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Ogawa S, Hosokawa T, Hayakawa C, Sawai T, Kakiuchi K, Nishioka D, Yoshimoto Y, Masuda Y, Nakamura Y, Ota S, Arawaka S. Risk factors and outcome of hyponatremia in patients with Guillain-Barré syndrome. Sci Rep 2024; 14:16664. [PMID: 39030260 PMCID: PMC11271546 DOI: 10.1038/s41598-024-67427-6] [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: 01/14/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024] Open
Abstract
The objective of the present study was to evaluate the risk factors and outcomes associated with hyponatremia in patients with Guillain-Barré syndrome (GBS). We retrospectively studied 80 consecutive patients with GBS who visited our hospital and compared clinical, laboratory, and electrophysiological findings of patients with and without hyponatremia. Disability was evaluated using the Hughes grading system. Of the 80 patients, 18 (23%) had hyponatremia. Hyponatremia was significantly associated with older age (P = 0.003), urinary retention (P < 0.0001), Hughes grade ≥ 4 at admission and nadir (P = 0.003 and P < 0.001, respectively), acute inflammatory demyelinating polyneuropathy subtype (P = 0.017), sepsis (P = 0.001), mechanical ventilator support (P = 0.013), longer hospitalization length of stay (P < 0.0001), and inability to walk independently at 6 months (P < 0.001). Multivariate analysis performed to assess the risk factors of hyponatremia revealed that urinary retention (odds ratio [OR] 30.7, 95% confidence interval [CI] 3.6-264.4; P = 0.002) and mechanical ventilator support (OR 13.8, 95% CI 1.6-118.0; P = 0.017) were significant independent risk factors of hyponatremia. In assessing the outcomes of patients with hyponatremia, multivariate analysis showed that hyponatremia was independently associated with hospitalization length of stay ≥ 60 days and inability to walk independently at 6 month, with the former showing statistical significance but the latter not (OR 9.3, 95% CI 1.8-47.7; P = 0.007 and OR 4.9, 95% CI 0.9-26.3; P = 0.066, respectively). Therefore, we demonstrate that, along with mechanical ventilator support, urinary retention-possibly indicating autonomic dysfunction-is a risk factor of hyponatremia in GBS. Moreover, we confirm that hyponatremia is associated with poor outcome in GBS.
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Affiliation(s)
- Shoji Ogawa
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Takafumi Hosokawa
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Chizuko Hayakawa
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Taiki Sawai
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kensuke Kakiuchi
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Daisuke Nishioka
- Department of Medical Statistics, Research and Development Center, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Yukiyo Yoshimoto
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yuichi Masuda
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshitsugu Nakamura
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shin Ota
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shigeki Arawaka
- Division of Neurology, Department of Internal Medicine IV, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Titus J, Sarmiento B, Crouse R. Management of Severe Pain in a Case of Sensory Guillain-Barre Syndrome. Cureus 2024; 16:e64432. [PMID: 39130815 PMCID: PMC11317124 DOI: 10.7759/cureus.64432] [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: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Guillain-Barre syndrome (GBS) is an acute post-infectious polyradiculoneuropathy characterized by autoantibodies targeting host antigens, resulting in nerve fiber demyelination and axonal degeneration. While symmetric ascending weakness is typical, neuropathic pain is a common yet variable manifestation. We present a case of a 52-year-old man with progressive bilateral leg weakness and severe neuropathic pain following a flu-like illness. Despite conventional analgesics, his pain persisted, necessitating a unique pain management approach. The patient's examination revealed hyporeflexia and sensory deficits consistent with GBS. Diagnostic workup, including lumbar puncture, showed albuminocytologic dissociation. Plasma exchange therapy was initiated, but severe nocturnal neuropathic pain persisted, exacerbating during treatment. Conventional pain medications were ineffective, prompting a multimodal approach. Combining hydromorphone and lorazepam provided significant pain relief, enabling completion of plasmapheresis sessions. This regimen, supplemented with gabapentin, proved effective in managing both GBS-associated and treatment-induced pain. This case underscores the debilitating nature of GBS-related pain and the importance of tailored pain management strategies. While conventional agents may fail, a multimodal approach, including opioids and adjunctive medications, can offer relief, facilitating essential treatments like plasmapheresis. Careful monitoring is imperative to mitigate risks associated with potent analgesics. Our experience contributes to the armamentarium for managing GBS-related pain, emphasizing individualized care to improve patient outcomes.
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Affiliation(s)
- Joane Titus
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Bernard Sarmiento
- Neurology, University of Central Florida College of Medicine, Orlando, USA
| | - Roger Crouse
- Internal Medicine, University of Central Florida Hospital Corporation of America (HCA) Healthcare Graduate Medical Education (GME), Orlando, USA
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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.
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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
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Ji X, Zhu J, Li L, Yang X, Zhou S, Cao L. Anti-sulfatide antibody-related Guillain-Barré syndrome presenting with overlapping syndromes or severe pyramidal tract damage: a case report and literature review. Front Neurol 2024; 15:1360164. [PMID: 38654738 PMCID: PMC11035893 DOI: 10.3389/fneur.2024.1360164] [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: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Anti-sulfatide antibodies are key biomarkers for the diagnosis of Guillain-Barré syndrome (GBS). However, case reports on anti-sulfatide antibody-related GBS are rare, particularly for atypical cases. Case description case 1 A 63 years-old man presented with limb numbness and diplopia persisting for 2 weeks, with marked deterioration over the previous 4 days. His medical history included cerebral infarction, diabetes, and coronary atherosclerotic cardiomyopathy. Physical examination revealed limited movement in his left eye and diminished sensation in his extremities. Initial treatments included antiplatelet agents, cholesterol-lowering drugs, hypoglycemic agents, and medications to improve cerebral circulation. Despite this, his condition worsened, resulting in bilateral facial paralysis, delirium, ataxia, and decreased lower limb muscle strength. Treatment with intravenous high-dose immunoglobulin and dexamethasone resulted in gradual improvement. A 1 month follow-up revealed significant neurological sequelae. Case description case 2 A 53 years-old woman was admitted for adenomyosis and subsequently experienced sudden limb weakness, numbness, and pain that progressively worsened, presenting with diminished sensation and muscle strength in all limbs. High-dose intravenous immunoglobulin, vitamin B1, and mecobalamin were administered. At the 1 month follow-up, the patient still experienced limb numbness and difficulty walking. In both patients, albuminocytologic dissociation was found on cerebrospinal fluid (CSF) analysis, positive anti-sulfatide antibodies were detected in the CSF, and electromyography indicated peripheral nerve damage. Conclusion Anti-sulfatide antibody-related GBS can present with Miller-Fisher syndrome, brainstem encephalitis, or a combination of the two, along with severe pyramidal tract damage and residual neurological sequelae, thereby expanding the clinical profile of this GBS subtype. Anti-sulfatide antibodies are a crucial diagnostic biomarker. Further exploration of the pathophysiological mechanisms is necessary for precise treatment and improved prognosis.
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Affiliation(s)
- Xiaotian Ji
- Department of Neurology, Sanya People’s Hospital, Sanya, China
| | - Jiaqian Zhu
- School of Medicine, Shenzhen University, Shenzhen, China
- Department of Neurology, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Lujiang Li
- Department of Neurology, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaodan Yang
- Department of Neurology, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shaolong Zhou
- Department of Neurology, Sanya People’s Hospital, Sanya, China
| | - Liming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China
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Liu S, Zhang WW, Jia L, Zhang HL. Guillain-Barré syndrome: immunopathogenesis and therapeutic targets. Expert Opin Ther Targets 2024; 28:131-143. [PMID: 38470316 DOI: 10.1080/14728222.2024.2330435] [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: 09/17/2023] [Accepted: 03/10/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a group of acute immune-mediated disorders in the peripheral nervous system. Both infectious and noninfectious factors are associated with GBS, which may act as triggers of autoimmune responses leading to neural damage and dysfunction. AREAS COVERED Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccines as well as flaviviruses have been associated with GBS, although a robust conclusion has yet to be reached. Immunomodulatory treatments, including intravenous immunoglobulins (IVIg) and plasma exchange (PE), have long been the first-line therapies for GBS. Depending on GBS subtype and severity at initial presentation, the efficacy of IVIg and PE can be variable. Several new therapies showing benefits to experimental animals merit further investigation before translation into clinical practice. We review the state-of-the-art knowledge on the immunopathogenesis of GBS in the context of coronavirus disease 2019 (COVID-19). Immunomodulatory therapies in GBS, including IVIg, PE, corticosteroids, and potential therapies, are summarized. EXPERT OPINION The association with SARS-CoV-2 remains uncertain, with geographical differences that are difficult to explain. Evidence and guidelines are lacking for the decision-making of initiating immunomodulatory therapies in mildly affected patients or patients with regional subtypes of GBS.
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Affiliation(s)
- Shan Liu
- Department of Nuclear Medicine, Second Hospital of Jilin University, Changchun, China
| | - Wei Wei Zhang
- Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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Elhadi M, Khan D, Carabenciov ID. 62-Year-Old Man Presenting With Diarrhea and Quadriparesis. Mayo Clin Proc 2023; 98:1858-1862. [PMID: 38044000 DOI: 10.1016/j.mayocp.2023.03.027] [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: 11/28/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Mohamed Elhadi
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Daniel Khan
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ivan D Carabenciov
- Advisor to residents and Consultant in Neurology, Mayo Clinic, Rochester, MN.
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Krall JTW, Chakravartty A, Caress JB, Files DC. Identification and Management of Acute Neuromuscular Respiratory Failure in the ICU. Chest 2023; 164:1454-1461. [PMID: 38070961 DOI: 10.1016/j.chest.2023.09.009] [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: 05/31/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023] Open
Abstract
Respiratory failure is a common and potentially life-threatening complication of neuromuscular diseases. Prompt recognition and accurate diagnosis of new or worsening chronic neuromuscular disease have important clinical management and prognostic implications. In this article, we present an approach to the acute presentation of undifferentiated neuromuscular respiratory failure in the ICU and guidance for determination and respiratory management of the underlying disorder.
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Affiliation(s)
- Jennifer T W Krall
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Akash Chakravartty
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - James B Caress
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - D Clark Files
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC
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Madike R, Muecke T, Dishnica N, Zhu L, Tan S, Kovoor J, Stretton B, Gupta A, Harroud A, Bersten A, Schultz D, Bacchi S. A vital parameter? Systematic review of spirometry in evaluation for intensive care unit admission and intubation and ventilation for Guillain-Barré syndrome. J Clin Neurosci 2023; 113:13-19. [PMID: 37146475 DOI: 10.1016/j.jocn.2023.04.022] [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: 01/22/2023] [Revised: 04/09/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Patients with Guillain-Barré syndrome (GBS) may require intensive care unit (ICU) admission for intubation and ventilation (I + V). The means to predict which patients will require I + V include spirometry measures. The aims of this study were to determine, for adult patients with GBS, how effectively different spirometry parameter thresholds predict the need for ICU admission and the requirement for I + V; and what effects these different parameter thresholds have on GBS patient outcomes. METHOD A systematic review was conducted of the databases PubMed, EMBASE, and Cochrane library in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review was registered prospectively on PROSPERO. RESULTS Initial searches returned 1011 results, of which 8 fulfilled inclusion criteria. All included studies were observational in nature. Multiple studies suggest that a vital capacity below 60% of predicted value on admission is associated with the need for eventual I + V. No included studies evaluated peak expiratory flow rate, or interventions with different thresholds for ICU or I + V. CONCLUSIONS There is a relationship between vital capacity and the need for I + V. However, there is limited evidence supporting specific thresholds for I + V. In addition to evaluating these factors, future research may evaluate the effect of different patient characteristics, including clinical presentation, weight, age, and respiratory comorbidities, on the effectiveness of spirometry parameters in the prediction of the need for I + V.
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Affiliation(s)
- Reema Madike
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia.
| | - Thomas Muecke
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Noel Dishnica
- Health and Information, Adelaide SA 5000, Australia; Flinders University, Bedford Park SA 5042, Australia
| | - Linyi Zhu
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Aashray Gupta
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Adil Harroud
- McGill University, Montreal, Quebec H3A 0G4, Canada
| | | | - David Schultz
- Flinders University, Bedford Park SA 5042, Australia
| | - Stephen Bacchi
- University of Adelaide, Adelaide SA 5005, Australia; Health and Information, Adelaide SA 5000, Australia; Flinders University, Bedford Park SA 5042, Australia; Royal Adelaide Hospital, Adelaide SA 5000, Australia
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Neumeister J, Huang D, Dzluneski S, Huttleston AM, Megargel C, Falgiani M, Ganti L. Hyperacute and Fulminant Guillain-Barré Syndrome Requiring Emergent Intubation. Cureus 2023; 15:e38499. [PMID: 37273381 PMCID: PMC10237680 DOI: 10.7759/cureus.38499] [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: 05/01/2023] [Indexed: 06/06/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune-mediated acute polyneuropathy that can progress to life-threatening respiratory failure. The diagnosis and treatment of this pathology are complicated by the rarity of the disease and diversity in clinical presentation due to rarer, more dangerous subtypes of GBS. Understanding the time course of progression from onset to nadir of neurological deficits, maintaining a high index of suspicion, and close airway monitoring are essential in rapid diagnosis, securing the airway, and treatment.
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Affiliation(s)
| | - Derrick Huang
- Emergency Medicine, HCA Florida Ocala Hospital, Ocala, USA
| | | | | | | | - Michael Falgiani
- Emergency Medicine, HCA Florida Ocala Hospital, Ocala, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Latha Ganti
- Emergency Medicine, HCA Florida Ocala Hospital, Ocala, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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Trollip E, Hawkins K, Kwek I, Dewart K, Qureshi M, Senaratne JM. Bupivacaine and morphine epidural use for refractory neuropathic pain relief in a Guillain-Barré syndrome patient. Clin Case Rep 2023; 11:e7221. [PMID: 37155422 PMCID: PMC10122688 DOI: 10.1002/ccr3.7221] [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: 08/22/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
Pain is common in the acute phase of Guillain-Barré Syndrome and can be severe and refractory. Pain in GBS may not always respond to contemporary pain therapy. An epidural can potentially be considered for the treatment of refractory pain after a careful patient-centered discussion with the patient about risks.
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Affiliation(s)
- Eudiet Trollip
- Department of Anesthesiology and Pain MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Ken Hawkins
- Department of Anesthesiology and Pain MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Isabel Kwek
- Department of Critical Care MedicineGrey Nuns HospitalEdmontonAlbertaCanada
| | - Krista Dewart
- Department of Critical Care MedicineGrey Nuns HospitalEdmontonAlbertaCanada
| | - Mehvash Qureshi
- Department of Critical Care MedicineGrey Nuns HospitalEdmontonAlbertaCanada
| | - Janek Manoj Senaratne
- Department of Critical Care MedicineGrey Nuns HospitalEdmontonAlbertaCanada
- Department of Critical Care MedicineUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
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Younger DS. Critical illness-associated weakness and related motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:707-777. [PMID: 37562893 DOI: 10.1016/b978-0-323-98818-6.00031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Weakness of limb and respiratory muscles that occurs in the course of critical illness has become an increasingly common and serious complication of adult and pediatric intensive care unit patients and a cause of prolonged ventilatory support, morbidity, and prolonged hospitalization. Two motor disorders that occur singly or together, namely critical illness polyneuropathy and critical illness myopathy, cause weakness of limb and of breathing muscles, making it difficult to be weaned from ventilatory support, commencing rehabilitation, and extending the length of stay in the intensive care unit, with higher rates of morbidity and mortality. Recovery can take weeks or months and in severe cases, and may be incomplete or absent. Recent findings suggest an improved prognosis of critical illness myopathy compared to polyneuropathy. Prevention and treatment are therefore very important. Its management requires an integrated team approach commencing with neurologic consultation, creatine kinase (CK) measurement, detailed electrodiagnostic, respiratory and neuroimaging studies, and potentially muscle biopsy to elucidate the etiopathogenesis of the weakness in the peripheral and/or central nervous system, for which there may be a variety of causes. These tenets of care are being applied to new cases and survivors of the coronavirus-2 disease pandemic of 2019. This chapter provides an update to the understanding and approach to critical illness motor disorders.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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12
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Upadhyay P, Saroa R. A Stitch in Time Defeats the Landry-Guillain-Barré Strohl Syndrome. Cureus 2022; 14:e29047. [PMID: 36237757 PMCID: PMC9553069 DOI: 10.7759/cureus.29047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
The Landry-Guillain-Barré Strohl Syndrome (LGBS) or Guillain-Barré syndrome (GBS) is an acute, frequently severe, potentially fatal, and fulminant polyradiculopathy. It is an autoimmune illness, which usually occurs as a sequela of certain known infections. In this case report, we are discussing the case of a 12-year-old girl who was managed in the ICU for LGBS successfully and recovered promptly. This case highlights the importance of timely administration of intravenous immunoglobulin (IVIG) therapy, which resulted in prompt recovery, reduced duration of ICU stay, and morbidity.
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Devlin I, Williams KL, Shrubsole K. Fragmented care and missed opportunities: the experiences of adults with myasthenia gravis in accessing and receiving allied health care in Australia. Disabil Rehabil 2022:1-9. [PMID: 35786287 DOI: 10.1080/09638288.2022.2094481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Although allied health services are important adjuncts to medical care for people with myasthenia gravis (MG), the underutilisation of these services is not well understood within the Australian context. It is critical to explore patients' perceptions to develop services that meet consumer needs. This study, therefore, sought to obtain insight into MG patients' perspectives and experiences, in addition to the outcomes, of accessing allied health services. MATERIALS AND METHODS Thirteen Australian adults with MG participated in semi-structured interviews. Qualitative analysis was conducted inductively using thematic content analysis. RESULTS Four themes were identified: (1) missed opportunities and unmet care needs were common, due to frequent patient-provider communication breakdowns and a lack of referral protocols, (2) personal factors - patient self-advocacy influenced their perceived need, with some lacking confidence to seek help, (3) perceived benefit and health provider capacities - most valued allied health despite differing perceptions of health professionals' attitudes, skills, and willingness to learn, and (4) a resultant fragmentation of care between services was universal. CONCLUSIONS Findings highlighted a need for clear referral pathways, coordinated multidisciplinary care, improved access to community-based services and education for allied health professionals about MG.Implications for rehabilitationAdults with myasthenia gravis (MG) report a lack of referral pathways to allied health services, leading to unmet needs and fragmented care.Although there is a perceived benefit to allied health care, experiences are impacted by health provider capacity and attitudes.There needs to be an overall shift towards multidisciplinary care for people with MG, and the development of clear referral pathways.Specific education about MG should be available for allied health professionals to improve their knowledge and skills in treating this population.
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Affiliation(s)
- Isobel Devlin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katrina L Williams
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Faculty of Health, Southern Cross University, Gold Coast, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
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Huhta TA, Ran L, Cooper CW, Davis MJ, Kornbluth J, Salem DN. An Association of Takotsubo Cardiomyopathy with Guillain-Barré Syndrome. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: 10.2147/rrcc.s336664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Shah N, Shrivastava M, Kumar S, Nagi RS. Supervised, individualised exercise reduces fatigue and improves strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome: a randomised trial. J Physiother 2022; 68:123-129. [PMID: 35396175 DOI: 10.1016/j.jphys.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022] Open
Abstract
QUESTION In people in the chronic phase of Guillain-Barré syndrome (GBS), how much more does a supervised, individualised exercise program improve functional independence with activities of daily living than a home-based exercise program? How do the two exercise programs compare regarding their effects on muscle strength, fatigue, pain and quality of life? DESIGN Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of outcome assessors. PARTICIPANTS Sixteen adults with stable residual disability ≥ 6 months after the onset of GBS. INTERVENTION Participants in the experimental group were allocated to 60-minute sessions of physiotherapist-supervised strengthening, endurance and breathing exercises, gait training and pain management, two to three sessions/week for 12 weeks. The control group was prescribed a home program of 30-minute sessions of maintenance exercises and education in self-management, two to three sessions/week for 12 weeks. OUTCOME MEASURES Functional independence in activities of daily living on the 100-point Barthel Index (primary outcome), muscle strength on the 60-point Medical Research Council scale, fatigue on the 0-to-63 Fatigue Severity Scale, a visual analogue scale of pain severity, and quality of life, measured at baseline and months 6 and 12. RESULTS At month 6, the median between-group difference was 5 (95% CI 0 to 20) for functional independence, 8 (95% CI 4 to 18) for strength, -13 (95% CI -28 to -1) for fatigue, and 12 (95% CI 3 to 13) for the environment domain of quality of life. Estimated effects at month 12 had a similar magnitude, but most of the CIs had greater uncertainty. CONCLUSION Supervised, individualised exercise reduced fatigue and improved strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome. REGISTRATION CTRI/2016/08/007150.
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Affiliation(s)
- Nehal Shah
- Department of Physiotherapy, Bhopal Memorial Hospital & Research Centre, Bhopal, India
| | | | - Sanjeev Kumar
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Raunaq Singh Nagi
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, India
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Li Q, Liu J, Jiang W, Jiang L, Lu M, Xiao L, Li Y, Lan Y, Li Y. A case of brucellosis-induced Guillain–Barre syndrome. BMC Infect Dis 2022; 22:72. [PMID: 35057735 PMCID: PMC8781241 DOI: 10.1186/s12879-021-07025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022] Open
Abstract
Background Guillain–Barre syndrome (GBS) is a rare neurological complication of brucellosis, and neurobrucellosis is the most common, but they have many similarities in clinical manifestations. Many clinicians are accustomed to merely explaining the manifestations of nervous system involvement with neurobrucellosis, but they ignore the possibility of GBS, and this leads to misdiagnosis, untimely treatment, and serious consequences. Case presentation A 55-year-old male patient was admitted to The First Affiliated Hospital of Harbin Medical University for intermittent fever, fatigue, and waist pain more than three months. Brucellosis was diagnosed from the blood test. Although anti-brucella treatment was given at the time of diagnosis, the disease continued to progress. At the time of the cerebrospinal fluid systematic physical examination and the neuroelectrophysiological test, acute motor sensory axonal neuropathy was diagnosed. The patient was given immediately administered immunoglobulin therapy. After three months of systemic treatment, the patient's muscle strength of the distal limbs gradually recovered. The numbness of the limbs eased slowly, and urination function and respiratory function returned to normal. He could sit by himself. Conclusions The possibility of GBS should be closely monitored for when a brucellosis patient shows typical clinical manifestations of progressive muscle weakness, protein-cell separation of the cerebral spinal fluid, and typical demyelinating sensorimotor polyneuropathy.
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Abidoye O, Raybon-Rojas E, Ogbuagu H. A Rare Case of Epstein-Barr Virus: Infectious Mononucleosis Complicated by Guillain-Barré Syndrome. Cureus 2022; 14:e21085. [PMID: 35165547 PMCID: PMC8827493 DOI: 10.7759/cureus.21085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/28/2022] Open
Abstract
Infectious mononucleosis (IM) is an acute disease caused by Epstein-Barr virus (EBV) infection affecting adolescents and young adults. Clinically, IM presents with fever, lymphadenopathy, and tonsillar pharyngitis. Guillain-Barré syndrome (GBS) has been reported as a possible rare complication of IM. IM-induced GBS is known but rarely reported in the literature. Here, we describe the case of a 19-year-old male with no significant medical history who was diagnosed with GBS following EBV-associated IM. A 19-year-old Caucasian male presented from a referring facility after complaining of generalized weakness involving the upper and lower extremity for about five days. Symptoms began with a sensation of tingling and numbness in the fingertips and toes that progressed over five days to where he was no longer able to ambulate. Physical examination was significant for oropharyngeal exudates, posterior oropharyngeal erythema, tonsillar hypertrophy, cervical lymphadenopathy, flaccid paralysis with areflexia, and paresthesia. Diagnostic workup was consistent with IM and GBS based on cerebrospinal findings. He was subsequently admitted to the intensive care unit, where he received plasmapheresis and intravenous immunoglobulin with significant improvement. This is a rare case of EBV-associated IM GBS. IM is a self-limiting disease but can lead to GBS as one of the known but rare complications. Neurological events have been reported in approximately 2% of patients. Only a few cases of IM leading to GBS have been reported in the literature. Detailed history and physical examination can help identify patients with IM-induced GBS. Moreover, increased awareness can help physicians easily identify and manage GBS, enabling timely recognition and initiation of prompt supportive care to improve recovery time.
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Vianello A, Racca F, Vita GL, Pierucci P, Vita G. Motor neuron, peripheral nerve, and neuromuscular junction disorders. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:259-270. [PMID: 36031308 DOI: 10.1016/b978-0-323-91532-8.00014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In amyotrophic lateral sclerosis (ALS), Guillain-Barré syndrome (GBS), and neuromuscular junction disorders, three mechanisms may lead, singly or together, to respiratory emergencies and increase the disease burden and mortality: (i) reduced strength of diaphragm and accessory muscles; (ii) oropharyngeal dysfunction with possible aspiration of saliva/bronchial secretions/drink/food; and (iii) inefficient cough due to weakness of abdominal muscles. Breathing deficits may occur at onset or more often along the chronic course of the disease. Symptoms and signs are dyspnea on minor exertion, orthopnea, nocturnal awakenings, excessive daytime sleepiness, fatigue, morning headache, poor concentration, and difficulty in clearing bronchial secretions. The "20/30/40 rule" has been proposed to early identify GBS patients at risk for respiratory failure. The mechanical in-exsufflator is a device that assists ALS patients in clearing bronchial secretions. Noninvasive ventilation is a safe and helpful support, especially in ALS, but has some contraindications. Myasthenic crisis is a clinical challenge and is associated with substantial morbidity including prolonged mechanical ventilation and 5%-12% mortality. Emergency room physicians and consultant pulmonologists and neurologists must know such respiratory risks, be able to recognize early signs, and treat properly.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Fabrizio Racca
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gian Luca Vita
- Unit of Neurology, Emergency Department, P.O. Piemonte, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Giuseppe Vita
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, Messina University Hospital, Messina, Italy.
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Hu K, Liu W, Gan Y, Huang Z. Transcriptome analysis of childhood Guillain-Barré syndrome associated with supportive care. Front Pediatr 2022; 10:1008996. [PMID: 36225338 PMCID: PMC9549380 DOI: 10.3389/fped.2022.1008996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Childhood Guillain-Barré syndrome (GBS) is a rare neurological disease. Early diagnosis followed by precise treatment can reduce mortality. In this study, we collected two transcriptome data between GBS and controls from the publicly available databases (GEO dataset). We identified two distinct down-regulated genes (PTGDS and AR) in GBS by transcriptome analysis (n = 20). Based on the two distinct down-regulated genes in the GBS group, a two-gene diagnostic signature was developed. Moreover, gene expression analysis for the two-gene was performed on a patient with GBS before and after Supportive Care. RT-PCR results show that the expression of PTGDS increased after the patient was given supportive care. Therefore, PTGDS might be considered as a potential target for therapeutic target in GBS.
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Affiliation(s)
- Ke Hu
- Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanli Liu
- Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Gan
- Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaoxuan Huang
- Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Taran S, McCredie VA, Goligher EC. Noninvasive and invasive mechanical ventilation for neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:361-386. [PMID: 36031314 DOI: 10.1016/b978-0-323-91532-8.00015-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patients with acute neurologic injuries frequently require mechanical ventilation due to diminished airway protective reflexes, cardiopulmonary failure secondary to neurologic insults, or to facilitate gas exchange to precise targets. Mechanical ventilation enables tight control of oxygenation and carbon dioxide levels, enabling clinicians to modulate cerebral hemodynamics and intracranial pressure with the goal of minimizing secondary brain injury. In patients with acute spinal cord injuries, neuromuscular conditions, or diseases of the peripheral nerve, mechanical ventilation enables respiratory support under conditions of impending or established respiratory failure. Noninvasive ventilatory approaches may be carefully considered for certain disease conditions, including myasthenia gravis and amyotrophic lateral sclerosis, but may be inappropriate in patients with Guillain-Barré syndrome or when relevant contra-indications exist. With regard to discontinuing mechanical ventilation, considerable uncertainty persists about the best approach to wean patients, how to identify patients ready for extubation, and when to consider primary tracheostomy. Recent consensus guidelines highlight these and other knowledge gaps that are the focus of active research efforts. This chapter outlines important general principles to consider when initiating, titrating, and discontinuing mechanical ventilation in patients with acute neurologic injuries. Important disease-specific considerations are also reviewed where appropriate.
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Affiliation(s)
- Shaurya Taran
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada.
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El-Abassi RN, Soliman M, Levy MH, England JD. Treatment and Management of Autoimmune Neuropathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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22
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Kumar M, Kalita J, Kant Misra U, Dhar N. Prediction models for mechanical ventilation and outcome in Guillain-Barré syndrome. J Clin Neurosci 2021; 92:131-135. [PMID: 34509240 DOI: 10.1016/j.jocn.2021.07.060] [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: 05/11/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
Various prediction models have been formulated to predict the need for mechanical ventilation (MV). In this study, we compare the sensitivity and specificity of Erasmus GBS Respiratory Insufficiency Score (EGRIS) and Sharshar score with single breath count (SBC) at 2 Hz to assess their usefulness in predicting MV and functional outcome. The primary outcome was prediction of MV and relative usefulness of all three models based on sensitivity and specificity. The secondary outcome was functional recovery at 6 months using the cut off points for MV and functional outcome at 6months was assessed using Hughes scale and categorized as good (<2) and poor (≥2). The median age was 30 years, and 64 (69.6%) were males. The sensitivity and specificity of EGRIS score was 78.1% and 67.2%, Sharshar score was 75.0% and 64.1%, and SBC at 2 Hz was 78.1% and 75.0%. The area under the receiver operating curves was maximum for SBC at 2 Hz (0.86) compared to other models, although insignificant. EGRIS score < 5 had better functional recovery compared to those with score ≥ 5 (66% vs 34%, p = 0.001). Similarly, in Sharshar score, 23/59 (39%) with score ≥ 4 had good recovery compared to 36 (61%) with score < 4 (p = 0.01). All the three models have comparable predictive values for MV. Outcome prediction is the best with EGRIS.
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Affiliation(s)
- Mritunjai Kumar
- Department of Neurology, AIIMS, Rishikesh, Uttarakhand, India
| | - Jayantee Kalita
- Ex-HOD, Department of Neurology, Sanjay Gandhi PGIMS, Lucknow 226014, Uttar Pradesh, India.
| | - Usha Kant Misra
- Ex-HOD, Department of Neurology, Sanjay Gandhi PGIMS, Lucknow 226014, Uttar Pradesh, India; Apollo Medics Super-specialty Hospitals and Senior Consultant Neurologist, Vivekanand Polyclinic, and Institute of Medical Science, Lucknow 22600, India.
| | - Nikita Dhar
- Department of Neurology, AIIMS, Rishikesh, Uttarakhand, India
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Wen P, Wang L, Liu H, Gong L, Ji H, Wu H, Chu W. Risk factors for the severity of Guillain-Barré syndrome and predictors of short-term prognosis of severe Guillain-Barré syndrome. Sci Rep 2021; 11:11578. [PMID: 34079013 PMCID: PMC8172857 DOI: 10.1038/s41598-021-91132-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 01/28/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is a neurological disorder characterized by paralysis. Identifying the severity, appropriate therapeutic method, and prognosis of GBS at an early stage is highly important. This study aimed to investigate the modifiable risk factors for the severity of GBS and consequent need for mechanical ventilation (MV) and to identify clinical predictive factors for poor short-term outcomes of severe GBS. 155 GBS patients who were admitted to the Affiliated Yantai Yuhuangding Hospital of Qingdao University during 2014–2020 were enrolled. Demographic, clinical, therapeutic and evolutionary data were collected and were then analyzed using univariate and multivariate regression analyses. Our analytic data demonstrated that the significant clinical predictors of severe GBS were recent history of surgery, older age, cranial nerve impairment, and elevated levels of liver enzymes (p < 0.05). Furthermore, autonomic dysfunction, lower Medical Research Council (MRC) score at nadir, and elevated levels of liver enzymes were significantly associated with MV for severe GBS (p < 0.05), and lower MRC score at nadir and autonomic dysfunction remained significant predictors of MV in severe GBS (p < 0.05). Lastly, recent history of surgery, lower MRC score at admission and at nadir, requirement for MV, and pneumonia during hospitalization were significantly associated with the short-term outcome of severe GBS and that lower MRC score at admission and need for MV were confirmed to be predictors of poor short-term prognosis (p < 0.05). Of note, this study suggested that recent history of surgery is a predictor of severity in GBS patients and is associated with the poor short-term prognosis of severe GBS.
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Affiliation(s)
- Puyuan Wen
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Lisha Wang
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Hong Liu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Li Gong
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Han Ji
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Hongliang Wu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China.
| | - Wenzheng Chu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China.
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Roberts M, Jin P, Shin S, Dhamoon M. Readmissions After Guillain-Barre Syndrome: Nationally Representative Data. J Clin Neuromuscul Dis 2021; 22:183-191. [PMID: 34019002 DOI: 10.1097/cnd.0000000000000319] [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: 06/12/2023]
Abstract
OBJECTIVES We aimed to obtain nationally representative data on hospital readmission rates after Guillain-Barre syndrome (GBS). METHODS International Classification of Disease, Ninth Revision codes from the 2013 National Readmissions Database identified adult GBS admissions, comorbidities, and readmission diagnoses. Logistic regression estimated odds ratios (ORs) for readmission. RESULTS Of 2109 GBS admissions identified, 20.8% were readmitted within 1 year and 12.2% within 30 days. Age did not predict readmission. Plasmapheresis use showed a nonsignificant trend toward readmission versus intravenous immunoglobulin use [OR 1.43, 95% confidence interval (CI) 1.00-2.051, P = 0.050]. Respiratory failure (OR 1.70, 95% CI 1.23-2.35, P = 0.0014), heart failure (OR 2.14, 95% CI 1.25-3.66, P = 0.0057), and renal failure (OR 2.00, 95% CI 1.20-3.32, P = 0.0078) predicted readmission. Top readmission diagnoses included GBS or chronic inflammatory demyelinating polyneuropathy (42.0%) and sepsis (3.5%). CONCLUSIONS One-fifth of GBS patients were readmitted within 1 year. Comorbid illnesses and respiratory complications increased a readmission risk but age did not.
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Affiliation(s)
- Mallory Roberts
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
| | - Peter Jin
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
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Meythaler JM, Brunner RC, Peduzzi J. Phase IIB Randomized Trial on the Use of 4-Aminopyridine in Guillain-Barré Syndrome. Arch Rehabil Res Clin Transl 2021; 3:100123. [PMID: 34179759 PMCID: PMC8212006 DOI: 10.1016/j.arrct.2021.100123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine the safety and efficacy of orally delivered 4-aminopyridine (4-AP) in persons with Guillain-Barré Syndrome (GBS) >6 months from initial diagnosis. DESIGN A randomized, double-blind, placebo-controlled, crossover study. SETTING Tertiary care clinical outpatient program. PARTICIPANTS Nineteen participants enrolled (14 male, 5 female; N=19), neurologic impairment secondary to GBS and functional loss on the FIM motor score (stable for ≥12mo) and >3.0 but <5.0 on the American Spinal Injury motor scale. Twelve participants (mean age, 59y; range, 23-77y) completed the study. INTERVENTIONS A 4-AP dose-escalation study with 8 weeks in each period with a 3-week washout period, followed by 3 months open-label follow-up. MAIN OUTCOME MEASURES FIM motor score was the primary outcome measure; also evaluated were the American Spinal Injury motor strength score (all limbs), handheld dynamometer, 6-minute walk test, Medical Outcomes Study 12-Item Short Form, Center for Epidemiological Studies Depression scale, Positive and Negative Affect Schedule, pain, GBS disability scale, Jepsen-Taylor Hand Function Test, Minnesota Manual Dexterity Test and Minnesota Rate of Manipulation Test, Get Up and Go Test, McGill Pain Inventory, Craig Handicap Assessment and Reporting Technique, and participant self-evaluation. RESULTS Seven participants discontinued the study prematurely: 3 because of adverse events, 3 because of travel difficulties or relocation, and 1 because of pretreatment laboratory abnormalities. After removing 3 participants with maximum FIM scores, 4-AP arm trended superior to placebo (P=.065). Patients subjectively could always tell when they were on the active agent usually by tingling sensations or a sense of wellness. No statistically significant differences were found for other outcome measures although there were strong trends. CONCLUSIONS This study demonstrates the safety of 4-AP in the patient population with GBS as the predominate goal of the study. A trend toward improved function after treatment was noted with most patients electing to stay on the medication after the trial.
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Affiliation(s)
- Jay M. Meythaler
- Department of Physical Medicine and Rehabilitation-Oakwood, Wayne State University School of Medicine, Vestavia Hills, Alabama
| | - Robert C. Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jean Peduzzi
- Department of Physical Medicine and Rehabilitation-Oakwood, Wayne State University School of Medicine, Vestavia Hills, Alabama
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Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep 2021; 70:1-30. [PMID: 33956777 PMCID: PMC8112830 DOI: 10.15585/mmwr.rr7002a1] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Botulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. Botulinum neurotoxin, which inhibits acetylcholine release at the neuromuscular junction, is produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, rarely, by related species (C. baratii and C. butyricum). Exposure to the neurotoxin occurs through ingestion of toxin (foodborne botulism), bacterial colonization of a wound (wound botulism) or the intestines (infant botulism and adult intestinal colonization botulism), and high-concentration cosmetic or therapeutic injections of toxin (iatrogenic botulism). In addition, concerns have been raised about the possibility of a bioterrorism event involving toxin exposure through intentional contamination of food or drink or through aerosolization. Neurologic symptoms are similar regardless of exposure route. Treatment involves supportive care, intubation and mechanical ventilation when necessary, and administration of botulinum antitoxin. Certain neurological diseases (e.g., myasthenia gravis and Guillain-Barré syndrome) have signs and symptoms that overlap with botulism. Before the publication of these guidelines, no comprehensive clinical care guidelines existed for treating botulism. These evidence-based guidelines provide health care providers with recommended best practices for diagnosing, monitoring, and treating single cases or outbreaks of foodborne, wound, and inhalational botulism and were developed after a multiyear process involving several systematic reviews and expert input.
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Affiliation(s)
- Agam K Rao
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jeremy Sobel
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Kevin Chatham-Stephens
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Carolina Luquez
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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Shang P, Feng J, Wu W, Zhang HL. Intensive Care and Treatment of Severe Guillain-Barré Syndrome. Front Pharmacol 2021; 12:608130. [PMID: 33995011 PMCID: PMC8113987 DOI: 10.3389/fphar.2021.608130] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Changchun, China
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Wei Wu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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Abstract
Bilateral facial palsy (BFP) is exceedingly rare, representing only 0.3%-2.0% of facial palsy cases. Unlike unilateral facial palsy, it is often caused by a serious underlying systemic disease and therefore warrants urgent medical intervention. The differential diagnosis is broad, and detailed history, physical examination, and investigations are essential for identifying the etiology. Common acquired causes in existing case series include Lyme disease, Guillain-Barré syndrome, sarcoidosis, trauma, and Bell’s palsy. Palsy that develops rapidly is often caused by trauma, infections, or autoimmune disorders, whereas slow progressive palsy suggests neoplastic diseases. While management varies by etiology, the physician can consider early empiric corticosteroids given their efficacy in numerous differential diagnoses. Antivirals can be considered in those with a strong history of viral prodrome. In this paper, we present the case of a puerperal patient with BFP and discuss its differential diagnosis, diagnostic approach, and management.
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Affiliation(s)
- Alvin Yang
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
| | - Vikram Dalal
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
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Clinical predictors for mechanical ventilation and prognosis in patients with Guillian-Barre syndrome: a 10-year experience. Neurol Sci 2021; 42:5305-5309. [PMID: 33880677 DOI: 10.1007/s10072-021-05251-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a common cause of flaccid paralysis. Up to a third of cases result in respiratory failure requiring mechanical ventilation. AIM We aim to study the possible predictors of respiratory compromise requiring mechanical ventilation in cases of GBS as well as their clinical outcome in the UAE population. METHODOLOGY A retrospective observational study was conducted between the periods of January 2009 till January 2019 in a tertiary center in Dubai. Cases were grouped according to their need for mechanical ventilation then compared for possible predicting factors. Up to 1-year follow-up was done to assess the clinical outcome. RESULTS Out of the 82 cases that were included in the study, 64 (78%) were males with a mean age at presentation being 37 ± 14.4. Most of the cases presented with disability score of 4 (n= 33, 40.2%), being bed bound or wheelchair bound. Twenty cases (24.4%) required mechanical ventilation at presentation. Axonal type of nerve injury was present in 11 (55%) patients requiring intubation, in contrast to 17 (27.4%) patients not requiring intubation. Cases that required mechanical ventilation were older (P .028). They also had a reduced rate of recovery after 1 month (P .004), and more residual deficit at 6 months (P .003) and 12 months (P <.001). This also translated in a longer duration of hospital stay (<.001). CONCLUSION Older age at presentation is a major predictor for the need of mechanical ventilation in GBS. This need for mechanical ventilation is associated with longer hospital stay as well as reduced rate of recovery up to 1 year after the onset of presentation.
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Al Maawali SM, Al Shibani AY, Nadeem AS, Al-Salti AM. Guillain-Barre syndrome: demographics, clinical features, and outcome in a single tertiary care hospital, Oman. ACTA ACUST UNITED AC 2021; 25:369-374. [PMID: 33459285 PMCID: PMC8015598 DOI: 10.17712/nsj.2020.5.20200057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Guillain-Barre syndrome (GBS) is an acute autoimmune-mediated peripheral nervous system disease. Different studies from various geographical regions have reported considerable variability regarding its epidemiology, clinical features, and outcome. Our study aimed to document demographics, clinical features, and outcomes among GBS patients admitted to a single tertiary care hospital in Muscat, Oman. METHODS A retrospective data analysis of 44 GBS patients, who were admitted during a two-year period from January 2016 to December 2018 at Khoula hospital, was carried out. Demographics, antecedent illness, duration of symptoms, muscle power graded by the Medical Research Council scale (MRCs), sensory & autonomic involvements, nerve conduction study results, CSF study, need for ventilation, condition at discharge and subsequent follow-up status were obtained. RESULTS Ninety-one percent of the patients were Omanis, with male predominant 63.6% and the average age was 42.69 years. Quadriparesis was the predominant presenting complaint (61.3%) and AIDP was the commonest variant (52%). All patients received a single cycle of IVIg and (13.6%) patients admitted to the ICU for mechanical ventilation. The study showed good outcome and recovery in 18 months follow up. CONCLUSION The clinical presentation of GBS in the majority of patients in Oman is similar to those reported in previous studies, and most patients had favorable prognoses. Our results can be used as baseline data for understanding the characteristics of GBS in Oman and, consequently, for better management.
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31
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Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune neuropathy that can cause motor, sensory, and autonomic symptoms. Although GBS primarily is a neuropathic disorder, multiple organ systems can be affected during the disease course, and older patients may be more vulnerable to systemic complications. Close clinical monitoring and early interventions using pharmacologic and nonpharmacological treatments may lead to an improved long-term outcome.
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Affiliation(s)
- Justin Kwan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 1D45, MSC 1140, 10 Center Drive, Bethesda, MD 20814, USA.
| | - Suur Biliciler
- Department of Neurology, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSE#466, Houston, TX 77030, USA
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32
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Cheng MCF, Murphy PB, Hart N, Evans MRB, Spillane JE, Howard RS. Prolonged Ventilatory Support for Patients Recovering From Guillain-Barré Syndrome. Neurol Clin Pract 2021; 11:18-24. [PMID: 33968468 PMCID: PMC8101308 DOI: 10.1212/cpj.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/28/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recovery from Guillain-Barré syndrome (GBS) may be protracted, and patients may need prolonged ventilatory support. We present clinical data from a tertiary referral weaning center managing patients with GBS requiring prolonged ventilatory support. METHODS A retrospective review of patients managed in a 34-bed specialist ventilator weaning facility in London, United Kingdom, between 2006 and 2017. Data including demographics, initial presentation, and ventilatory support were collected. Functional recovery and outcome data were collected between 12 months and 3 years following disease onset. RESULTS Twenty-nine patients with severe GBS requiring prolonged ventilation were included. In several patients, coexisting conditions or complications affected the course. Seventy-six percent (n = 22) were successfully weaned from invasive ventilation with a median time to tracheostomy decannulation of 193 days (range: 49-527 days). Use of noninvasive ventilation (NIV), as part of the weaning program, was applied in 59% (13/22), with 14% (3/22) requiring long-term nocturnal NIV. Twenty-four percent (7/29) were not decannulated, with 14% (4/29) supported on long-term invasive ventilation. Forty-five percent (10/22) weaned from invasive ventilation were able to achieve short distance-assisted ambulation. Mortality at 36 months was 17% (5/29), with 3 of these deaths occurring in patients invasively ventilated during their acute admission. CONCLUSIONS GBS with severe respiratory muscle weakness and bulbar dysfunction may require prolonged invasive ventilation. However, there is potential for complete weaning from invasive mechanical ventilatory support with associated function recovery. These data highlight the importance of maintaining ongoing support and rehabilitation for patients with GBS requiring prolonged ventilation.
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Affiliation(s)
- Michael C F Cheng
- Lane Fox Respiratory Service (MCFC, NH, MRBE, JES, RSH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Lane Fox Clinical Respiratory Physiology Research Centre (MCFC, PBM, NH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Department of Neurology (MRBE, JES), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust, London, United Kingdom; and Central Clinical School (MCFC), Faculty of Medicine and Health, University of Sydney, Australia
| | - Patrick B Murphy
- Lane Fox Respiratory Service (MCFC, NH, MRBE, JES, RSH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Lane Fox Clinical Respiratory Physiology Research Centre (MCFC, PBM, NH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Department of Neurology (MRBE, JES), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust, London, United Kingdom; and Central Clinical School (MCFC), Faculty of Medicine and Health, University of Sydney, Australia
| | - Nicholas Hart
- Lane Fox Respiratory Service (MCFC, NH, MRBE, JES, RSH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Lane Fox Clinical Respiratory Physiology Research Centre (MCFC, PBM, NH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Department of Neurology (MRBE, JES), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust, London, United Kingdom; and Central Clinical School (MCFC), Faculty of Medicine and Health, University of Sydney, Australia
| | - Matthew R B Evans
- Lane Fox Respiratory Service (MCFC, NH, MRBE, JES, RSH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Lane Fox Clinical Respiratory Physiology Research Centre (MCFC, PBM, NH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Department of Neurology (MRBE, JES), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust, London, United Kingdom; and Central Clinical School (MCFC), Faculty of Medicine and Health, University of Sydney, Australia
| | - Jennifer E Spillane
- Lane Fox Respiratory Service (MCFC, NH, MRBE, JES, RSH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Lane Fox Clinical Respiratory Physiology Research Centre (MCFC, PBM, NH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Department of Neurology (MRBE, JES), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust, London, United Kingdom; and Central Clinical School (MCFC), Faculty of Medicine and Health, University of Sydney, Australia
| | - Robin S Howard
- Lane Fox Respiratory Service (MCFC, NH, MRBE, JES, RSH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Lane Fox Clinical Respiratory Physiology Research Centre (MCFC, PBM, NH), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust; Department of Neurology (MRBE, JES), St. Thomas' Hospital, Guy's & St. Thomas' NHS (Foundation) Trust, London, United Kingdom; and Central Clinical School (MCFC), Faculty of Medicine and Health, University of Sydney, Australia
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Aabdi M, Mellagui Y, Bensaid A, Bkiyar H, Housni B. Guillain-Barré Syndrome During the Postpartum Period. Cureus 2020; 12:e12021. [PMID: 33457125 PMCID: PMC7797439 DOI: 10.7759/cureus.12021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy that manifests with ascending symmetrical and progressive weakness or paralysis with the absence of reflexes. The incidence of this syndrome in pregnancy and postpartum periods is similar to the general population; however, few published clinical cases have been described. Here, we report the case of a 26-year-old patient who developed GBS with respiratory distress two weeks after her baby's delivery that required long-term mechanical ventilation. The patient's clinical conditions were significantly improved after the use of immunoglobulins and rehabilitation, and she was discharged. Physicians should be aware of the possibility of developing GBS during pregnancy and postpartum periods.
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Affiliation(s)
- Mohammed Aabdi
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Yassine Mellagui
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Amine Bensaid
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Houssam Bkiyar
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
| | - Brahim Housni
- Anesthesiology, Mohammed VI University Hospital Center, Oujda, MAR
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34
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Shang P, Zhu M, Baker M, Feng J, Zhou C, Zhang HL. Mechanical ventilation in Guillain-Barré syndrome. Expert Rev Clin Immunol 2020; 16:1053-1064. [PMID: 33112177 DOI: 10.1080/1744666x.2021.1840355] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Up to 30% of patients with Guillain-Barré syndrome (GBS) develop respiratory failure requiring intensive care unit (ICU) admission and mechanical ventilation. Progressive weakness of the respiratory muscles is the leading cause of acute respiratory distress and respiratory failure with hypoxia and/or hypercarbia. Bulbar weakness may compromise airway patency and predispose patients to aspiration pneumonia. Areas covered: Clinical questions related to the use of mechanical ventilation include but are not limited to: When to start? Invasive or noninvasive? When to wean from mechanical ventilation? When to perform tracheostomy? How to manage complications of GBS in the ICU including nosocomial infection, ventilator-associated pneumonia, and ICU-acquired weakness? In this narrative review, the authors summarize the up-to-date knowledge of the incidence, pathophysiology, evaluation, and general management of respiratory failure in GBS. Expert opinion: Respiratory failure in GBS merits more attention from caregivers. Emergency intubation may lead to life-threatening complications. Appropriate methods and time point of intubation and weaning, an early tracheostomy, and predictive prophylaxis of complications benefit patients' long-term prognosis.
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University , Changchun, China.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Mingqin Zhu
- Department of Neurology, First Hospital of Jilin University , Changchun, China.,Departments of Laboratory Medicine and Pathology, Neurology and Immunology, Mayo Clinic , Rochester, MN, USA
| | - Matthew Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University , Changchun, China
| | - Chunkui Zhou
- Department of Neurology, First Hospital of Jilin University , Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China , Beijing, China
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Huang Y, Luo C, Jiang Y, Du J, Tao C, Chen Y, Hao Y. Bayesian Network to Predict the Risk of Post Influenza Vaccination Guillain-Barré Syndrome: A Development and Validation Study (Preprint). JMIR Public Health Surveill 2020; 8:e25658. [PMID: 35333192 PMCID: PMC8994148 DOI: 10.2196/25658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/27/2020] [Accepted: 02/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Identifying the key factors of Guillain-Barré syndrome (GBS) and predicting its occurrence are vital for improving the prognosis of patients with GBS. However, there are scarcely any publications on a forewarning model of GBS. A Bayesian network (BN) model, which is known to be an accurate, interpretable, and interaction-sensitive graph model in many similar domains, is worth trying in GBS risk prediction. Objective The aim of this study is to determine the most significant factors of GBS and further develop and validate a BN model for predicting GBS risk. Methods Large-scale influenza vaccine postmarketing surveillance data, including 79,165 US (obtained from the Vaccine Adverse Event Reporting System between 1990 and 2017) and 12,495 European (obtained from the EudraVigilance system between 2003 and 2016) adverse events (AEs) reports, were extracted for model development and validation. GBS, age, gender, and the top 50 prevalent AEs were included for initial BN construction using the R package bnlearn. Results Age, gender, and 10 AEs were identified as the most significant factors of GBS. The posttest probability of GBS suggested that male vaccinees aged 50-64 years and without erythema should be on the alert or be warned by clinicians about an increased risk of GBS, especially when they also experience symptoms of asthenia, hypesthesia, muscular weakness, or paresthesia. The established BN model achieved an area under the receiver operating characteristic curve of 0.866 (95% CI 0.865-0.867), sensitivity of 0.752 (95% CI 0.749-0.756), specificity of 0.882 (95% CI 0.879-0.885), and accuracy of 0.882 (95% CI 0.879-0.884) for predicting GBS risk during the internal validation and obtained values of 0.829, 0.673, 0.854, and 0.843 for area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy, respectively, during the external validation. Conclusions The findings of this study illustrated that a BN model can effectively identify the most significant factors of GBS, improve understanding of the complex interactions among different postvaccination symptoms through its graphical representation, and accurately predict the risk of GBS. The established BN model could further assist clinical decision-making by providing an estimated risk of GBS for a specific vaccinee or be developed into an open-access platform for vaccinees’ self-monitoring.
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Affiliation(s)
- Yun Huang
- Department of Medical Statistics, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Chongliang Luo
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Ying Jiang
- Department of Neurology and Multiple Sclerosis Research Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jingcheng Du
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cui Tao
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Yuantao Hao
- Department of Medical Statistics, Sun Yat-Sen University, Guangzhou, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
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Tian M, Yang J, Li L, Li J, Lei W, Shu X. Vaccine-Associated Neurological Adverse Events: A Case Report and Literature Review. Curr Pharm Des 2020; 25:4570-4578. [PMID: 31742492 DOI: 10.2174/1381612825666191119095132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/07/2019] [Indexed: 01/02/2023]
Abstract
Vaccination is an effective strategy to reduce the burden of preventable illness. However, many clinical reports revealed that various vaccinations may associate with neurological disorders, mainly including autoimmune disease, febrile seizure, and vaccine-associated paralytic poliomyelitis (VAPP). Although more and more reports revealed that part of the above post-vaccine neurological disorders is not directly related to vaccination, it may be merely a coincidence. However, these reports may increase the hesitancy on vaccination for the public population and influence the coverage of vaccination. In this report, we described a child with acute flaccid paralysis possibly caused by a poliovirus vaccine. To provide feasible ways to realize or reduce the risk of neurological adverse events caused by vaccines, we further provide a mini-review of the literature of vaccination associated with neurological adverse events. This revealed that oral poliomyelitis vaccine use exclusively and type 2 serotype poliomyelitis vaccine virus were the risk factors for VAPP. The combination vaccine was associated with an increased risk of ADEM and FS following immunization when compared with the administration of vaccines separately. Even though cases have been reported that vaccination may be a trigger of anti-NMDARe and GBS, there is no direct evidence to prove that vaccination increased the risk of GBS and anti-NMDARe.
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Affiliation(s)
- Maoqiang Tian
- Department of Pediatrics, First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Jing Yang
- Department of Pediatrics, First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Lei Li
- Department of Pediatrics, First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Juan Li
- Department of Pediatrics, First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Wenting Lei
- Department of Pediatrics, First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Xiaomei Shu
- Department of Pediatrics, First Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
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Guillain–Barré Syndrome Secondary to West Nile Virus in New York City. Case Rep Infect Dis 2020; 2020:6501658. [PMID: 32774950 PMCID: PMC7399731 DOI: 10.1155/2020/6501658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/20/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022] Open
Abstract
West Nile virus (WNV) is an arthropod-borne flavivirus belonging taxonomically to the Japanese encephalitis subgroup. Usually, it is transmitted by Culex pipiens mosquitoes. Consequently, an increase in WNV-positive mosquitoes presents a rise of the number of patients, as it has been seen in NYC. We present a 65-year-old patient with WNV infection who presented with Guillain–Barré syndrome (GBS). She had a rapidly progressing ascending paralysis, a common feature in GBS patients but an uncommon presentation in WNV. Realizing WNV as an emerging pathogen along with its uncommon presentation of GBS can be potentially lifesaving if caught at an early stage.
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38
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Mathis S, Soulages A, Le Masson G, Vallat JM. History of acute polyradiculoneuropathy (part 2): From 1916 to 2019. Neurology 2020; 94:836-840. [PMID: 32345731 DOI: 10.1212/wnl.0000000000009402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/10/2020] [Indexed: 12/27/2022] Open
Abstract
First reported by Guillain, Barré, and Strohl during the Great War, the concept of "Guillain-Barré syndrome" (GBS) progressively emerged as a clinical entity in its own right. Despite many debates about its clinical and pathophysiologic characteristics, GBS is now recognized as a disease throughout the world. We describe here the main steps of the rich history of GBS, from 1916 to the present.
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Affiliation(s)
- Stéphane Mathis
- From the Department of Neurology, Nerve-Muscle Unit (S.M., A.S., G.L.M.), CHU Bordeaux (Pellegrin University Hospital); University of Bordeaux (G.L.M.); INSERM (G.L.M.), Neurocentre Magendie, "Physiopathologie de la Plasticité Neuronale," Bordeaux; and Department of Neurology (J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France.
| | - Antoine Soulages
- From the Department of Neurology, Nerve-Muscle Unit (S.M., A.S., G.L.M.), CHU Bordeaux (Pellegrin University Hospital); University of Bordeaux (G.L.M.); INSERM (G.L.M.), Neurocentre Magendie, "Physiopathologie de la Plasticité Neuronale," Bordeaux; and Department of Neurology (J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
| | - Gwendal Le Masson
- From the Department of Neurology, Nerve-Muscle Unit (S.M., A.S., G.L.M.), CHU Bordeaux (Pellegrin University Hospital); University of Bordeaux (G.L.M.); INSERM (G.L.M.), Neurocentre Magendie, "Physiopathologie de la Plasticité Neuronale," Bordeaux; and Department of Neurology (J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
| | - Jean-Michel Vallat
- From the Department of Neurology, Nerve-Muscle Unit (S.M., A.S., G.L.M.), CHU Bordeaux (Pellegrin University Hospital); University of Bordeaux (G.L.M.); INSERM (G.L.M.), Neurocentre Magendie, "Physiopathologie de la Plasticité Neuronale," Bordeaux; and Department of Neurology (J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
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Abstract
Guillain-Barré Syndrome (GBS) is an acute monophasic immune-mediated neuropathy, generally considered to be of good prognosis. However, 15-20% of GBS patients cannot walk independently at six months from onset. Poor prognostic factors for long-term functional disability included old age, preceding diarrhea, muscle weakness on admission and on day 7 from admission, severe GBS disability score at two weeks from admission and IgG antibody against GD1a/GD1b ganglioside complex. Factors related with requirement of mechanical ventilation included the time from onset to admission <7 days, muscle weakness on admission, facial and/or bulbar weakness and IgG antibody against GQ1b. Recently modified Erasmus GBS outcome score (mEGOS) and Erasmus GBS respiratory insufficiency score (EGRIS) were reported as prognostic factors for the long-term functional disability and respiratory insufficiency. Those were designed on Dutch patients. The usefulness of these tools in Japan or other countries remained unknown. The authors validated mEGOS and EGRIS on Japanese GBS patients in Japanese GBS outcome study, which revealed that these tools were also adaptable on Japanese GBS patients. To identify clinical and biological factors of GBS in more detail, such a large scale prospective study as International GBS outcome study (IGOS) is warranted.
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Affiliation(s)
- Yuko Yamagishi
- Department of Neurology, Kindai University, Faculty of Medicine
| | - Susumu Kusunoki
- Department of Neurology, Kindai University, Faculty of Medicine
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40
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Altmann P, De Simoni D, Kaider A, Ludwig B, Rath J, Leutmezer F, Zimprich F, Hoeftberger R, Lunn MP, Heslegrave A, Berger T, Zetterberg H, Rommer PS. Increased serum neurofilament light chain concentration indicates poor outcome in Guillain-Barré syndrome. J Neuroinflammation 2020; 17:86. [PMID: 32183837 PMCID: PMC7079539 DOI: 10.1186/s12974-020-01737-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Guillain-Barré syndrome (GBS) is an autoimmune disease that results in demyelination and axonal damage. Five percent of patients die and 20% remain significantly disabled on recovery. Recovery is slow in most cases and eventual disability is difficult to predict, especially early in the disease. Blood or cerebrospinal fluid (CSF) biomarkers that could help identify patients at risk of poor outcome are required. We measured serum neurofilament light chain (sNfL) concentrations from blood taken upon admission and investigated a correlation between sNfL and clinical outcome. Methods Baseline sNfL levels in 27 GBS patients were compared with a control group of 22 patients with diagnoses not suggestive of any axonal damage. Clinical outcome parameters for GBS patients included (i) the Hughes Functional Score (HFS) at admission, nadir, and discharge; (ii) the number of days hospitalised; and (iii) whether intensive care was necessary. Results The median sNfL concentration in our GBS sample on admission was 85.5 pg/ml versus 9.1 pg/ml in controls. A twofold increase in sNfL concentration at baseline was associated with an HFS increase of 0.6 at nadir and reduced the likelihood of discharge with favourable outcome by a factor of almost three. Higher sNfL levels upon admission correlated well with hospitalisation time (rs = 0.69, p < 0.0001), during which transfer to intensive care occurred more frequently at an odds ratio of 2.4. Patients with baseline sNfL levels below 85.5 pg/ml had a 93% chance of being discharged with an unimpaired walking ability. Conclusions sNfL levels measured at hospital admission correlated with clinical outcome in GBS patients. These results represent amounts of acute axonal damage and reflect mechanisms resulting in disability in GBS. Thus, sNfL may serve as a convenient blood-borne biomarker to personalise patient care by identifying those at higher risk of poor outcome.
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Affiliation(s)
- Patrick Altmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Desiree De Simoni
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Birgit Ludwig
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Hoeftberger
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Austria
| | - Michael P Lunn
- Neuroimmunology and CSF Laboratory, Institute of Neurology, University College London, London, UK
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,The UK Dementia Research Institute at UCL, London, UK
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,The UK Dementia Research Institute at UCL, London, UK.,Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Institute of Neuroscience and Physiology, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
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41
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Korinthenberg R, Trollmann R, Felderhoff-Müser U, Bernert G, Hackenberg A, Hufnagel M, Pohl M, Hahn G, Mentzel HJ, Sommer C, Lambeck J, Mecher F, Hessenauer M, Winterholler C, Kempf U, Jacobs BC, Rostasy K, Müller-Felber W. Diagnosis and treatment of Guillain-Barré Syndrome in childhood and adolescence: An evidence- and consensus-based guideline. Eur J Paediatr Neurol 2020; 25:5-16. [PMID: 31941581 DOI: 10.1016/j.ejpn.2020.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022]
Abstract
This evidence- and consensus-based practical guideline for the diagnosis and treatment of Guillain-Barré Syndrome (GBS) in childhood and adolescence has been developed by a group of delegates from relevant specialist societies and organisations; it is the result of an initiative by the German-Speaking Society of Neuropediatrics (GNP), and is supported by the Association of Scientific Medical Societies (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften). A systematic analysis of the literature revealed that only a few adequately-controlled studies exist for this particular age group, while none carries a low risk of bias. For this reason, the diagnostic and therapeutic recommendations largely rely on findings in adult patients with GBS, for which there are a higher number of suitable studies available. Consensus was established using a written, multi-step Delphi process. A high level of consensus could be reached for the crucial steps in diagnosis and treatment. We recommend basing the diagnostic approach on the clinical criteria of GBS and deriving support from CSF and electrophysiological findings. Repetition of invasive procedures that yield ambiguous results is only recommended if the diagnosis cannot be ascertained from the other criteria. For severe or persistently-progressive GBS treatment with intravenous immunoglobulin (IVIG) is recommended, whereas in cases of IVIG intolerance or inefficacy we recommended treatment with plasmapheresis. Corticosteroids are ineffective for GBS but can be considered when acute onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) is suspected due to a prolonged disease course. The full German version of the Guideline is available on the AWMF website (https://www.awmf.org/leitlinien/detail/ll/022-008.html).
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Affiliation(s)
- R Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University Medical Center (UMC), University of Freiburg, Germany.
| | - R Trollmann
- Department of Neuropediatrics, UMC, Friedrich- Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - G Bernert
- Department of Pediatrics, Kaiser-Franz-Joseph-Hospital with Preyer's Childrens Hospital, Vienna, Austria
| | - A Hackenberg
- Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland
| | - M Hufnagel
- Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, UMC, University of Freiburg, Germany
| | - M Pohl
- Section Pediatric Nephrology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, UMC, University of Freiburg, Germany
| | - G Hahn
- Department of Radiological Diagnostics, UMC, University of Dresden, Germany
| | - H J Mentzel
- Section Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Jena, Germany
| | - C Sommer
- Department of Neurology, UMC, University of Wuerzburg, Germany
| | - J Lambeck
- Department of Neurology and Neurophysiology, UMC, University of Freiburg, Germany
| | - F Mecher
- Physio Deutschland, German Federal Association for Physiotherapy, Germany
| | - M Hessenauer
- Centre for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Germany
| | - C Winterholler
- German Federal Association of Logopedics (dbl e.V. Deutscher Bundesverband für Logopädie e.v), Germany
| | - U Kempf
- Mother of a GBS PPatient, Kraichtal-Neuenbürg, Germany
| | - B C Jacobs
- Departments of Neurology and Immunology, Erasmus MC, UMC Rotterdam, the Netherlands
| | - K Rostasy
- Department of Neuropediatrics, Children´s Hospital Datteln, University Witten/Herdecke, Germany
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42
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Silva CT, Silva S, Silva MJ, Almeida AF, Fonseca J, Melo C, Sampaio M, Sousa R. Guillain-Barré Syndrome in a Teenage Girl: A Severe Case With Anti-GM2 Antibodies Associated With Acute CMV Infection and Literature Review. Clin Pediatr (Phila) 2020; 59:300-304. [PMID: 31888351 DOI: 10.1177/0009922819898186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Sónia Silva
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marta João Silva
- Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculdade de Medicina do Porto, Porto, Portugal
| | | | - Jacinta Fonseca
- Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculdade de Medicina do Porto, Porto, Portugal
| | - Cláudia Melo
- Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculdade de Medicina do Porto, Porto, Portugal
| | - Mafalda Sampaio
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Raquel Sousa
- Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculdade de Medicina do Porto, Porto, Portugal
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43
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Kalita J, Kumar M, Misra UK. Serial single breath count is a reliable tool for monitoring respiratory functions in Guillain-Barré Syndrome. J Clin Neurosci 2020; 72:50-56. [DOI: 10.1016/j.jocn.2020.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
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44
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Iacopi E, Ferranti S, Riitano N, Abbruzzese L, Pieruzzi L, Goretti C, Zampa V, Piaggesi A. Bioactive Glass in a Rare Case of Osteomyelitis of the Heel in a Guillain-Barré Syndrome: A Case Report. INT J LOW EXTR WOUND 2020; 20:60-66. [DOI: 10.1177/1534734619896462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Guillain-Barré syndrome (GBS) represents an acute inflammatory immune-mediated demyelinating polyradiculoneuropathy with an incidence of 0.6 per 100 000 people. In this article, we report the case of a 19-year-old girl affected by GBS since the age of 2 who presented at our clinic complaining for a chronic plantar hindfoot–infected ulceration. Serology showed increase of inflammatory markers and leukocytosis, and magnetic resonance imaging revealed osteomyelitis of calcaneum and soft tissue alterations with air bubbles. The patient was treated in our clinic by an integrated multidisciplinary approach consisting of immediate admission, soft tissue and bone debridement, and administration of antibiotics under the close control of infectious disease specialist. After the control of acute condition, the patient underwent negative pressure therapy associated with instillation of antiseptic solution until the restoration of bone and soft tissue loss of substance and, eventually, to the application of bioactive glass substitute until the achievement of complete wound healing.
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45
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Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, van Doorn PA, Dourado ME, Hughes RAC, Islam B, Kusunoki S, Pardo CA, Reisin R, Sejvar JJ, Shahrizaila N, Soares C, Umapathi T, Wang Y, Yiu EM, Willison HJ, Jacobs BC. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019; 15:671-683. [PMID: 31541214 PMCID: PMC6821638 DOI: 10.1038/s41582-019-0250-9] [Citation(s) in RCA: 412] [Impact Index Per Article: 82.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Abstract
Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
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Affiliation(s)
- Sonja E Leonhard
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Melissa R Mandarakas
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Francisco A A Gondim
- Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Kathleen Bateman
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maria L B Ferreira
- Department of Neurology, Hospital da Restauração, Recife, Pernambuco, Brazil
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mario E Dourado
- Department of Integrative Medicine, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Richard A C Hughes
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Badrul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - James J Sejvar
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Cristiane Soares
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Eppie M Yiu
- Department of Neurology, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
- Neurosciences Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Hugh J Willison
- College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands.
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.
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46
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Therapeutic Plasma Exchange in Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Presse Med 2019; 48:338-346. [PMID: 31679897 DOI: 10.1016/j.lpm.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 12/28/2022] Open
Abstract
Therapeutic plasma exchange (TPE) has been used as a treatment modality in many autoimmune disorders, including neurological conditions, such as Guillain-Barre syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The American Society for Apheresis (ASFA) publishes its guidelines on the use of therapeutic apheresis every 3 years based on published evidence to assist physicians with both the medical and technical aspects of apheresis consults. The ASFA Guidelines included the use of TPE in both GBS and CIDP as an acceptable first-line therapy, either alone and/or in conjunction with other therapeutic modalities. In this article, we briefly reviewed GBS and CIDP, discussed the role of apheresis in these conditions as well as various technical aspects of the TPE procedure, such as apheresis calculation, number of volume exchange, replacement fluid, and management of potential complications.
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47
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Prada V, Massa F, Salerno A, Fregosi D, Beronio A, Serrati C, Mannironi A, Mancardi G, Schenone A, Benedetti L. Importance of intensive and prolonged rehabilitative treatment on the Guillain-Barrè syndrome long-term outcome: a retrospective study. Neurol Sci 2019; 41:321-327. [DOI: 10.1007/s10072-019-04077-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 09/11/2019] [Indexed: 12/01/2022]
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48
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Chang KH, Lyu RK, Lin WT, Huang YT, Lin HS, Chang SH. Gulllain-Barre Syndrome After Trivalent Influenza Vaccination in Adults. Front Neurol 2019; 10:768. [PMID: 31396144 PMCID: PMC6667925 DOI: 10.3389/fneur.2019.00768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/02/2019] [Indexed: 11/13/2022] Open
Abstract
Lines of evidence suggest trivalent influenza vaccination may be associated with Guillain-Barre syndrome (GBS), an immune-mediated acute inflammatory neuropathy. On the other hand, this vaccination protects against influenza infection, which has been demonstrated as a trigger of GBS. To clarify the net effect of trivalent influenza vaccines on GBS, we conducted a retrospective nationwide nested case-control study using the database of the Taiwan National Health Insurance program. We identified 182 hospitalized patients with GBS aged ≥50 years from 2007 to 2015 as the cases, and 910 hospitalized patients, matched by gender, age, date of hospitalization, comorbidities, and medications, as the control subjects. Nearby and remote exposures of vaccination were defined as subjects who had received trivalent influenza vaccine 42 (nearby exposure) and 90 days (remote exposure) before the date of hospitalization, respectively. We found 7 (3.85%) GBS patients and 26 (2.86%) matched control subjects who demonstrated nearby exposures of influenza vaccine (odds ratio: 1.46, 95% confidence interval: 0.56-3.78). Seventeen (9.34%) GBS patients were exposed to influenza vaccines remotely, while the number of remote exposure of influenza vaccines in matched control subjects was 72 (7.91%, odds ratio: 1.26, 95% confidence interval: 0.67-2.38). These results do not support an association between trivalent influenza vaccine and GBS among the patients aged ≥50 years.
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Affiliation(s)
- Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Rong-Kuo Lyu
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ting Lin
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huang-Shen Lin
- Division of Infectious Diseases, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shang-Hung Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Cardiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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49
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Vellipuram AR, Cruz-Flores S, Chaudhry MRA, Rawla P, Maud A, Rodriguez GJ, Kassar D, Piriyawat P, Qureshi MA, Khatri R. Comparative Outcomes of Respiratory Failure Associated with Common Neuromuscular Emergencies: Myasthenia Gravis versus Guillain-Barré Syndrome. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E375. [PMID: 31311172 PMCID: PMC6681261 DOI: 10.3390/medicina55070375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 01/05/2023]
Abstract
Background and objectives: Myasthenia gravis (MG) and Guillain-Barré Syndrome (GBS) are autoimmune neuromuscular disorders that may present as neuromuscular emergencies requiring mechanical ventilation and critical care. Comparative outcomes of these disease processes, once severe enough to require mechanical ventilation, are not known. In this study, we compared the patients requiring mechanical ventilation in terms of in-hospital complications, length of stay, disability, and mortality between these two disease entities at a national level. Materials and Methods: Mechanically ventilated patients with primary diagnosis of MG (n = 6684) and GBS (n = 5834) were identified through retrospective analysis of Nationwide Inpatient Sample (NIS) database for the years 2006 to 2014. Results: Even though mechanically ventilated MG patients were older (61.0 ± 19.1 versus 54.9 ± 20.1 years) and presented with more medical comorbidities, they had lower disease severity on admission, as well as lower in-hospital complications sepsis, pneumonia, and urinary tract infections as compared with GBS patients. In the multivariate analysis, after adjusting for confounders including treatment, GBS patients had significantly higher disability (odds ratio (OR) 15.6, 95% confidence interval (CI) 10.9-22.2) and a longer length of stay (OR 3.48, 95% CI 2.22-5.48). There was no significant difference in mortality between the groups (8.45% MG vs. 10.0% GBS, p = 0.16). Conclusion: Mechanically ventilated GBS patients have higher disease severity at admission along with more in-hospital complications, length of stay, and disability compared with MG patients. Potential explanations for these findings include delay in the diagnosis, poor response to immunotherapy particularly in patients with axonal GBS variant, or longer recovery time after nerve damage.
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Affiliation(s)
- Anantha R Vellipuram
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA.
| | - Salvador Cruz-Flores
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Mohammad Rauf A Chaudhry
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Prashanth Rawla
- Department of Internal Medicine, Hospitalist Sovah Health, Martinsville, VA 24112, USA
| | - Alberto Maud
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Gustavo J Rodriguez
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Darine Kassar
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Paisith Piriyawat
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Mohtashim A Qureshi
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Rakesh Khatri
- Department of Neurology, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
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50
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Sava M, Catană MG, Roman-Filip C. The importance of early neurorehabilitation in the recovery of post-vaccination Guillain-Barre syndrome – a case report. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide, having an incidence of about 1/100,000 across several studies in a number of countries. We present the case of a 60-year-old female patient, with known hypertension, admitted to our department for paresthesia and muscle weakness predominantly in the distal upper and lower limbs. Symptomatology had an acute onset after 14 days from influenza vaccine administration. Lumbar puncture revealed CSF glucose (91 mg/dl), CSF protein (0.508 g/l) and no pleocytosis. Electromyography supported the presumptive diagnosis of polyradiculoneuritis. The patient underwent three sessions of double filtration and the final diagnosis was Guillain-Barre polyradiculoneuritis secondary to influenza vaccination. Approximately 80% of patients with polyradiculoneuritis recover completely within a few months to one year; however, 5-10% of these patients experience one or more recurrences. It should be emphasized that acute-phase rehabilitation must start immediately and include an individualized program of gentle strengthening, and manual resistive and progressive resistive exercises.
Key words: polyradiculoneuropathy, influenza vaccine, neurorehabilitation,
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Affiliation(s)
- Mihai Sava
- 2Emergency Clinical Hospital Sibiu, Intensive Care Unit 3"Lucian Blaga" University, Sibiu, Romania
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