
5
|
Yang F, Tian Z, Lu Y, Li Y, Liu K. Miller-Fisher syndrome subtype with isolated bilateral mydriasis: a pediatric case report. BMC Neurol 2025; 25:166. [PMID: 40240898 PMCID: PMC12004657 DOI: 10.1186/s12883-025-04180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/07/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Miller-Fisher Syndrome (MFS), a distinct subtype of Guillain-Barré Syndrome (GBS), accounts for 5% of GBS cases and classically manifests with the triad of ophthalmoplegia, ataxia, and areflexia. Isolated bilateral mydriasis as the sole presenting feature is exceptionally rare, particularly in pediatric populations. While pupillary abnormalities have been documented in adult MFS cases, their diagnostic significance and management in children remain poorly characterized. We report a novel pediatric case of a 7-year-old girl presenting with 7 days of unexplained bilateral painless mydriasis unresponsive to light accommodation. Initial symptomatic management targeting potential toxic or neuropathic etiologies proved ineffective. Recognition of this atypical presentation prompted serological evaluation for autoimmune neuropathy markers, which demonstrated positivity for GQ1b IgM, GQ1b IgG, and GT1a IgG antibodies, confirming MFS diagnosis. Rapid clinical improvement followed intravenous immunoglobulin (IVIG) therapy. This case highlights the diagnostic challenges posed by incomplete or atypical MFS manifestations and underscores the necessity of early antibody testing in unexplained autonomic or neurological symptoms. CONCLUSION This report expands the phenotypic spectrum of pediatric MFS by demonstrating isolated bilateral mydriasis as a potential initial manifestation, clinicians evaluating pupillary dilation should consider MFS in differential diagnoses. Future studies should continue to explore the pathophysiological link between anti-GQ1b antibodies and isolated autonomic dysfunction in pediatric MFS.
Collapse
Affiliation(s)
- Fengqi Yang
- Comprehensive pediatrics, Kunming Children's Hospital, No.28, Shulin Street, Kunming, 650103, Yunnan Province, China
| | - Zhu Tian
- Comprehensive pediatrics, Kunming Children's Hospital, No.28, Shulin Street, Kunming, 650103, Yunnan Province, China
| | - Yanhong Lu
- Comprehensive pediatrics, Kunming Children's Hospital, No.28, Shulin Street, Kunming, 650103, Yunnan Province, China
| | - Yang Li
- Comprehensive pediatrics, Kunming Children's Hospital, No.28, Shulin Street, Kunming, 650103, Yunnan Province, China
| | - Kai Liu
- Comprehensive pediatrics, Kunming Children's Hospital, No.28, Shulin Street, Kunming, 650103, Yunnan Province, China.
| |
Collapse
|
6
|
Nagappa M, Mondal S, Rajeevan S, Pradeepkumar B, Chalasani V, Dey S, Babu GS, Sarkar A, Viswanathan LG, Seshagiri DV, Binu VS, Debnath M. Exploring the role of altered oxi-inflammasome activity in the immunobiology of inflammatory neuropathies. J Neuroimmunol 2025; 401:578556. [PMID: 39987753 DOI: 10.1016/j.jneuroim.2025.578556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 10/28/2024] [Accepted: 02/14/2025] [Indexed: 02/25/2025]
Abstract
OBJECTIVES Inflammasome plays a significant role in inflammatory responses. The role of inflammasome and its interactions with oxidative stress markers has not been examined in inflammatory neuropathies like Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). This study aims to explore the roles of inflammasome and oxidative stress pathways in inflammatory neuropathies. METHODS This case-controlled study comprised patients with inflammatory neuropathies (n = 60, GBS = 44, CIDP = 16) and age- and gender-matched healthy controls (n = 60). The expressions of inflammasome-related genes (Nlrp3, Casp1, and Il1b) were quantified along with the plasma levels of malondialdehyde (MDA), the end product of lipid peroxidation in all study participants. RESULTS The expressions of Nlrp3 (p = 0.0083) and Casp1 (p = 0.0007) genes were significantly up-regulated in GBS patients compared to controls. The plasma MDA levels were also markedly higher in GBS patients than in controls (p = 0.029). The gene expression levels of Nlrp3, Casp1, and Il1b and plasma MDA levels were comparable between CIDP patients and healthy controls. There were no correlations between the expressions of the studied genes and MDA levels with the clinical scores of GBS. CONCLUSION The up-regulated expression of Nlrp3 and Casp1 genes and increased levels of MDA suggest the presence of an activated oxi-inflammatory pathway in GBS. These findings provide a new dimension to the current understanding of the immuno-pathogenesis of GBS.
Collapse
Affiliation(s)
- Madhu Nagappa
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sandipan Mondal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Srinath Rajeevan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - B Pradeepkumar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Vamsi Chalasani
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Saikat Dey
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Gopika Suresh Babu
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Aritrani Sarkar
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Doniparthi V Seshagiri
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - V S Binu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| |
Collapse
|
7
|
McAree M, Frontera JA. Clinical Reasoning: A 56-Year-Old Woman With New-Onset Hoarseness and Dysphagia. Neurology 2025; 104:e213363. [PMID: 40063858 DOI: 10.1212/wnl.0000000000213363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 12/09/2024] [Indexed: 03/16/2025] Open
Abstract
STATEMENT OF THE CLINICAL PROBLEM ADDRESSED BY THE CASE We report an atypical clinical presentation of a rapidly progressive neurologic emergency that required prompt investigation and treatment of impending respiratory failure. We discuss the differential diagnosis, evaluation, emergency management, and treatment options of patients with atypical variants of this disorder. BRIEF DESCRIPTION OF CASE PRESENTATION A 56-year-old woman with a history of hypothyroidism, anxiety, and depression presented to the emergency department 3 weeks after an upper respiratory and ear infection with cough, pain with sinus palpation, tingling in her fingers bilaterally and right foot, hives, and an episode of blurry vision on awakening. She was discharged home with antibiotics. That evening, she developed rapidly progressing hoarseness and dysphagia and returned to the emergency department. An initial examination and laryngoscopy revealed complete left vocal cord paralysis, consistent with a left cranial nerve X palsy, which prompted a neurologic evaluation. Her examination progressively worsened over the next day requiring mechanical ventilation and ICU admission. SUMMARY OF THE KEY TEACHING POINT IN THE CASE New-onset bulbar cranial neuropathies should raise concern for neurologic disorders that can be rapidly progressive and result in respiratory failure. Urgent diagnosis and treatment are warranted.
Collapse
Affiliation(s)
- Michael McAree
- Department of Neurology, NYU Grossman School of Medicine, NY
| | | |
Collapse
|
8
|
Pereira JG, Pontes TMB, Carvalho FMM, Gomes ABF, Erbisti RS, de Sousa Junior IP, Colares JKB, Lima DM, de Paula VS. Detection of Herpesviruses (Predominantly HHV-6) in Patients with Guillain-Barré Syndrome. Biomedicines 2025; 13:845. [PMID: 40299442 PMCID: PMC12025303 DOI: 10.3390/biomedicines13040845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Revised: 03/20/2025] [Accepted: 03/27/2025] [Indexed: 04/30/2025] Open
Abstract
Background/Objectives: Guillain-Barré syndrome (GBS) is a neurological disease that affects the peripheral nerves. The exact cause of this condition is still uncertain, but cross-reactivity between pathogen antigens and nervous tissue may play a crucial role in disease pathogenesis. Roseolovirus humanbeta6 (HHV-6), a neurotropic virus with latency capacity, may be considered a significant candidate for triggering or worsening neurological conditions. In this study, we aimed to investigate the detection of HHV-6 in the CNS from GBS patients. Of the 23 individuals suspected of having GBS, 13 were confirmed as having the disease. We then analyzed the frequency of herpesviruses in the cerebrospinal fluid (CSF) samples from these 13 individuals with GBS who were also tested for enteroviruses and arboviruses and had negative results. Results: After extraction of viral DNA from CSF samples, real-time PCR (qPCR) methodology was used to analyze the frequency and viral load of herpesviruses. Sociodemographic and clinical data were collected for analysis and verification through statistical tests such as Fisher's exact test and the Mann-Whitney test. Thirteen individuals diagnosed with GBS were tested. Among the 13 patients analyzed, 61.5% were men, 38.4% (5/13) tested positive for HHV-6, 61.5% of the patients tested positive for a herpesvirus, 30.8% had two viral DNAs identified, and one patient presented three different strains. Patients who tested positive for HHV-6 had a significantly longer average length of stay (25.6 days versus 11 days for negative patients). HHV-6 was the most frequent subtype detected in patients positive for herpesviruses (62.5%, 5/8). Discussion/Conclusions: Our results show a possible relationship between HHV-6 and GBS cases despite the small number of patients, raising the question of whether the presence of HHV-6 influences GBS, since its investigation using qPCR is not routinely used. This may have some impact on prognosis, since antiviral therapy is not included in the standard treatment of GBS patients, and viral DNA load may interfere with the inflammatory process of GBS.
Collapse
Affiliation(s)
- Jéssica Gonçalves Pereira
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, Brazil; (J.G.P.); (I.P.d.S.J.)
| | - Tainá Madeira Barros Pontes
- Graduate Program in Medical Sciences, University of Fortaleza, Fortaleza 60811-905, Brazil; (T.M.B.P.); (F.M.M.C.); (A.B.F.G.); (J.K.B.C.)
| | - Fernanda Martins Maia Carvalho
- Graduate Program in Medical Sciences, University of Fortaleza, Fortaleza 60811-905, Brazil; (T.M.B.P.); (F.M.M.C.); (A.B.F.G.); (J.K.B.C.)
- Neurology Department, Fortaleza General Hospital, Fortaleza 60150-160, Brazil
| | - André Borges Ferreira Gomes
- Graduate Program in Medical Sciences, University of Fortaleza, Fortaleza 60811-905, Brazil; (T.M.B.P.); (F.M.M.C.); (A.B.F.G.); (J.K.B.C.)
- Neurology Department, Fortaleza General Hospital, Fortaleza 60150-160, Brazil
| | - Rafael Santos Erbisti
- Department of Statistics, Institute of Mathematics and Statistics, Fluminense Federal University, Niterói 24210-240, Brazil;
| | - Ivanildo Pedro de Sousa Junior
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, Brazil; (J.G.P.); (I.P.d.S.J.)
| | - Jeová Keny Baima Colares
- Graduate Program in Medical Sciences, University of Fortaleza, Fortaleza 60811-905, Brazil; (T.M.B.P.); (F.M.M.C.); (A.B.F.G.); (J.K.B.C.)
| | - Danielle Malta Lima
- Graduate Program in Medical Sciences, University of Fortaleza, Fortaleza 60811-905, Brazil; (T.M.B.P.); (F.M.M.C.); (A.B.F.G.); (J.K.B.C.)
| | - Vanessa Salete de Paula
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, Brazil; (J.G.P.); (I.P.d.S.J.)
| |
Collapse
|
9
|
Korkmaz G, Dagdas S, Saltoglu T, Ceran F, Aydın MS, Bektas H, Subutay N, Dilek I, Ozet G. Effectiveness and safety of therapeutic plasma exchange in neurological diseases: An 11-year report from a tertiary care center. Ther Apher Dial 2025; 29:312-320. [PMID: 39500332 DOI: 10.1111/1744-9987.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/08/2024] [Accepted: 10/22/2024] [Indexed: 03/06/2025]
Abstract
BACKGROUND Therapeutic plasma exchange has been a well-known treatment method for many years and is widely available. It leads to the improvement of neurological symptoms in autoimmune neurological diseases by the removal of antibodies. The aim of this study was to present therapeutic plasma exchange responses and procedure-related adverse events in patients with autoimmune neurological diseases based on our 11-year experience. METHOD A retrospective evaluation was conducted on adult patients who underwent a therapeutic plasma exchange procedure due to neurological diseases between January 2013 and January 2024. Data were gathered from electronic and written hospital and apheresis unit records. RESULTS A total of 265 patients underwent 1274 procedures with a preliminary diagnosis of autoimmune neurological disease. Five patients were excluded from the analysis due to their final diagnoses. The most common clinical indications were Guillain-Barré syndrome (45.4%), myasthenia gravis (26.1%), and multiple sclerosis (19.2%). The overall response rate was 81.3%, with 21.7% exhibiting a complete response and 59.6% demonstrating a partial response. With the exception of one patient (hypertensive crisis), no complications necessitating the termination of the procedure were observed. The most prevalent complication was an easily manageable allergic reaction. CONCLUSION Therapeutic plasma exchange has been demonstrated to be an efficacious and safe treatment option in autoimmune neurological diseases, with a favorable overall response rate and a manageable mild-to-moderate side effect profile.
Collapse
Affiliation(s)
- Gulten Korkmaz
- Department of Hematology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Simten Dagdas
- Department of Hematology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Tugce Saltoglu
- Department Of Neurology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Funda Ceran
- Department of Hematology, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Hesna Bektas
- Department Of Neurology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Nese Subutay
- Department Of Neurology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Imdat Dilek
- Department of Hematology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Gulsum Ozet
- Department of Hematology, Ankara Bilkent City Hospital, Ankara, Turkey
| |
Collapse
|
10
|
Wu Q, Li FY, Hu J, Xu W, Feng TQ, Zhou HS, Wang Z, Zeng WG. Guillain-Barré Syndrome following weight loss: a review of five diet-induced cases and nineteen bariatric surgery cases. Front Neurol 2025; 16:1557515. [PMID: 40201020 PMCID: PMC11975578 DOI: 10.3389/fneur.2025.1557515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Accepted: 03/10/2025] [Indexed: 04/10/2025] Open
Abstract
Introduction Obesity is a worldwide health concern frequently addressed by weight reduction strategies, including bariatric surgery and restricted diets. While effective, these approaches can result in complications, including Guillain-Barré Syndrome (GBS), a rare but serious autoimmune disorder. This study aims to analyze clinical and neurophysiological features of diet-induced GBS and compare them to cases linked with bariatric surgery. Methods We retrospectively reviewed medical records of five patients admitted to our institution between August 2012 and August 2022, who developed GBS during active dieting resulting in significant weight loss. Clinical presentations, laboratory results, neurophysiological findings, and nutritional status during treatment were analyzed. Additionally, we performed a literature review comparing these cases with nineteen previously reported instances of bariatric surgery-associated GBS. Results All five patients exhibited acute, symmetrical limb weakness primarily affecting the lower extremities, accompanied by diminished tendon reflexes. Neurophysiological assessments revealed axonal damage in all cases, and albuminocytologic dissociation was present in two patients. Three patients received intravenous immunoglobulin (IVIG) therapy, while the remaining two underwent nutritional therapy alone. All patients achieved full recovery within 6 months. Notably, the rate of weight loss observed significantly exceeded recommended safe guidelines. Discussion Rapid and substantial weight loss may play a role in triggering GBS, possibly due to nutritional deficiencies or immune dysregulation. Clinicians should recognize the potential neurological risks associated with aggressive weight-loss strategies. Early diagnosis and appropriate intervention are crucial for favorable outcomes and preventing complications.
Collapse
Affiliation(s)
- Qiong Wu
- Department of Neurosurgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Fang-Yi Li
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Jue Hu
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Wei Xu
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Tie-Qiao Feng
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hua-Shan Zhou
- Department of Pathology, Changsha Hospital for Maternal and Child Health Care, Affiliated to Hunan Normal University, Changsha, China
| | - Zhen Wang
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Wen-Gao Zeng
- Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| |
Collapse
|
11
|
Ibewuike U, Kim J, Mody S, Obala G, Ibezim E. A unique case report on campylobacter rectus infection leading to acute motor axonal neuropathy in a pediatric patient. Radiol Case Rep 2025; 20:1482-1485. [PMID: 39811058 PMCID: PMC11731201 DOI: 10.1016/j.radcr.2024.11.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 11/21/2024] [Indexed: 01/16/2025] Open
Abstract
A unique case report on campylobacter rectus infection leading to acute motor axonal neuropathy in a pediatric patient. Campylobacter rectus is an anaerobic bacterium found in the oral cavity. While it has been linked to periodontal disease, its association with acute motor axonal neuropathy (AMAN), a variant of Guillain-Barre Syndrome, remains unverified. The majority of Guillain-Barre Syndrome (GBS) cases related to Campylobacter are attributed to the species Campylobacter jejuni. A 14-year-old male was admitted to the hospital with sepsis. About 1 week before his admission, the patient sustained an injury to his left eye from a cell phone, resulting in considerable edema. A punch biopsy of the left periorbital soft tissue yielded a culture positive for Campylobacter rectus. Following this, the patient developed weakness in all 4 limbs, with more pronounced weakness in the legs than in the arms, and he lost motor function in both lower legs, although sensory function remained intact. Analysis of cerebrospinal fluid (CSF) revealed albuminocytologic dissociation. An MRI of the spine showed anterior nerve root predominant enhancement.Electromyography was consistent with acute motor axonal neuropathy. Acute motor axonal neuropathy (AMAN), a subtype of Guillain-Barré Syndrome, arises from an atypical immune response, frequently initiated by infections caused by Campylobacter jejuni, although other infectious agents have also been identified. To the best of our knowledge, this is the first recorded instance associating Campylobacter rectus infection with AMAN.
Collapse
Affiliation(s)
| | - John Kim
- Division of Neuroradiology/NIR, University of Michigan, MI, USA
| | - Swati Mody
- Division of Pediatric Radiology, University of Michigan, MI, USA
| | - Gregory Obala
- Section of Neuroradiology, Oregon Health and Science University, Portland, OR, USA
| | - Ebere Ibezim
- Department of Radiology, Imo State University, Imo State, Nigeria
| |
Collapse
|
12
|
Multani A, Leon MA, Lee-Haynes L, Durant EJ. Miller Fisher Syndrome as a Stroke Mimic: A Case Report. Cureus 2025; 17:e79997. [PMID: 40182394 PMCID: PMC11968072 DOI: 10.7759/cureus.79997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2025] [Indexed: 04/05/2025] Open
Abstract
Guillain-Barre syndrome (GBS) is a heterogeneous autoimmune disorder characterized by peripheral neuropathy, often triggered by preceding infections or vaccinations. It encompasses several clinical variants, including the rare Miller Fisher Syndrome (MFS), distinguished by ophthalmoplegia, ataxia, and areflexia. Diagnosis is challenging due to varied presentations and potential overlap with other neurological conditions. We present a case of a 42-year-old male initially suspected to have a stroke when he presented with unilateral loss of sensation and dysarthria. He was later diagnosed with MFS after his condition progressed and he developed generalized weakness, ophthalmoplegia, ataxia, and areflexia. Despite initial stability, his condition deteriorated, requiring intensive care. Early recognition and treatment, such as intravenous immunoglobulin (IVIg) and plasmapheresis, are critical for improving outcomes in GBS and its variants. This case underscores the importance of clinical suspicion and appropriate diagnostic strategies in managing these complex neurological disorders.
Collapse
Affiliation(s)
- Anmol Multani
- Department of Emergency Medicine, Kaiser Permanente, Modesto, USA
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Miguel A Leon
- Department of Emergency Medicine, Kaiser Permanente, Modesto, USA
| | | | - Edward J Durant
- Department of Emergency Medicine, Kaiser Permanente, Modesto, USA
| |
Collapse
|
13
|
Solorzano GE. Initial Management of Neuromuscular Emergencies. Med Clin North Am 2025; 109:389-399. [PMID: 39893019 DOI: 10.1016/j.mcna.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
Neuromuscular emergencies can be anxiety provoking for neurologist and nonneurologist alike. This review will discuss common causes of neuromuscular respiratory failure and how to treat them. An algorithmic approach to neuromuscular neurology will be employed to help the nonneurologist be more comfortable with acute neuromuscular emergencies.
Collapse
|
14
|
Winkel A, Sanders L, Cook M, Roberts L. High-Speed Video Blink Analysis Improves Detection of Facial Palsy in Early Guillain-Barré Syndrome. Muscle Nerve 2025; 71:429-434. [PMID: 39749660 DOI: 10.1002/mus.28332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 12/17/2024] [Accepted: 12/19/2024] [Indexed: 01/04/2025]
Abstract
INTRODUCTION/AIMS Electrophysiological investigations in early Guillain-Barré Syndrome (GBS) can be nondiagnostic. Improved testing for facial weakness in the early phase of GBS may improve diagnostic processes, as such weakness is found in approximately 50% of patients with GBS. This work pilots the utility of high-speed video analysis to complement blink reflex testing in early GBS. METHODS This work prospectively evaluated consecutive patients admitted to a metropolitan teaching hospital in Melbourne, Australia, with suspected acute GBS within the first 14 days of neurological symptoms and compared them to a cohort of healthy controls. Blink reflex testing, mechanically-activated masseter reflexes, and analysis of high-speed video recordings of the evoked blinks were performed at admission (day 0), day 7, and day 21 (±2 days). RESULTS 19 suspected GBS patients (12 GBS and 7 mimics) were compared to 22 healthy controls. At the first test, 83% of GBS patients and 29% of mimics demonstrated blink reflex abnormalities. 50% of GBS manifested video abnormalities (14% mimics), but abnormalities preceded electrophysiological changes in two GBS patients. The calculated reference values for peak lid velocity and lid excursion by video analysis were ~160 mm/s and 7-8 mm, respectively, with slightly different values for ipsilateral versus contralateral responses. DISCUSSION Combining high-speed video analysis and blink reflex testing improves the detection of facial involvement in early GBS and helps discriminate from mimic disorders. Further work in a larger cohort is required to validate the sensitivity and specificity of this technique.
Collapse
Affiliation(s)
- Antony Winkel
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurosciences, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Lauren Sanders
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leslie Roberts
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Chen S, Ou R, Wei Q, Zhao B, Chen X. Sequential administration of efgartigimod shortened the course of Guillain-Barré syndrome: a case series. Ther Adv Neurol Disord 2025; 18:17562864251314746. [PMID: 40012687 PMCID: PMC11863258 DOI: 10.1177/17562864251314746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 01/06/2025] [Indexed: 02/28/2025] Open
Abstract
Guillain-Barré syndrome (GBS) is a serious neurological condition with limited treatment options. A recent report demonstrated successful treatment with efgartigimod alone in two patients with GBS, although it did not significantly shorten the disease duration. This case series investigates the effects of sequential efgartigimod administration in patients with different GBS phenotypes and varying levels of disease severity. All three patients tested positive for immunoglobulin G (IgG) antibodies against serum gangliosides. In Case 1, the patient was treated with 0.4 g/kg of intravenous immunoglobulin (IVIg) for 5 days, showing minimal recovery. After receiving 3 weekly doses of efgartigimod (10 mg/kg), the patient achieved independent ambulation 19 days post-onset, with a reduction in serum ganglioside antibody titers and total IgG levels. Case 2 involved a middle-aged man with Miller Fisher syndrome (MFS)-GBS overlap, who experienced worsened autonomic dysfunction following IVIg treatment. After three doses of efgartigimod, the patient showed symptom improvement within 1 month, alongside a reduction in IgG antibody levels. In Case 3, a 27-year-old male with MFS-GBS overlap, initially unresponsive to IVIg, showed significant improvement in ophthalmoplegia following two doses of efgartigimod, with his serum ganglioside antibodies eventually becoming undetectable. Our findings suggest that sequential efgartigimod treatment may effectively reduce serum anti-ganglioside antibody titers and potentially shorten the disease course in severe GBS and MFS-GBS overlap syndrome. Additionally, it may offer clinical benefits for patients with GBS who have a poor or no response to IVIg, particularly in treating ophthalmoplegia.
Collapse
Affiliation(s)
- Sihui Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| |
Collapse
|
16
|
Gómez-Dabó L, Llaurado A, Sánchez-Tejerina D, González V, Montalvo-Olmedo C, Lázaro-Hernández C, Rodrigo-Gisbert M, López-Maza S, Iza-Achutegui M, Giramé-Rizzo L, Raguer N, Juntas R. A Rare Guillain-Barré Syndrome Variant with Multi-Ganglioside Reactivity: A Case of Severe Cranial Nerve Involvement. Rev Neurol 2025; 80:37744. [PMID: 40084652 PMCID: PMC11907704 DOI: 10.31083/rn37744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 11/06/2024] [Accepted: 11/15/2024] [Indexed: 03/16/2025]
Abstract
INTRODUCTION We present a rare case of acute immune-mediated polyradiculoneuritis, a Guillain-Barré Syndrome (GBS) variant, manifesting as ophthalmoparesis-ataxia, facial diplegia, and acute bulbar palsy, accompanied by a unique autoimmune profile. CLINICAL CASE A 75-year-old female developed rapidly progressive symptoms, including bilateral non-reactive mydriasis, ptosis, complete ophthalmoplegia, bilateral facial weakness, tongue immobility, palatal paralysis, limb dysmetria, ataxia, and brisk generalized tendon reflexes, all while maintaining a preserved mental state. Symptoms emerged 10 days after a probable gastrointestinal infection. Severe bulbar dysfunction necessitated orotracheal intubation and a tracheotomy. Extensive cranial nerve involvement initially suggested a brainstem lesion, with oculomotor and acute bulbar palsy as prominent signs. However, brainstem and spinal magnetic resonance imaging along with cerebrospinal fluid analysis yielded negative results. Electromyography reveled a sensorimotor demyelinating polyradiculoneuropathy, and serum testing identified IgG antibodies targeting multiple gangliosides, including the disialosyl group and terminal NeuNAc(α2-3)Gal. Treatment with intravenous immunoglobulin (IVIG) led to gradual clinical improvement. CONCLUSIONS This case highlights a rare and severe GBS phenotype characterized by reactivity to multiple gangliosides. It highlights the role of shared ganglioside epitopes in antibody-mediated neurological damage and expands the clinical spectrum of GBS variants.
Collapse
Affiliation(s)
- Laura Gómez-Dabó
- Department of Neurology, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Arnau Llaurado
- Neuromuscular Diseases Unit, Neurology Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Daniel Sánchez-Tejerina
- Neuromuscular Diseases Unit, Neurology Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Victoria González
- Department of Neurology, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Carmen Montalvo-Olmedo
- Department of Neurology, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Carlos Lázaro-Hernández
- Department of Neurology, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- Department of Neurology, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Samuel López-Maza
- Department of Neurology, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Maider Iza-Achutegui
- Department of Neurology, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Lídia Giramé-Rizzo
- Department of Neurology, University Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Nuria Raguer
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Raúl Juntas
- Neuromuscular Diseases Unit, Neurology Department, University Hospital Vall d’Hebron, 08035 Barcelona, Spain
| |
Collapse
|
17
|
Sato H, Okudera R, Hongo Y, Matsui T, Ikewaki K, Suzuki K. [A case of anti-ganglioside antibody-positive Guillain-Barré syndrome with asymmetrical muscle weakness throughout the course of the disease]. Rinsho Shinkeigaku 2025; 65:27-31. [PMID: 39694522 DOI: 10.5692/clinicalneurol.cn-002001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024]
Abstract
A 56-year-old woman who presented with left drop foot and low back pain a week after the onset of diarrhea. Neurological symptoms progressed for a week and gradually improved thereafter. No weakness was observed in upper limbs and clearly asymmetrical muscle weakness was observed in left lower limbs during the course of the disease. Nerve conduction study demonstrated absent motor responses in the left tibial and fibular nerves, and compound muscle action potentials in the right tibial nerve was decreased in amplitude without conduction slowing. Serum IgG anti-GalNAc-GD1a antibody and anti-ganglioside complex antibodies were positive. Based on these findings, we diagnosed her as a rare variant of Guillain-Barré syndrome (GBS) with marked asymmetrical muscle weakness. In the literature, GBS patients with asymmetrical muscle weakness often have anti-ganglioside antibodies associated with acute motor axonal neuropathy. A detailed history taking and information on the clinical course are helpful for accurate diagnosis of GBS with atypical distribution of weakness.
Collapse
Affiliation(s)
- Hitomi Sato
- Division of Neurology, Anti-aging, and Vascular Medicine, Department of Internal Medicine, National Defense Medical College
| | - Rena Okudera
- Division of Neurology, Anti-aging, and Vascular Medicine, Department of Internal Medicine, National Defense Medical College
| | - Yu Hongo
- Division of Neurology, Anti-aging, and Vascular Medicine, Department of Internal Medicine, National Defense Medical College
| | - Taro Matsui
- Division of Neurology, Anti-aging, and Vascular Medicine, Department of Internal Medicine, National Defense Medical College
| | - Katsunori Ikewaki
- Division of Neurology, Anti-aging, and Vascular Medicine, Department of Internal Medicine, National Defense Medical College
| | - Kazushi Suzuki
- Division of Neurology, Anti-aging, and Vascular Medicine, Department of Internal Medicine, National Defense Medical College
| |
Collapse
|
18
|
de Moura Brasil Matos A, Gomes ABF, Carvalho FMM, de Oliveira FTM, da Silva LSA, Dahy FE, de Moura JVL, Freire MV, Vidal JE, Marcusso RMN, Smid J, Procaci VR, Massaud RM, Von Glehn F, Casseb J, Romano CM, de Oliveira ACP. Neurological syndromes associated with COVID-19: a multicenter study in Brazil. BMC Infect Dis 2025; 25:123. [PMID: 39871154 PMCID: PMC11770952 DOI: 10.1186/s12879-025-10504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 01/15/2025] [Indexed: 01/29/2025] Open
Abstract
BACKGROUND Neurological manifestations associated with COVID-19 remain partially described, mainly in low- and middle-income countries where diagnostic tools are limited. To address this, we assembled medical centers in Brazil with the goal of describing neurological syndromes associated with COVID-19 during the first wave of the pandemic. METHODS From June 1st, 2020 to June 1st, 2021, non-consecutive adult patients with new onset of six neurological syndromes up to 60 days after confirmed COVID-19 were included. Data were compiled from four tertiary centers and compared with general local COVID-19 data, as well as with a previous cohort focused on vascular syndrome. RESULTS 197 patients were included, presenting with vascular syndromes (81), encephalopathy (68), encephalitis (19), Guillain-Barré syndrome (13), other neuropathies (12), and myelitis (4). The incidence curve of neurocovid mirrored that of COVID-19. Neurological syndromes were present regardless of COVID-19 severity. The median time from COVID-19 to onset of neurological symptoms was 14 days, suggesting a post-infectious immune-mediated mechanism. Patients were 10 times more likely to die (χ2 (1) = 356.55, p < 0.01, OR = 10.89) and 38 times more likely to be hospitalized than other COVID-19 patients (χ2 (1) = 1167.9, p < 0.01, OR = 38.22). Those developing vascular syndromes patients were 3 times more likely to require ICU (χ2 (1) = 37.12, p < 0.01, OR = 3.78) and 4 times more likely to die (χ2 (1) = 58.808, p < 0.01, OR = 4.73) than patients with vascular syndromes due to different etiologies. CONCLUSIONS Our study corroborates the association of neurological syndromes with COVID-19. The incidence correlated with local waves of COVID-19, and patients with neurocovid exhibited a higher susceptibility to adverse outcomes compared to other COVID-19 patients. Among all neurological syndromes, vascular syndromes were the most common, and their severity surpassed that of vascular syndromes not attributed to COVID-19.
Collapse
Affiliation(s)
| | - Andre Borges Ferreira Gomes
- Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza, CE, Brazil
- Graduate Program in Medical Sciences, Universidade de Fortaleza, Fortaleza, CE, Brazil
| | - Fernanda Martins Maia Carvalho
- Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza, CE, Brazil
- Graduate Program in Medical Sciences, Universidade de Fortaleza, Fortaleza, CE, Brazil
| | | | | | | | | | | | | | | | - Jerusa Smid
- Instituto de Infectologia Emilio Ribas, São Paulo, SP, Brazil
| | | | | | - Felipe Von Glehn
- Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brazil
| | - Jorge Casseb
- Faculdade de Medicina, Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camila Malta Romano
- Faculdade de Medicina, Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, SP, Brazil.
- Faculdade de Medicina, Hospital das Clinicas FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | | |
Collapse
|
19
|
Kebede MA, Tekle AB, Eshetu MA, Shash EP, Berhanu MT, Ahmed ET, Negatie HM. Guillain-Barré syndrome following falciparum malaria infection: a case report. BMC Neurol 2025; 25:37. [DOI: https:/doi.org/10.1186/s12883-025-04049-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 01/21/2025] [Indexed: 05/14/2025] Open
|
20
|
Kebede MA, Tekle AB, Eshetu MA, Shash EP, Berhanu MT, Ahmed ET, Negatie HM. Guillain-Barré syndrome following falciparum malaria infection: a case report. BMC Neurol 2025; 25:37. [PMID: 39863898 PMCID: PMC11763149 DOI: 10.1186/s12883-025-04049-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 01/21/2025] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND Malaria is an infectious disease caused by Plasmodium parasites, transmitted to humans by infected female Anopheles mosquitoes. Five Plasmodium species infect humans: P. vivax, P. falciparum, P. ovale, P. malariae, and P. knowlesi. Guillain-Barré Syndrome (GBS) is an inflammatory condition that can lead to paralysis, autonomic dysfunction, respiratory failure, and sensory symptoms. GBS typically follows an infection with Campylobacter bacteria, commonly found in undercooked poultry, but is rarely associated with malaria. CLINICAL PRESENTATION A 16-year-old female patient presented to our emergency department with a 1-day history of altered mentation. She had experienced a severe global headache and fever for 3 days prior to presentation. The patient tested positive for falciparum malaria and was admitted to the ward, where she received IV artesunate and other supportive management. After 3 days of admission, she noticed weakness and numbness in her lower extremities. Subsequently, the weakness progressed upward to involve her upper extremities. After extensive workup, the patient was managed with consideration of Guillain-Barré Syndrome (GBS), and she made a complete recovery after 12 weeks. DISCUSSION Guillain-Barré Syndrome (GBS) is an acute paralytic illness often triggered by infections, particularly viral ones. It is the leading cause of sudden muscle weakness, typically following respiratory or gastrointestinal infections, with Campylobacter jejuni being the most common cause. This patient's neurological symptoms pointed to paralysis of the lower motor neurons. Guillain-Barré Syndrome is also suggested by elevated protein levels and a lack of cells in the cerebrospinal fluid. This clinical picture emerged following a Plasmodium falciparum infection. Although the specific subtype (demyelinating or axonal) was not determined in this case due to the absence of a nerve conduction study, demyelinating subtypes have been found in GBS following Plasmodium infection. CONCLUSION In conclusion, while malaria is an exceptionally rare cause of Guillain-Barré Syndrome (GBS), it should be considered in patients with recent malaria infection who present with symptoms of lower motor neuron lesions.
Collapse
Affiliation(s)
- Molla Asnake Kebede
- Department of Medicine, School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, 260, Ethiopia
| | - Alemayehu Beharu Tekle
- Department of Emergency and Critical Care Medicine, School of Medicine, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Misikir Alemu Eshetu
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Erkyehun Pawlos Shash
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Melaku Tsediew Berhanu
- Department of Emergency and Critical Care Medicine, School of Medicine, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Elias Tabiet Ahmed
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Hashime Meketa Negatie
- Department of Radiology, School of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| |
Collapse
|
21
|
Hamdeh MA, Mounshar AAMAA, Asad RM, Shubietah A, Basalat NMAJ, Hassouneh JS, Al Murr MJ. Guillain-Barré Syndrome Following Laparoscopic Sleeve Gastrectomy: A Tale of Two Cases. Obes Surg 2025; 35:345-349. [PMID: 39680291 DOI: 10.1007/s11695-024-07635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 10/23/2024] [Accepted: 12/10/2024] [Indexed: 12/17/2024]
Abstract
Obesity management through laparoscopic sleeve gastrectomy can occasionally lead to rare but severe complications, including Guillain-Barré Syndrome (GBS). This report analyzes two cases of GBS following LSG, highlighting differences in symptoms, diagnosis, and management. The first patient experienced rapid onset neurological symptoms post-surgery, confirmed as GBS through clinical and electrophysiological assessments, and responded well to intravenous immunoglobulin. The second patient showed similar symptoms but received only multivitamins and physiotherapy due to financial constraints, with a slow but progressive recovery. These cases underscore the necessity for vigilant postoperative monitoring for GBS, reflecting on potential immune dysregulation and microbiota changes as contributory factors. This awareness is crucial for improving patient outcomes and understanding the neurological impacts of bariatric surgery.
Collapse
Affiliation(s)
- Mo'ath Abu Hamdeh
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Occupied Palestinian Territories.
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Occupied Palestinian Territories.
| | - Ali Abdelhai Mohammad Abdallah Abu Mounshar
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Occupied Palestinian Territories
- Neurology Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Rasmea Mohammad Asad
- College of Medicine, Hebron University, Hebron, Occupied Palestinian Territories
| | - Abdalhakim Shubietah
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Occupied Palestinian Territories
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Occupied Palestinian Territories
| | | | | | | |
Collapse
|
22
|
Afzali AM, Vosko M, Reinhardt N, Zinevych I, Gmeiner V, Korn T, Gasperi C, Berthele A, Feneberg E, Hemmer B. Serum neurofilament light chain predicts disease severity in axonal variants of acute immune neuropathies: A retrospective monocentric cohort study. Eur J Neurol 2025; 32:e16539. [PMID: 39562307 PMCID: PMC11625949 DOI: 10.1111/ene.16539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 10/14/2024] [Accepted: 10/24/2024] [Indexed: 11/21/2024]
Abstract
BACKGROUND AND PURPOSE The purpose was to explore the prognostic utility of neurofilament light chain (NfL) in patients with immune-mediated polyradiculoneuropathies (IMPs). METHODS This retrospective monocentric study analysed serum and cerebrospinal fluid samples from patients diagnosed with IMP collected prior to treatment initiation. NfL concentrations were correlated with clinical outcomes, including F score and hospitalization duration. RESULTS Amongst 115 IMP patients tested, baseline cerebrospinal fluid and serum NfL (sNfL) concentrations were higher in acute inflammatory axonal polyradiculoneuropathy (AIAP) than other IMP variants. In the AIAP cohort, a positive correlation was observed between baseline sNfL concentrations, F score and hospitalization duration. Multivariate linear regression analysis further supported the predictive relationship between elevated baseline sNfL concentrations and clinical outcomes. Using receiver operating characteristic analysis, a cut-off value for sNfL of 351 pg/mL was found to predict an F score >3 in AIAP with a sensitivity of 40% and specificity of 81.8%. AIAP patients with sNfL concentrations above this threshold required longer hospitalization (extended by 15 days). DISCUSSION Our findings highlight the potential of baseline sNfL as an effective marker for distinguishing between IMP variants and predicting the prognosis of AIAP. Further validation may facilitate translation of sNfL into clinical practice, potentially identifying high-risk patients for tailored treatment approaches.
Collapse
Affiliation(s)
- Ali Maisam Afzali
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
- Institute for Experimental NeuroimmunologyTechnical University of Munich School of Medicine and HealthMunichGermany
| | - Milan Vosko
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
| | - Nya Reinhardt
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
| | - Iaroslav Zinevych
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
| | - Vincent Gmeiner
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
| | - Thomas Korn
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
- Institute for Experimental NeuroimmunologyTechnical University of Munich School of Medicine and HealthMunichGermany
- Munich Cluster for Systems NeurologyMunichGermany
| | - Christiane Gasperi
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
| | - Achim Berthele
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
| | - Emily Feneberg
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
| | - Bernhard Hemmer
- Department of NeurologyTechnical University of Munich School of Medicine and HealthMunichGermany
- Munich Cluster for Systems NeurologyMunichGermany
| |
Collapse
|
23
|
Agarwal A, Mittal S, Garg D, Vishnu VY, Srivastava AK. Acute hepatitis A and hepatitis C co-infection triggering Guillain-Barre syndrome. Trop Doct 2025; 55:73-74. [PMID: 39492643 DOI: 10.1177/00494755241295268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2024]
Affiliation(s)
- Ayush Agarwal
- Assistant Professor, Department of Neurology, AIIMS, New Delhi, India
| | - Sapna Mittal
- Senior Resident, Department of Neurology, AIIMS, New Delhi, India
| | - Divyani Garg
- Assistant Professor, Department of Neurology, AIIMS, New Delhi, India
| | | | | |
Collapse
|
24
|
Stanley J, Zhou Q. Numbness on the Medical Take: An Atypical Presentation of Guillain-Barre Syndrome With Unilateral Paraesthesia and Rapid Progression to Bulbar Palsy: A Case Report. Clin Case Rep 2025; 13:e9586. [PMID: 39736918 PMCID: PMC11682874 DOI: 10.1002/ccr3.9586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/25/2024] [Accepted: 10/11/2024] [Indexed: 01/01/2025] Open
Abstract
Guillain-Barré syndrome (GBS) is characterized classically by progressive and symmetrical motor weakness and areflexia. We describe a case of GBS with initially preserved reflexes and power, leading to delayed diagnosis, who latterly required urgent ventilator support and plasmapharesis to highlight the importance of considering atypical presentations of this common condition.
Collapse
Affiliation(s)
- J. Stanley
- Acute Medical DepartmentUniversity Hospital Bristol and WestonBristolUK
- Bristol Medical SchoolUniversity of BristolBristolUK
| | - Q. Zhou
- Acute Medical DepartmentUniversity Hospital Bristol and WestonBristolUK
| |
Collapse
|
25
|
Min X, Feng H, Zhao R, Guo Z, Su H. Anti-sulfatide antibody-positive Guillain-Barré syndrome in adults following off-craniotomy for cerebellar contusion: A case report. Medicine (Baltimore) 2024; 103:e40970. [PMID: 39969334 PMCID: PMC11688002 DOI: 10.1097/md.0000000000040970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 11/27/2024] [Indexed: 02/20/2025] Open
Abstract
RATIONALE Gullain-Barré syndrome (GBS) is a rare autoimmune condition primarily presenting with symmetrical progressive limb weakness. It is frequently associated with sensory and autonomic symptoms and autonomic disturbances and often manifests seropositivity for anti-ganglioside antibodies. Infections are considered major precipitants; however, GBS post-craniotomy for severe traumatic brain injury is a rarity. PATIENT CONCERNS A 79-year-old female underwent craniotomy for a cerebellar contusion sustained from severe traumatic brain injury, leading to quadriplegia, autonomic dysfunction, dilated pupils, and respiratory failure. However, the patient's GBS manifested slightly differently. Her limb weakness was asymmetric and progressed from 1 upper limb to the other. DIAGNOSES The diagnosis of GBS was confirmed based on clinical presentation, cerebrospinal fluid analysis showing albuminocytologic dissociation, and the detection of anti-sulfatide antibodies in serum. INTERVENTIONS The patient received intravenous immunoglobulin (IVIG) therapy at 2 g/kg daily, along with supportive measures including mechanical ventilation and rehabilitation. OUTCOMES The patient demonstrated significant improvement within 5 days of IVIG treatment, achieving near-complete functional recovery with grade 4 muscle strength at discharge 6 weeks post-intervention. LESSONS This case highlights the need to consider GBS in postoperative patients with acute limb weakness, even in atypical presentations. Early recognition and timely IVIG treatment are critical for favorable outcomes.
Collapse
Affiliation(s)
- Xiaobin Min
- Department of Neurosurgery, Tianjin Baodi Hospital, Baodi Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Haoye Feng
- Department of Neurosurgery, Tianjin Baodi Hospital, Baodi Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Riguang Zhao
- Department of Neurology, Tianjin Baodi Hospital, Baodi Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Zhigang Guo
- Department of Neurosurgery, Tianjin Baodi Hospital, Baodi Hospital of Tianjin Medical University, Tianjin, P.R. China
| | - Hongjun Su
- Department of Neurology, Tianjin Baodi Hospital, Baodi Hospital of Tianjin Medical University, Tianjin, P.R. China
| |
Collapse
|
26
|
Leonhard SE, Papri N, Querol L, Rinaldi S, Shahrizaila N, Jacobs BC. Guillain-Barré syndrome. Nat Rev Dis Primers 2024; 10:97. [PMID: 39702645 DOI: 10.1038/s41572-024-00580-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2024] [Indexed: 12/21/2024]
Abstract
Guillain-Barré syndrome (GBS) is a rare immune-mediated polyradiculoneuropathy. Patients typically develop rapidly progressive weakness and sensory deficits that can result in complete paralysis requiring mechanical ventilation. GBS is usually a monophasic disease in which an aberrant immune response to an infection or other trigger damages the peripheral nerves. For example, in patients with preceding Campylobacter jejuni infection, molecular mimicry causes a cross-reactive antibody response to nerve gangliosides. Diagnosis is based on clinical features, supported by cerebrospinal fluid analysis and nerve conduction studies. Effective treatments include plasma exchange and intravenous immunoglobulins. However, ~20% of patients who received treatment are unable to walk after 6 months and ~5% die as a consequence of GBS. Important knowledge gaps in GBS include its pathogenesis, especially after viral infections. In addition, there is a lack of specific biomarkers to improve the diagnosis, monitor the disease activity, and predict the clinical course and outcome of GBS. Major challenges for the future include finding more effective and personalized treatments, which are affordable in low-income and middle-income countries, and preparation for outbreaks of infections as potential triggers for GBS.
Collapse
Affiliation(s)
- Sonja E Leonhard
- Department of Clinical Microbiology and Infectious Disease, Erasmus MC, Rotterdam, The Netherlands
| | - Nowshin Papri
- Laboratory of Gut-Brain Axis, Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Luis Querol
- Neuromuscular Unit, Department of Neurology, Hospital de la Santa Creu i Santa Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red para Enfermedades Raras, CIBERER, Madrid, Spain
| | - Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Nortina Shahrizaila
- Neurology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands.
- Erasmus MC Center of Expertise for Neuromuscular Diseases, Rotterdam, The Netherlands.
| |
Collapse
|
27
|
Papri N, Mohammed A, Rahman MM, Hasan I, Azam R, Saha T, Shaon FTU, Jahan I, Hayat S, Ara G, Islam B, Islam Z. Pain determinants and quality of life in Guillain-Barre syndrome: a prospective cohort study. BMJ Neurol Open 2024; 6:e000925. [PMID: 39687605 PMCID: PMC11647308 DOI: 10.1136/bmjno-2024-000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 11/15/2024] [Indexed: 12/18/2024] Open
Abstract
Background Pain is a serious manifestation in both the acute and chronic stages of Guillain-Barre syndrome (GBS). We evaluated the frequency, characteristics and associated factors of pain and its impact on quality of life (QoL) among patients with GBS. Methods We enrolled 644 patients with GBS from prospective cohort studies in Bangladesh conducted between 2010 and 2024. Data were collected at enrolment and at standard follow-up time points up to 26 weeks. Pain intensity was measured by a pain numeric rating scale. Group differences were tested using the χ² or Fisher's exact test, longitudinal changes were analysed with repeated-measures analysis of variance and correlations were analysed with Spearman's rank test. Results The median age of the patients was 31 years, with 70% men. During enrolment, 71% of patients reported pain, which persisted among 38% at week 13 and 26% at week 26. Pain was significantly associated with disease severity, muscle weakness and treatment with intravenous immunoglobulin in both the acute and chronic stages. Patients with acute pain had a higher proportion of axonal GBS (p=0.000) than those without pain. Chronic pain was associated with higher age (p=0.006), male sex (p=0.000), preceding diarrhoea (p=0.033) and dysautonomia (p=0.000). Higher pain intensity was reported among women (p=0.027), patients with higher age (p=0.029) and severe form of GBS (p=0.038) compared with counter groups. Acute pain was significantly associated with the 'self-care' (p=0.023), 'usual activities' (p=0.049) and 'anxiety/depression' (p=0.048) domains of QoL, whereas chronic pain was associated with the 'anxiety/depression' (p=0.005) domain. Conclusions Pain presented as a serious symptom negatively affecting the QoL in GBS. Systematic evaluation of pain is recommended to ensure a personalised treatment approach for GBS.
Collapse
Affiliation(s)
| | | | | | | | | | - Tamal Saha
- Gut-Brain Axis, ICDDRB, Dhaka, Bangladesh
| | | | | | | | - Gulshan Ara
- Nutrition Research Division, ICDDRB, Dhaka, Bangladesh
| | - Badrul Islam
- Sheikh Fazilatunnessa Mujib Memorial KPJ Specialized Hospital & Nursing College, Dhaka, Bangladesh
| | | |
Collapse
|
28
|
Chen Y, Li K, Lv W, Xie J, Qian Y, Cui C, Deng B. What Is the Impact of the Novel Coronavirus and the Vaccination on Guillain-Barre Syndrome? Mol Neurobiol 2024; 61:9835-9850. [PMID: 37728848 DOI: 10.1007/s12035-023-03638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
The COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has resulted in devastating medical and economic consequences worldwide over the past 3 years. As the pandemic enters a new stage, it is essential to consider the potential impact on rare diseases such as Guillain-Barre syndrome (GBS), which has been intimately associated with COVID-19 since the first COVID-19-related GBS case was reported in January 2020. There are notable differences between COVID-19-related GBS and GBS without COVID-19 in terms of diagnostic types and clinical manifestations. Furthermore, with the widespread administration of COVID-19 vaccines, there have been reports of GBS occurring shortly after vaccination, which requires close attention despite its rarity. This review also explores the vaccines associated with heightened GBS risks, offering insights that may guide vaccination policies and clinical practice. To provide a visual summary of these findings, we have included a graphical abstract.
Collapse
Affiliation(s)
- Yinuo Chen
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Kezheng Li
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- First Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Wenjing Lv
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiali Xie
- Department of Neurology, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Yuqin Qian
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Can Cui
- Department of Clinical Sciences Malmö, Lund University, Skåne, Sweden
| | - Binbin Deng
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- First Clinical College of Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
29
|
Wang G, Zhong L, Wang M, Zhou J, Liu S, Miao W, Li L, Liu Y, Guo S, Li H, Wang X, Xie L, Xie M, Fu S, Xuan T, Li F, Yang T, Shao L, Shi M, Li X, Li X, Gao L, Zhai S, Ding J, Wang T, Liu D, Ma G, Wu J, Wan D, Guo J, Zhang X, Wu J, Wang Y, Jin A, Ma L, Yang H, He X, Ma X, Liu H, Ma B, Yang N, Hou X, Xu T, Qin CF, Wang H, Xie P, Wang Z. Peripheral nerve injury associated with JEV infection in high endemic regions, 2016-2020: a multicenter retrospective study in China. Emerg Microbes Infect 2024; 13:2337677. [PMID: 38578315 PMCID: PMC11036900 DOI: 10.1080/22221751.2024.2337677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/17/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Previously, we reported a cohort of Japanese encephalitis (JE) patients with Guillain-Barré syndrome. However, the evidence linking Japanese encephalitis virus (JEV) infection and peripheral nerve injury (PNI) remains limited, especially the epidemiology, clinical presentation, diagnosis, treatment, and outcome significantly differ from traditional JE. We performed a retrospective and multicenter study of 1626 patients with JE recorded in the surveillance system of the Chinese Center for Disease Control and Prevention, spanning the years 2016-2020. Cases were classified into type 1 and type 2 JE based on whether the JE was combined with PNI or not. A comparative analysis was conducted on demographic characteristics, clinical manifestations, imaging findings, electromyography data, laboratory results, and treatment outcomes. Among 1626 laboratory confirmed JE patients, 230 (14%) were type 2 mainly located along the Yellow River in northwest China. In addition to fever, headache, and disturbance of consciousness, type 2 patients experienced acute flaccid paralysis of the limbs, as well as severe respiratory muscle paralysis. These patients presented a greater mean length of stay in hospital (children, 22 years [range, 1-34]; adults, 25 years [range, 0-183]) and intensive care unit (children, 16 years [range, 1-30]; adults, 17 years [range, 0-102]). The mortality rate was higher in type 2 patients (36/230 [16%]) compared to type 1 (67/1396 [5%]). The clinical classification of the diagnosis of JE may play a crucial role in developing a rational treatment strategy, thereby mitigating the severity of the disease and potentially reducing disability and mortality rates among patients.
Collapse
Affiliation(s)
- Guowei Wang
- The First Clinical Medical School, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Lianmei Zhong
- Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, People’s Republic of China
| | - Juan Zhou
- Guangzhou Women and Children’s Medical Center, Guangzhou, People’s Republic of China
| | - Shuting Liu
- Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Wang Miao
- Neuro-Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Leilei Li
- West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, The Air Force Medical University, Xi’an, People’s Republic of China
| | - Shougang Guo
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Haining Li
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xiaoming Wang
- The Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Liuqing Xie
- Meishan People’s Hospital, Meishan, People’s Republic of China
| | - Min Xie
- Chengdu Seventh People’s Hospital, Chengdu, People’s Republic of China
| | - Shihong Fu
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Tingting Xuan
- The First Clinical Medical School, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Fan Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Tingting Yang
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia, Yinchuan, People’s Republic of China
| | - Lufei Shao
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Mingfang Shi
- Department of Pediatrics, Yibin Hospital, Children's Hospital of Chongqing Medical University, Yibin, People’s Republic of China
| | - Xiaocong Li
- The First Clinical Medical School, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xiaoling Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, People’s Republic of China
| | - Li Gao
- Baoji Central Hospital, Baoji, People’s Republic of China
| | - Shaopeng Zhai
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, People’s Republic of China
| | - Jia Ding
- The First People’s Hospital of Tianshui, Tianshui, People’s Republic of China
| | - Tianhong Wang
- The First Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Dayong Liu
- The Affiliated Hospital of Gansu Medical College, Pingliang, People’s Republic of China
| | - Guosheng Ma
- Gansu Provincial People’s Hospital, Lanzhou, People’s Republic of China
| | - Jiang Wu
- The First People’s Hospital of Longnan, Longnan, People’s Republic of China
| | - Dongjun Wan
- The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou, People’s Republic of China
| | - Junlin Guo
- Qingyang People's Hospital, Qingyang, People’s Republic of China
| | - Xinbo Zhang
- Department of Neurology, Xijing Hospital, The Air Force Medical University, Xi’an, People’s Republic of China
| | - Jinxia Wu
- Department of Pediatrics, Yibin Hospital, Children's Hospital of Chongqing Medical University, Yibin, People’s Republic of China
| | - Yinxu Wang
- The Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Ansong Jin
- The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Lei Ma
- Emergency Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Huan Yang
- Emergency Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xuexian He
- Cerebrospinal Fluid Laboratory, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Xiaona Ma
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia, Yinchuan, People’s Republic of China
| | - Huijuan Liu
- Department of Infectious Diseases, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Boya Ma
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Ningai Yang
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia, Yinchuan, People’s Republic of China
| | - Xiaolin Hou
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Ting Xu
- General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Cheng-feng Qin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People’s Republic of China
| | - Huanyu Wang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, Chongqing, People’s Republic of China
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhenhai Wang
- Neurology Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
- Diagnosis and Treatment Engineering Technology Research Center of Nervous System Diseases of Ningxia, Yinchuan, People’s Republic of China
| |
Collapse
|
30
|
Rivera-Franco N, López-Alvarez D, Castillo A, Aristizabal E, Puiu D, Salzberg SL, Pardo CA, Parra B. Genomic variability in Zika virus in GBS cases in Colombia. PLoS One 2024; 19:e0313545. [PMID: 39561198 PMCID: PMC11575819 DOI: 10.1371/journal.pone.0313545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 10/25/2024] [Indexed: 11/21/2024] Open
Abstract
Major clusters of Guillain-Barré Syndrome (GBS) emerged during the Zika virus (ZIKV) outbreaks in the South Pacific and the Americas from 2014 to 2016. The factors contributing to GBS susceptibility in ZIKV infection remain unclear, although considerations of viral variation, patient susceptibility, environmental influences, and other potential factors have been hypothesized. Studying the role of viral genetic factors has been challenging due to the low viral load and rapid viral clearance from the blood after the onset of Zika symptoms. The prolonged excretion of ZIKV in urine by the time of GBS onset, when the virus is no longer present in the blood, provides an opportunity to unravel whether specific ZIKV mutations are related to the development of GBS in certain individuals. This study aimed to investigate the association between specific ZIKV genotypes and the development of GBS, taking advantage of a unique collection of ZIKV-positive urine samples obtained from GBS cases and controls during the 2016 ZIKV outbreak in Colombia. Utilizing Oxford-Nanopore technology, we conducted complete genome sequencing of ZIKV in biological samples from 15 patients with GBS associated with ZIKV and 17 with ZIKV infection without neurological complications. ZIKV genotypes in Colombia exhibited distribution across three clades (average bootstrap of 90.9±14.9%), with two clades dominating the landscape. A comparative analysis of ZIKV genomes from GBS and non-neurological complications, alongside 1368 previously reported genomes, revealed no significant distinctions between the two groups. Both genotypes were similarly distributed among observed clades in Colombia. Furthermore, no variations were identified in the amino acid composition of the viral genome between the two groups. Our findings suggest that GBS in ZIKV infection is perhaps associated with patient susceptibility and/or other para- or post-infectious immune-mediated mechanisms rather than with specific ZIKV genome variations.
Collapse
Affiliation(s)
- Nelson Rivera-Franco
- Laboratorio de Técnicas y Análisis Ómicos-TAOLab/CiBioFi, Facultad de Ciencias Naturales y Exactas, Universidad del Valle, Cali, Valle del Cauca, Colombia
- Grupo VIREM-Virus Emergentes y Enfermedad, Escuela de Ciencias Básicas, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
- Department of Neurology & Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Diana López-Alvarez
- Laboratorio de Técnicas y Análisis Ómicos-TAOLab/CiBioFi, Facultad de Ciencias Naturales y Exactas, Universidad del Valle, Cali, Valle del Cauca, Colombia
- Grupo VIREM-Virus Emergentes y Enfermedad, Escuela de Ciencias Básicas, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
- Departamento de Ciencias Biológicas, Facultad de Ciencias Agropecuarias, Universidad Nacional de Colombia, Palmira, Valle del Cauca, Colombia
| | - Andrés Castillo
- Laboratorio de Técnicas y Análisis Ómicos-TAOLab/CiBioFi, Facultad de Ciencias Naturales y Exactas, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Erica Aristizabal
- Grupo VIREM-Virus Emergentes y Enfermedad, Escuela de Ciencias Básicas, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Daniela Puiu
- Center for Computational Biology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Steven L Salzberg
- Center for Computational Biology, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Carlos A Pardo
- Department of Neurology & Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Beatriz Parra
- Grupo VIREM-Virus Emergentes y Enfermedad, Escuela de Ciencias Básicas, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
| |
Collapse
|
31
|
Shashidhara AK, Bala S, Browne S, Cliff M, Mallia P. Post-infectious Inflammatory Motor-Predominant Neuropathy Following Mycoplasma Infection. Cureus 2024; 16:e74657. [PMID: 39734953 PMCID: PMC11681799 DOI: 10.7759/cureus.74657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2024] [Indexed: 12/31/2024] Open
Abstract
We present a case of a 37-year-old gentleman diagnosed with post-infectious Guillain-Barré syndrome (GBS) secondary to a Mycoplasma pneumoniae infection. This case highlights the subclinical presentation of neurological symptoms, often overlooked as a complication of M. pneumoniae infection. The patient exhibited significant neurological deficits following initial respiratory symptoms, demonstrating the need for awareness of these potential extrapulmonary complications in clinical practice.
Collapse
Affiliation(s)
- Anush K Shashidhara
- General Internal Medicine, Royal Free London NHS Foundation Trust, London, GBR
| | - Sithu Bala
- General Internal Medicine, Royal Free London NHS Foundation Trust, London, GBR
| | - Stefan Browne
- General Internal Medicine, Royal Free London NHS Foundation Trust, London, GBR
| | - Michael Cliff
- Neurology, Royal Free London NHS Foundation Trust, London, GBR
| | - Patrick Mallia
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, GBR
| |
Collapse
|
32
|
Iliadi-Tulbure C, Cemortan M, Jubirca S, Cospormac V, Bubulici C, Vicol MM. Guillain-Barré syndrome in pregnancy: a case report and review of the literature. AJOG GLOBAL REPORTS 2024; 4:100396. [PMID: 39434812 PMCID: PMC11491707 DOI: 10.1016/j.xagr.2024.100396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2024] Open
Abstract
Guillain-Barré syndrome represents a heterogeneous group of immune-mediated peripheral neuropathies that are characterized by various clinical manifestations. Reporting this clinical case emphasizes the rarity of Guillain-Barré syndrome, the diagnostic challenges faced by healthcare providers, and the risk of delayed diagnosis for both the mother and fetus. A 34-year-old pregnant woman at 33 weeks of gestation presented to the inpatient ward complaining of paresthesia in the lower and upper limbs, muscle pain, balance disturbances, moderate headache, nausea and vertigo, general weakness, and pronounced fatigue. The patient had experienced an acute viral respiratory infection 4 weeks before presenting to the hospital. The patient was admitted to the intensive care unit with a preliminary diagnosis of acute viral respiratory infection and nasopharyngitis. The patient's condition worsened dynamically, manifesting bulbar syndrome (swallowing problems), paresthesia of the anterior abdominal wall, reduced perception of fetal movements, numbness of the tongue, and low fever (37.2°C). A diagnosis of acute inflammatory demyelinating polyradiculopathy (Guillain-Barré syndrome) was established. Despite treatment, the neurologic symptoms worsened. The paravertebral radicular type pains were difficult to manage with administered analgesic therapy, and there was a progression of the bulbar syndrome. Treatment with intravenous immunoglobulin was initiated. Consequently, it was recommended by the multidisciplinary council to perform an emergency cesarean delivery, in the interest of the mother and fetus. Guillain-Barré syndrome is a rare condition that occurs during pregnancy and requires thorough evaluation, prompt multidisciplinary assessment, and individualized management of delivery to improve maternal and fetal prognosis.
Collapse
Affiliation(s)
- Corina Iliadi-Tulbure
- Department of Obstetrics and Gynecology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova (Iliadi-Tulbure and Cemortan)
| | - Maria Cemortan
- Department of Obstetrics and Gynecology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova (Iliadi-Tulbure and Cemortan)
| | - Svetlana Jubirca
- Public Medical and Health Institution, Institute of Mother and Child, Chisinau, Republic of Moldova (Jubirca)
| | - Viorica Cospormac
- Anaesthesiology and Resuscitation Department No. 2, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova (Cospormac)
| | | | - Maria-Magdalena Vicol
- Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova (Vicol)
| |
Collapse
|
33
|
Altorfer FCS, Weng A, Sneag DB, Pavlakis PP, Lebl DR. Guillain-Barré Syndrome Following Lumbar Spine Surgery: A Case Report Highlighting Early Magnetic Resonance Neurography Findings. HSS J 2024:15563316241294049. [PMID: 39564404 PMCID: PMC11572550 DOI: 10.1177/15563316241294049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 10/02/2024] [Indexed: 11/21/2024]
Affiliation(s)
| | - Ashley Weng
- Department of Neurology, Hospital for Special Surgery, New York, NY, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | | | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
34
|
Hsieh CY, Chen PT, Shao SC, Lin SJ, Liao SC, Lai ECC. Validating ICD-10 Diagnosis Codes for Guillain-Barré Syndrome in Taiwan's National Health Insurance Claims Database. Clin Epidemiol 2024; 16:733-742. [PMID: 39445227 PMCID: PMC11497080 DOI: 10.2147/clep.s485953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 09/18/2024] [Indexed: 10/25/2024] Open
Abstract
Purpose To validate the International Classification of Diseases, 10th Revision (ICD-10) codes for Guillain-Barré syndrome (GBS) in Taiwan's insurance claims database. Methods We identified adult patients hospitalized at any Chang Gung Memorial Foundation branch hospital between January 1st, 2017, and December 31st, 2022, with ICD-10 code G61.0 in any of the five discharge diagnosis positions, indicating possible Guillain-Barré syndrome. We then validated the possible GBS diagnosis using data from electronic medical records of the identified patients, based on the diagnostic criteria established by the National Institute of Neurological Disorders and Stroke. We determined the positive predictive values (PPV) of various operational definitions, including the position (primary or other) where the code was recorded in the discharge diagnosis, nerve conduction study (NCS) claims, and / or specific GBS treatments. Results The final validation cohort of 484 patients with ICD-10 code for GBS in the discharge diagnosis was found to include 368 true GBS patients. Identifying inpatients using only the ICD-10 code for GBS in any of the five positions for discharge diagnosis yielded a PPV of 76.0%. With more restrictive definitions (primary diagnosis only, or requiring additional claims for NCS and/or treatments), the PPV tended to increase, but with fewer true GBS patients identified. Using ICD-10 GBS code in the primary diagnosis plus NCS and treatment claims yielded the highest PPV (98.3%); however, 140 (38.0%) of the true GBS patients were missed using this definition. In contrast, using the ICD-10 GBS code in any position, plus claims for NCS, achieved a relatively good PPV (85.8%) with minimal loss of true GBS patients (13, ie, 3.5%). Conclusion In Taiwan's NHI claims data, identifying true GBS patients using only the ICD-10 code yielded a PPV of 76.0%; however, adding claims for diagnostic procedure and GBS treatment increased the PPV to 98.3%.
Collapse
Affiliation(s)
- Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ting Chen
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Population Health Data Center, National Cheng Kung University, Tainan, Taiwan
| | - Swu-Jane Lin
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Shu-Chen Liao
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Population Health Data Center, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
35
|
Coviello A, Iacovazzo C, Vargas M, Posillipo C, Sagnelli F, Diglio P, Cirillo D, Servillo G. A Death for Guillain-Barrè Syndrome After Receiving a COVID-19 Vaccine: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241274692. [PMID: 39377049 PMCID: PMC11457283 DOI: 10.1177/11795476241274692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/19/2024] [Indexed: 10/09/2024]
Abstract
The virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) causes COVID-19, a potentially fatal disease. The COVID-19 vaccine is indicated for active immunization to prevent COVID-19 caused by SARS-CoV-2. We reported the case of a 66-year-old woman with a medical history of hypertension and anxious-depressive syndrome who developed Guillain Barré Syndrome (GBS) 4 weeks after receiving the COVID-19 vaccine. During the patient's hospital stay, they received cycles of high-dose intravenous immunoglobulin (IVIG) and plasmapheresis treatments.. Despite the treatment, a deterioration of respiratory function led the patient to premature mortality.
Collapse
Affiliation(s)
- Antonio Coviello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Concetta Posillipo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Francesco Sagnelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Pasquale Diglio
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Dario Cirillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy
| |
Collapse
|
36
|
Allen JA. New chronic inflammatory demyelinating polyneuropathy/Guillain-Barré syndrome guidelines - impact on clinical practise. Curr Opin Neurol 2024; 37:455-460. [PMID: 38873801 DOI: 10.1097/wco.0000000000001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
PURPOSE OF REVIEW There is no diagnostic biomarker that can reliably detect Guillain-Barré syndrome (GBS) or chronic inflammatory demyelinating polyneuropathy (CIDP). Diagnosis relies upon integrating key clinical characteristics and relevant supportive data. Consequently, misdiagnosis and delayed diagnosis are common. Diagnostic criteria have proven valuable resources to improve diagnosis, but are underutilized during routine clinical care. RECENT FINDINGS In 2021, the EAN/PNS CIDP criteria was published, and were followed by the EAN/PNS GBS criteria in 2023. Both guidelines utilized GRADE methodology to formulate evidence-based recommendations that are intended to be used by adult and paediatric clinicians across diverse care settings to optimize diagnostic accuracy and improve patient outcomes during routine clinical care. SUMMARY The EAN/PNS GBS and CIDP criteria detail specific clinical, electrophysiological, and laboratory features that raise diagnostic confidence, and call attention to diagnostic mimics. The sensitivity of EAN/PNS and other modern criteria to detect GBS and CIDP is high, but utilization during clinical practice is low. Complexity is one factor limiting widespread application. Strategies are needed to optimize criteria adoption during routine clinical care such that GBS and CIDP diagnosis can be achieved with greater speed and accuracy.
Collapse
Affiliation(s)
- Jeffrey A Allen
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
37
|
Kuwabara S, Kusunoki S, Kuwahara M, Yamano Y, Nishida Y, Ishida H, Kasuya T, Kupperman E, Lin Q, Frick G, Misawa S. Efficacy and safety of eculizumab in Guillain-Barré syndrome: A phase 3, multicenter, double-blind, randomized, placebo-controlled clinical trial. J Peripher Nerv Syst 2024; 29:339-349. [PMID: 38987228 DOI: 10.1111/jns.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND AIMS Guillain-Barré syndrome (GBS) is an acute, self-limited, immune-mediated peripheral neuropathy. Current treatments for GBS include intravenous immunoglobulin (IVIg) and plasma exchange, which may not sufficiently benefit severely affected patients. This study evaluated the efficacy and safety of eculizumab add-on therapy to IVIg (standard-of-care treatment) in patients with severe GBS. METHODS This phase 3, multicenter, double-blind, randomized, placebo-controlled clinical trial (NCT04752566), enrolled Japanese adults (age ≥ 18 years) with severe GBS (Hughes functional grade [FG] score FG3 or FG4/FG5 within 2 weeks of onset of GBS). Participants were randomized 2:1 to receive intravenous infusion of eculizumab or placebo (once weekly for 4 weeks) with IVIg treatment with 20 weeks of follow-up. Primary efficacy endpoint was the time to first reach FG score ≤1 (able to run). Key secondary endpoints were proportion of participants achieving FG ≤1 at weeks 8 and 24 and FG improvement ≥3 at week 24. Pharmacodynamic analysis of serum free C5 concentration over time was performed. Safety was evaluated. RESULTS The analysis included 57 participants (eculizumab, n = 37; placebo, n = 20). Primary endpoint was not achieved (hazard ratio, 0.9; 95% CI, 0.45-1.97; p = .89). Key secondary endpoints did not reach statistical significance. Serum C5 concentration was reduced by 99.99% at 1 h postdose and sustained to week 5 but returned to baseline at the end of follow-up period. No new safety signals for eculizumab were identified. INTERPRETATION Although well tolerated, eculizumab treatment did not show significant effects on motor function recovery compared to placebo in patients with GBS.
Collapse
Affiliation(s)
- Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Motoi Kuwahara
- Department of Neurology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yoshihisa Yamano
- Department of Neurology, St. Marianna University School of Medicine Kawasaki, Japan
| | - Yoichiro Nishida
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | - Qun Lin
- AstraZeneca Rare Disease, Alexion, Boston, USA
| | - Glen Frick
- AstraZeneca Rare Disease, Alexion, Boston, USA
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
38
|
Finsterer J. Post-COVID dysphagia requires exclusion of SARS-CoV-2-associated brainstem encephalitis, vasculitis, polyneuritis cranialis, and myositis. Brain Behav 2024; 14:e70032. [PMID: 39317972 PMCID: PMC11422173 DOI: 10.1002/brb3.70032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/05/2024] [Accepted: 08/22/2024] [Indexed: 09/26/2024] Open
|
39
|
Acero-Garces D, Zuluaga-Lotero D, Ortiz-Muñoz D, Arango GP, Moyano M, Vargas-Manotas J, Rojas CA, Urrego J, Rojas JP, Rosso F, Ramos-Burbano GE, Llanos MD, Lizarazo J, Lopez-Gonzalez R, Jimenez-Arango JA, Benavides-Melo J, Martinez-Villota VA, Gonzalez G, Dominguez-Penuela SC, Quintero JA, Luque KA, Ruiz AM, Claros K, Osorio L, Pardo CA, Parra B. Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic. J Neurol Sci 2024; 463:123140. [PMID: 39047509 PMCID: PMC11338696 DOI: 10.1016/j.jns.2024.123140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.
Collapse
Affiliation(s)
| | | | | | - Gloria P Arango
- Universidad Del Valle, School of Human Rehabilitation, Faculty of Health, Cali, Colombia
| | - Martha Moyano
- Universidad Del Valle, School of Public Health, Cali, Colombia
| | - José Vargas-Manotas
- Universidad Simón Bolívar, Barranquilla, Colombia; La Misericordia Clínica Internacional, Barranquilla, Colombia
| | - Christian A Rojas
- Universidad del Valle, School of Medicine, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia; Clinica Imbanaco, Department of Pediatrics, Cali, Colombia
| | - Jonathan Urrego
- Universidad del Valle, School of Medicine, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia
| | - Juan P Rojas
- Fundación Clínica Infantil Club Noel, Department of Pediatrics, Cali, Colombia; Universidad Libre seccional Cali, Cali, Colombia
| | - Fernando Rosso
- Fundación Valle del Lili, Department of Internal Medicine, Cali, Colombia; Universidad ICESI, Cali, Colombia
| | - Gustavo E Ramos-Burbano
- Universidad del Valle, School of Medicine, Cali, Colombia; Clinica Rey David, Cali, Colombia
| | | | - Jairo Lizarazo
- Hospital Universitario Erasmo Meoz, Cúcuta, Colombia; Universidad de Pamplona, Cúcuta, Colombia
| | | | | | | | | | - Guillermo Gonzalez
- Hospital Universitario de Neiva Hernando Moncaleano Perdomo, Neiva, Colombia; Universidad Surcolombiana, Neiva, Colombia
| | | | - Jaime A Quintero
- Universidad del Valle, Department of Microbiology, Cali, Colombia
| | | | | | - Katherinne Claros
- Hospital Universitario de Neiva Hernando Moncaleano Perdomo, Neiva, Colombia
| | - Lyda Osorio
- Universidad Del Valle, School of Public Health, Cali, Colombia
| | - Carlos A Pardo
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, MD, USA.
| | - Beatriz Parra
- Universidad del Valle, Department of Microbiology, Cali, Colombia
| |
Collapse
|
40
|
Shinde V, Penmetsa P, Nair KR, Dixit Y. A Neuropathy Mimic: Statin-Induced Myopathy Presenting as Guillain-Barré Syndrome. Cureus 2024; 16:e66483. [PMID: 39246875 PMCID: PMC11380724 DOI: 10.7759/cureus.66483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Statins are widely used to manage dyslipidemia and prevent cardiovascular diseases due to their effectiveness and general safety profile. However, they can sometimes cause severe muscle-related adverse effects, presenting diagnostic challenges when symptoms overlap with other conditions. This case report describes a middle-aged woman who presented to the emergency department with bilateral lower limb weakness, initially suggesting Guillain-Barré syndrome (GBS). Despite her history of low-grade fever and diarrhea, primary and secondary surveys, including electrocardiogram, blood gas analysis, and nerve conduction studies, showed no definitive signs of GBS. The patient had a recent history of percutaneous transluminal coronary angioplasty and was on dual antiplatelet therapy and rosuvastatin. Elevated creatine kinase levels and exclusion of other differential diagnoses led to the diagnosis of statin-induced myopathy, a rare but severe adverse effect of statins. The patient was treated with intravenous fluids, cessation of statins, and sessions of hemodialysis and plasmapheresis, resulting in significant improvement and eventual recovery of muscle power and neurological function. This case highlights the importance of recognizing statin-induced myopathy in patients with muscle weakness and emphasizes the need for thorough clinical evaluation to differentiate it from other conditions such as GBS. Further research is warranted to understand the pathophysiology of statin myopathy and identify at-risk populations.
Collapse
Affiliation(s)
- Varsha Shinde
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Pranay Penmetsa
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Karthik R Nair
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Yash Dixit
- Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| |
Collapse
|
41
|
Bellanti R, Rinaldi S. Guillain-Barré syndrome: a comprehensive review. Eur J Neurol 2024; 31:e16365. [PMID: 38813755 PMCID: PMC11235944 DOI: 10.1111/ene.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024]
Abstract
Guillain-Barré syndrome (GBS) is a potentially devastating yet treatable disorder. A classically postinfectious, immune-mediated, monophasic polyradiculoneuropathy, it is the leading global cause of acquired neuromuscular paralysis. In most cases, the immunopathological process driving nerve injury is ill-defined. Diagnosis of GBS relies on clinical features, supported by laboratory findings and electrophysiology. Although previously divided into primary demyelinating or axonal variants, this dichotomy is increasingly challenged, and is not endorsed by the recent European Academy of Neurology (EAN)/Peripheral Nerve Society (PNS) guidelines. Intravenous immunoglobulin and plasma exchange remain the primary modalities of treatment, regardless of the electrophysiological subtype. Most patients recover, but approximately one-third require mechanical ventilation, and 5% die. Disease activity and treatment response are currently monitored through interval neurological examination and outcome measures, and the potential role of fluid biomarkers is under ongoing scrutiny. Novel potential therapies for GBS are being explored but none have yet modified clinical practice. This review provides a comprehensive update on the pathological and clinical aspects of GBS for clinicians and scientists.
Collapse
Affiliation(s)
- Roberto Bellanti
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Simon Rinaldi
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| |
Collapse
|
42
|
Naderi-boldaji V, Zand F, Asmarian N, Marbooti H, Masjedi M, Tabibzadeh SM, Esmaeilinezhad Z, Nazeri M. Clinical Characteristics and Prognosis of ICU-Admitted Patients with Guillain-Barre Syndrome: A Report from a Large Teaching Hospital in South Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:501-507. [PMID: 39205821 PMCID: PMC11347590 DOI: 10.30476/ijms.2023.99401.3144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/17/2023] [Accepted: 10/09/2023] [Indexed: 09/04/2024]
Abstract
Background Guillain-Barre Syndrome (GBS) is the most prevalent acute peripheral polyneuropathy disorder. The disparities between populations and variations in the major risk factors highlight the importance of country-specific studies. This study aimed to report clinical characteristics and outcomes of ICU-admitted patients with GBS in an academic medical center in Iran. Methods The data were collected retrospectively from all patients with GBS admitted to Namazi Hospital, affiliated with Shiraz University of Medical Sciences, (Shiraz, Iran), between March 2016 to March 2021. Specialized neurological information and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were recorded. The SPSS software was used to analyze the data. The analyzed data were reported as numbers and percentages, or mean±SD, or median(Interquartile). Results The study included 132 GBS patients, with an average age of 47.87±15.4 years and a male-to-female ratio of 1.69:1. More than half of the patients (58.5%) were classified as having an axonal disease. In patients with axonal illness, 51.4% of patients had lower limb powers<3, while only 36% of those had the demyelinating disease. This group also required mechanical ventilation more frequently (54% vs. 46%) and for a longer duration (26 [9-37] vs. 10 [1-61]) days. Pneumonia and sepsis were each observed in 16% of patients, and 12% developed a urinary tract infection. The most common type of GBS was acute inflammatory demyelinating polyneuropathy (AIDP). Only 6 (3.8%) patients died. Conclusion The axonal type of GBS was more frequent, and these patients required mechanical ventilation more frequently and for a longer duration than those in other electrophysiological categories. A preprint version of the manuscript is available at DOI: https://doi.org/10.21203/rs.3.rs-2181605/v1.
Collapse
Affiliation(s)
- Vida Naderi-boldaji
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farid Zand
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hoda Marbooti
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoor Masjedi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Maryam Tabibzadeh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Esmaeilinezhad
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoume Nazeri
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
43
|
Elendu C, Osamuyi EI, Afolayan IA, Opara NC, Chinedu-Anunaso NA, Okoro CB, Nwankwo AU, Ezidiegwu DO, Anunaso CA, Ogbu CC, Aghahowa SO, Atuchukwu CS, Akpa EU, Peterson JC. Clinical presentation and symptomatology of Guillain-Barré syndrome: A literature review. Medicine (Baltimore) 2024; 103:e38890. [PMID: 39058828 PMCID: PMC11272278 DOI: 10.1097/md.0000000000038890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Guillain-Barré Syndrome (GBS) is a rare but potentially life-threatening neurological disorder characterized by acute onset ascending paralysis and sensory abnormalities. This article provides a comprehensive overview of GBS, covering its epidemiology, etiology, clinical presentation, diagnostic evaluation, management and treatment, prognosis, psychosocial impact, recent advances in research, public health implications, and ethical considerations. Epidemiological data reveal variations in GBS prevalence, incidence rates, and geographical distribution influenced by climate, infectious disease prevalence, and genetic susceptibility. Etiological factors include preceding infections, vaccinations, and autoimmune mechanisms, although the precise pathophysiology remains incomplete. Clinical presentation encompasses prodromal symptoms, motor deficits, sensory abnormalities, autonomic dysfunction, and variants such as Miller-Fisher Syndrome and Bickerstaff brainstem encephalitis. Neurological examination findings include weakness, paralysis, sensory deficits, and reflex changes, while autonomic dysfunction manifests as cardiovascular, respiratory, and gastrointestinal symptoms. Diagnostic evaluation relies on clinical criteria, laboratory tests (e.g., cerebrospinal fluid analysis, nerve conduction studies), and consideration of differential diagnoses. Management strategies encompass supportive care, immunomodulatory therapies (e.g., intravenous immunoglobulin, plasma exchange), and rehabilitation interventions to optimize functional outcomes and promote recovery. Prognosis varies depending on clinical features, treatment response, and complications such as respiratory failure and autonomic instability. Psychosocial impact encompasses psychological effects on patients and caregivers, highlighting the importance of coping strategies and support systems. Recent advances in research focus on emerging treatments, genetic predisposition, and biomarker discovery, offering promise for improving GBS outcomes. Public health implications include vaccination safety concerns and healthcare system considerations for GBS management. Ethical considerations encompass patient autonomy, resource allocation, and end-of-life decision-making.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Collins C. Ogbu
- University of Port Harcourt Teaching Hospital, Choba, Nigeria
| | | | | | | | | |
Collapse
|
44
|
Tewedaj ZD, Huluka DK, Kebede YT, Abebe AT, Hussen MS, Mohammed BD, Juhar LH. A retrospective analysis of the clinical profile and factors associated with mortality and poor hospital outcomes in adult Guillain-Barre syndrome patients. Sci Rep 2024; 14:15520. [PMID: 38969647 PMCID: PMC11226644 DOI: 10.1038/s41598-024-65265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune polyneuropathy with substantial geographic variations in demography, antecedent events, clinical manifestations, electrophysiological sub-types, diagnostic findings, treatment modalities, and prognostic indicators. However, there is limited contemporary data on GBS patient profiles and prognostic factors from low-resource settings like Ethiopia. The objective of this study is to investigate the clinical profile, factors associated with mortality, and hospital outcomes among GBS patients admitted to Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. A retrospective cross-sectional study was conducted among 60 GBS patients admitted to TASH from January 2018 to December 2022. Data on demographics, clinical features, treatments, complications, and outcomes were extracted from medical records. Bivariate and multivariate logistic regression analyses identified factors associated with mortality and poor hospital outcomes. The cohort had a mean age of 28.5 years, with 76.7% aged 14-34 years. Males comprised 61.7% of cases. Ascending paralysis (76.7%) was the predominant presentation. Absent or reduced reflexes were seen in 91.7% of patients. The most common antecedent event was gastroenteritis (26.7%), followed by upper respiratory tract infection (URTI) (15%) and vaccination (11.7%). The mean interval from symptom onset to hospital presentation was 8.77 days, and the peak symptom severity was 4.47 days. The axonal variant (75.5%) was the most common subtype, followed by the demyelinating variant (24.5%). Intravenous immunoglobulin was administered to 41.7% of patients. Respiratory failure requiring invasive mechanical ventilator (MV) support occurred in 26.7% of cases. The mortality rate was 10%, with mechanical ventilation being the only factor significantly associated with mortality (95% CI 2.067-184.858; P < 0.010). At discharge, 55% had a good outcome, and 45% had a poor outcome, according to the Hughes Functional Disability Scale (HFDS). Mechanical ventilation (AOR 0.024, 95% CI 0.001-0.607) and a GBS disability score > 3 (AOR 0.106, 95% CI 0.024-0.467) were factors significantly associated with poor hospital outcomes. GBS in this cohort primarily affected individuals of young age, commonly preceded by gastroenteritis and characterized by a high frequency of the axonal variant. Mechanical ventilation was found to be significantly linked to mortality. Alongside mechanical ventilation requirements, severe disability upon presentation emerged as a crucial determinant of poor outcomes upon discharge, underscoring the importance of early identification of high-risk patients and prompt interventions.
Collapse
Affiliation(s)
- Zinabu Derso Tewedaj
- Department of Internal Medicine, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Dawit Kebede Huluka
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yabets Tesfaye Kebede
- Department of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Abel Tezera Abebe
- Department of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Meksud Shemsu Hussen
- Department of Internal Medicine, Ethio-Tebib General Hospital, Addis Ababa, Ethiopia
| | - Bekri Delil Mohammed
- Department of Internal Medicine, Ethio-Tebib General Hospital, Addis Ababa, Ethiopia
| | - Leja Hamza Juhar
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
45
|
Maini DK, Dixit A, Sharma B, Nanda S, Rehani V, Anand R. Journey of Guillain Barre syndrome from the pre-pandemic era to the pandemic era: A 4-year retrospective study. J Family Med Prim Care 2024; 13:2623-2627. [PMID: 39071018 PMCID: PMC11272027 DOI: 10.4103/jfmpc.jfmpc_1558_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 07/30/2024] Open
Abstract
Aims To study demographic and clinical profiles of Guillain Barre syndrome (GBS) in the pre-pandemic and coronavirus disease 2019 (COVID-19) pandemic era and to compare the GBS incidence, severity, and its outcome in the pre-pandemic and pandemic eras. Methodology This is a 4-year retrospective study done in a tertiary care hospital in Delhi, India, between March 2018 and March 2022. Patients were divided into the pre-pandemic era and pandemic era (2 years before and 2 years after March 2020). Results The number of patients (N) was 25 in the pandemic/vaccine era, while N = 49 in the pre-pandemic era. The mean duration of hospitalization was significantly higher (P = 0.03) during the pandemic era (10.68 ± 6.67 days) compared to the pre-pandemic era (7.59 ± 3.55 days). There was no statistical difference in age (P = 0.56), gender (P = 0.70), GBS variants (P = 0.40), clinical spectrum, antecedent infection (P = 0.91), Hughes Disability Score on admission and discharge (P = 0.93 and P = 0.52, respectively), respiratory involvement requiring a ventilator (P = 0.19), and mortality (P = 0.26) in both the eras. Conclusion Our study showed no association of the incidence of GBS with the ongoing COVID-19 pandemic. The mean hospitalization days were significantly increased during COVID-19 in view of associated respiratory involvement. The commonly held hypothesis of the increase in GBS cases during the pandemic/vaccine era has not been observed in our study.
Collapse
Affiliation(s)
- Deepinder Kaur Maini
- Amity Institute of Neuropsychology and Neurosciences, Amity University, Noida, India
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| | - Anubhuti Dixit
- Amity Institute of Neuropsychology and Neurosciences, Amity University, Noida, India
| | - Bipan Sharma
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| | - Satyan Nanda
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| | - Varun Rehani
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| | - Rajiv Anand
- Department of Neurology, BLK Max Super Speciality Hospital, Delhi, India
| |
Collapse
|
46
|
Terayama A, Kuwahara M, Yoshikawa K, Yamagishi Y, Samukawa M, Yamashita S, Onishi K, Nagano T, Tatsumi C, Ishii J, Kawamoto M, Tokashiki T, Deguchi S, Deguchi K, Ishida A, Baba Y, Yamaguchi S, Kusunoki S, Nagai Y. Takotsubo cardiomyopathy in Guillain-Barré syndrome. J Neurol 2024; 271:4067-4074. [PMID: 38573364 DOI: 10.1007/s00415-024-12295-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND PURPOSE Takotsubo cardiomyopathy (TCM) is a serious autonomic complication of Guillain-Barré syndrome (GBS). However, the association between TCM and GBS has not been investigated in detail. We investigated the characteristics of GBS patients with TCM (GBS-TCM). METHODS Clinical features and anti-ganglioside antibody between the GBS-TCM patients and 62 classical GBS patients without TCM as control patients were compared. RESULTS Eight GBS-TCM patients were identified, in whom TCM was diagnosed at a mean of 6.5 [range 3-42] days after the onset of GBS. The age at onset of GBS was elder in the GBS-TCM patients than in the control GBS patients (76.5 [56-87] vs. 52 [20-88] years, p < 0.01). Notably, cranial nerve deficits, particularly in the lower cranial nerves, were observed in all GBS-TCM patients (100% vs. 41.9%, p < 0.01). Additionally, the GBS-TCM patients showed a higher GBS disability score at nadir (5 [4-5] vs. 4 [1-5], p < 0.01), and lower Medical Research Council sum scores at admission and nadir (37 [30-44] vs. 48 [12-60] at admission, p < 0.05, and 20 [12-44] vs. 40 [0-60] at nadir, p < 0.05, respectively). Mechanical ventilation was more frequently required in the GBS-TCM patients (62.5% vs. 11.3%, p < 0.01). Three GBS-TCM patients were positive for anti-ganglioside antibodies. CONCLUSIONS TCM occurred at a relatively early phase of GBS. The characteristics of GBS-TCM were the elder, lower cranial nerve involvements, severe limb weakness, and respiratory failure.
Collapse
Affiliation(s)
- Atsushi Terayama
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Motoi Kuwahara
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan.
| | - Keisuke Yoshikawa
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yuko Yamagishi
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Makoto Samukawa
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Shoko Yamashita
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kyohei Onishi
- Department of Cardiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Tomoya Nagano
- Division of Cardiology, Kiwa Hospital, Wakayama, Japan
| | - Chikao Tatsumi
- Department of Neurology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Osaka, Japan
| | - Junko Ishii
- Department of Neurology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takashi Tokashiki
- Division of Neurology, National Hospital Organization Okinawa National Hospital, Okinawa, Japan
| | - Shoko Deguchi
- Department of Neurology, Okayama City Hospital, Okayama, Japan
| | - Kentaro Deguchi
- Department of Neurology, Okayama City Hospital, Okayama, Japan
| | - Atsushi Ishida
- Department of Neurology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Yasuhiko Baba
- Department of Neurology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Shigeki Yamaguchi
- Department of Neurology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Susumu Kusunoki
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
- Japan Community Health Care Organization Headquarters, Tokyo, Japan
| | - Yoshitaka Nagai
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| |
Collapse
|
47
|
Nukui T, Niimi H, Hayashi T, Dougu N, Yamamoto M, Shibuya R, Matsuda N, Tanaka R, Hirosawa H, Furuta R, Mitsui T, Maesaka H, Takasawa S, Kitajima I, Nakatsuji Y. Increased Cerebrospinal Fluid Adenosine 5'-Triphosphate Levels in Patients with Guillain-Barré Syndrome and Chronic Inflammatory Demyelinating Polyneuropathy. Neurol Res Int 2024; 2024:7229216. [PMID: 38887668 PMCID: PMC11182687 DOI: 10.1155/2024/7229216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/20/2024] [Accepted: 06/01/2024] [Indexed: 06/20/2024] Open
Abstract
Background Extracellular adenosine 5'-triphosphate (ATP) acts as a signaling molecule in the peripheral nerves, regulating myelination after nerve injury. The present study examined whether the cerebrospinal fluid (CSF) ATP levels in patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) are related to disease severity. Methods CSF ATP levels in 13 patients with GBS and 18 patients with CIDP were compared with those in a control group of 16 patients with other neurological diseases (ONDs). In patients with CIDP, CSF ATP levels were compared before and after treatment. The correlations between CSF ATP levels and other factors, including clinical data and CSF protein levels, were also evaluated. Results Median CSF ATP levels were significantly higher in patients with GBS and CIDP than in those with ONDs. When patients with CIDP were classified into two groups depending on their responsiveness to immunotherapy, median CSF ATP levels were significantly higher in good responders than in ONDs. CSF ATP levels tended to decrease after treatment in patients with CIDP. In patients with CIDP, there is a negative correlation between CSF ATP and CSF protein levels. Conclusions CSF ATP levels were increased in patients with GBS and CIDP. In particular, CSF ATP levels tended to decrease following treatment in patients with CIDP. CSF ATP levels may be useful biomarkers for the diagnosis or monitoring of therapeutic effects in patients with GBS and CIDP.
Collapse
Affiliation(s)
- Takamasa Nukui
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hideki Niimi
- Department of Clinical Laboratory and Molecular Pathology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Toyama, Japan
| | - Tomohiro Hayashi
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Mamoru Yamamoto
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Ryoko Shibuya
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Noriyuki Matsuda
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Ryo Tanaka
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroaki Hirosawa
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Risako Furuta
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Taichi Mitsui
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroki Maesaka
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Syuhei Takasawa
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Isao Kitajima
- Department of Clinical Laboratory and Molecular Pathology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Toyama, Japan
| | - Yuji Nakatsuji
- Department of Neurology, Faculty of Medicine, University of Toyama, Toyama, Japan
| |
Collapse
|
48
|
Hannaford A, Paling E, Silsby M, Vincenten S, van Alfen N, Simon NG. Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders. Muscle Nerve 2024; 69:653-669. [PMID: 38433118 DOI: 10.1002/mus.28068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
Electrodiagnostic studies (EDx) are frequently performed in the diagnostic evaluation of peripheral nerve disorders. There is increasing interest in the use of newer, alternative diagnostic modalities, in particular imaging, either to complement or replace established EDx protocols. However, the evidence to support this approach has not been expansively reviewed. In this paper, diagnostic performance data from studies of EDx and other diagnostic modalities in common peripheral nerve disorders have been analyzed and described, with a focus on radiculopathy, plexopathy, compressive neuropathies, and the important neuropathy subtypes of Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy and diabetic neuropathy. Overall EDx retains its place as a primary diagnostic modality in the evaluated peripheral nerve disorders. Magnetic resonance imaging and ultrasound have developed important complementary diagnostic roles in compressive and traumatic neuropathies and atypical CIDP, but their value is more limited in other neuropathy subtypes. Identification of hourglass constriction in nerves of patients with neuralgic amyotrophy may have therapeutic implications. Investigation of radiculopathy is confounded by poor correlation between clinical features and imaging findings and the lack of a diagnostic gold standard. There is a need to enhance the literature on the utility of these newer diagnostic modalities.
Collapse
Affiliation(s)
- Andrew Hannaford
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Elijah Paling
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Matthew Silsby
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sanne Vincenten
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Neil G Simon
- Northern Beaches Clinical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
49
|
Li Y, Zhao R, Li L, Xue H, Meng H, Li G, Liang F, Zhang H, Ma J, Pang X, Wang J, Chang X, Guo J, Zhang W. Relative frequencies and clinical features of Guillain-Barré Syndrome before and during the COVID-19 pandemic in North China. BMC Infect Dis 2024; 24:541. [PMID: 38816802 PMCID: PMC11138026 DOI: 10.1186/s12879-024-09401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Most studies investigated the relationship between COVID-19 and Guillain-Barré syndrome (GBS) by comparing the incidence of GBS before and during the pandemic of COVID-19. However, the findings were inconsistent, probably owing to varying degrees of the lockdown policy. The quarantine requirements and travel restrictions in China were lifted around December 7, 2022. This study aimed to explore whether the relative frequency of GBS increased during the major outbreak in the absence of COVID-19-mandated social restrictions in China. METHODS GBS patients admitted to the First Hospital, Shanxi Medical University, from December 7, 2022 to February 20, 2023, and from June, 2017 to August, 2019 were included. The relative frequencies of GBS in hospitalized patients during different periods were compared. The patients with and without SARS-CoV-2 infection within six weeks prior to GBS onset formed the COVID-GBS group and non-COVID-GBS group, respectively. RESULTS The relative frequency of GBS among hospitalized patients during the major outbreak of COVID-19 (13/14,408) was significantly higher than that before the COVID-19 epidemic (29/160,669, P < 0.001). More COVID-GBS patients (11/13) presented AIDP subtype than non-COVID-GBS cases (10/27, P = 0.003). The mean interval between onset of infective symptoms and GBS was longer in COVID-GBS (21.54 ± 11.56 days) than in non-COVID-GBS (5.76 ± 3.18 days, P < 0.001). CONCLUSIONS COVID-19 significantly increased the incidence of GBS. Most COVID-GBS patients fell into the category of AIDP, responded well to IVIg, and had a favorable prognosis.
Collapse
Affiliation(s)
- Yaqian Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Rongjuan Zhao
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ling Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Huiru Xue
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Huaxing Meng
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Guanxi Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Feng Liang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Huiqiu Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Jing Ma
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaomin Pang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xueli Chang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junhong Guo
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China.
| |
Collapse
|
50
|
Rodríguez-Méndez AA, Briseño-Ramírez J, Rivas-Ruvalcaba FJ, Solis-Estrada J, Alcázar-García LB, Díaz-Ramírez K, Lira-Jaime G, Sánchez-Román EJ, Zúñiga-Ramírez C. Clinical predictors for mechanical ventilation assistance in Guillain-Barré syndrome. Front Neurol 2024; 15:1385945. [PMID: 38784912 PMCID: PMC11111953 DOI: 10.3389/fneur.2024.1385945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Background Guillain-Barré syndrome (GBS) frequently leads to respiratory failure and autonomic dysfunction, resulting in approximately one-third of patients requiring mechanical ventilation. Objective This study aimed to identify clinical predictors for mechanical ventilation in patients with GBS. Methods This research was conducted from 2010 to 2021 using registries from a tertiary hospital in an upper middle-income Latin American country. Participants were categorized into two groups based on their ventilation status. Demographic data were collected, and independent predictors of the need for mechanical ventilation were determined through multivariate logistic regression analysis. Results Dysautonomic events occurred in 36% of the patients, with 17% requiring mechanical ventilation; the average duration of intubation was 1.16 ± 3.18 days. The multivariate analysis indicated that bulbar dysfunction significantly increased the likelihood of requiring mechanical ventilation by 19-fold (OR 18.67, 95% CI 5.85-59.42), followed by ophthalmoplegia, which increased the likelihood by sixfold (OR 5.68, 95% CI 1.28-25.19). Conclusion Bulbar dysfunction, dysautonomia, and lower Medical Research Council (MRC) scores were significant predictors of the need for mechanical ventilation in hospitalized GBS patients. These findings support the need for close monitoring and early admission to the intensive care unit (ICU) admission for at-risk patients.
Collapse
Affiliation(s)
- Axel Abel Rodríguez-Méndez
- Department of Internal Medicine, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico
| | - Jaime Briseño-Ramírez
- Department of Internal Medicine, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico
- Health Division, Tlajomulco University Center, University of Guadalajara, Guadalajara, Mexico
| | | | - Javier Solis-Estrada
- Department of Internal Medicine, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico
| | | | - Karely Díaz-Ramírez
- Department of Neurology, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico
| | - Gabriela Lira-Jaime
- Department of Neurology, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico
| | | | - Carlos Zúñiga-Ramírez
- Department of Neurology, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico
| |
Collapse
|