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      Clinical Profile, Functional Outcome, and Mortality of Guillain-Barre Syndrome: A Five-Year Tertiary Care Experience from Nepal

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          Abstract

          Introduction

          Guillain-Barre syndrome is the most common cause of acute flaccid paralysis in the adult population. It occurs at the rate of 0.34 to 4 per 100000 individuals. This study was conducted to determine the clinicoepidemiological profile and outcome of the patients with Guillain-Barre syndrome.

          Materials and Methods

          We conducted a retrospective study of patients with Guillain-Barre syndrome, presented at B.P. Koirala Institute of Health Sciences, a tertiary care centre in eastern Nepal, from January 2013 to December 2017. All patients diagnosed with Guillain-Barre syndrome were included in this study. The handwritten case record files of the study population were retrieved from medical record section of the institute.

          Results

          Of 31 patients with Guillain-Barre syndrome, the mean age of patients was 17±12 years. The most common presenting symptom of study population was ascending paralysis (93.5%). Respiratory failure requiring mechanical ventilation occurred in 16.1%. The common variants are AIDP and AMAN. Respiratory tract infection (29%) was the most common antecedent event. The in-hospital mortality of Guillain-Barre syndrome was 6.45%.

          Conclusion

          Guillain-Barre syndrome is commonly seen in the young population. The most common symptom of Guillain-Barre syndrome was ascending paralysis. The in-hospital mortality rate of patients with GBS was 6.45%.

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          Guillain-Barré syndrome: incidence and mortality rates in US hospitals.

          Amer Alshekhlee, Zulfiqar Hussain, Badr Sultan … (2008)
          To determine the incidence, in-hospital mortality, and predictors of death in Guillain-Barré syndrome (GBS) in a large US cohort. Our cohort was identified from the Nationwide Inpatient Sample database, 2000 through 2004. We excluded patients younger than 18 years and those who presented with rapidly paralyzing conditions due to other causes. GBS patients who were transferred between hospitals were counted once. The incidence rate adjusted for 20% of the US census reported by the Census Bureau. A logistic regression model was used to identify predictors of death. After data cleansing, 4,954 patients were identified with a primary diagnosis of GBS. The adjusted incidence rate varied between 1.65 and 1.79 per 100,000 during the years included in this study. The in-hospital mortality rate was 2.58% (128/4,954) and did not change significantly over the study period. Eleven percent had variable pulmonary complications, and 9.1% received endotracheal intubation, which was a predictor of mortality (adjusted odds ratio 5.09, 95% CI 3.21-8.05). Other predictors of mortality included older age, composite comorbidity index, cardiac complications, and sepsis. The mortality rate in Guillain-Barré syndrome is low, and predictors of death are similar to those predicting poor disability outcome. The disease incidence was stable over the 5 years included in this study.
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            Anti-N-methyl-D-aspartate receptor(NMDAR) antibody encephalitis presents in atypical types and coexists with neuromyelitis optica spectrum disorder or neurosyphilis

            Kaiyu Qin, Wenqing Wu, Yuming Huang … (2017)
            Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a clinically heterogeneous disorder characterized by epileptic seizures, psychosis, dyskinesia, consciousness impairments, and autonomic instability. Symptoms are always various. Sometimes it presents in milder or incomplete forms. We report 4 cases of anti-NMDAR encephalitis with incomplete forms, 3 cases of which were accompanied by neuromyelitis optica spectrum disorder or neurosyphilis respectively. Case presentation A 33-year-old man presented with dysarthria, movement disorder and occasional seizures. He had 6 relapses in 28 years. When suffered from upper respiratory tract syndrome, he developed behavioral and consciousness impairment. Cranial MRI was normal. Viral PCR studies and oncologic work-up were negative. Anti-NMDAR antibody was detected in CSF and serum. A 21-year-old female manifested dizziness and diplopia ten months and six months before, respectively. Both responded to steroid therapy and improved completely. This time she presented with progressive left limb and facial anesthesia, walking and holding unsteadily. Spinal cord MRI follow-up showed abnormality of medulla oblongata and cervical cord(C1). Anti-AQP4 and anti-NMDAR were positive in CSF. Steroid-pulse therapy ameliorated her symptoms. A 37-year-old male experienced worsening vision. He was confirmed neurosyphilis since the CSF tests for syphilis were positive. Protein was elevated and the oligoclonal IgG bands(OB) and anti-NMDAR was positive in CSF. Anti-aquaporin 4(AQP4) antibodies and NMO-IgG were negative. Cranial MRI showed high FLAIR signal on frontal lobe and low T2 signal adjacent to the right cornu posterious ventriculi lateralis. Treatment for neurosyphlis was commenced with gradual improvement. A 39-year-old male, developed serious behavioral and psychiatric symptoms. Examination showed abnormal pupils and unsteady gait. He was confirmed neurosyphilis according to the CSF tests for syphilis. Anti-NMDAR was positive in CSF and serum. Cranial MRI showed lateral ventricles and the third ventricle enlargement and signal abnormality involving bilateral temporal lobe, corona radiate and centrum semiovale. PenicillinG, pulsed methylprednisolone and intravenous immunoglobulin was administered. He was stable. Conclusion Anti-NMDAR encephalitis can present in atypical types. When relapsing, it may present with partial aspects or with isolated symptoms of the full-blown syndrome. Anti-NMDAR encephalitis may be related to neuromyelitis optica spectrum disorder or neurosyphilis.
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              Epidemiological study of Guillain-Barre syndrome in south east England

              J Rees, R Thompson, N Smeeton … (1998)
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Bhupendra Shah:
                ORCID: http://orcid.org/0000-0003-4370-0464
                Journal
                Journal ID (nlm-ta): Neurol Res Int
                Journal ID (iso-abbrev): Neurol Res Int
                Journal ID (publisher-id): NRI
                Title: Neurology Research International
                Publisher: Hindawi
                ISSN (Print): 2090-1852
                ISSN (Electronic): 2090-1860
                Publication date Collection: 2019
                Publication date (Electronic): 2 June 2019
                Volume: 2019
                Electronic Location Identifier: 3867946
                Affiliations
                1B.P. Koirala Institute of Health Sciences, Nepal
                2Department of Pediatrics and Adolescent Medicine, B.P. Koirala Institute of Health Sciences, Nepal
                3Department of Anaesthesiology and Critical Care, B.P. Koirala Institute of Health Sciences, Nepal
                4Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Nepal
                Author notes

                Academic Editor: Jeff Bronstein

                Author information
                http://orcid.org/0000-0003-4370-0464
                Article
                DOI: 10.1155/2019/3867946
                PMC ID: 6582782
                PubMed ID: 31275647
                SO-VID: dc3f17fb-ed35-4b5a-8041-981d0ead00be
                Copyright © Copyright © 2019 Saroj Kumar Bhagat et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 February 2019
                Date revision received : 25 April 2019
                Date accepted : 15 May 2019
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Neurology
                Data availability:
                ScienceOpen disciplines: Neurology

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