Clinical profile of Guillain Barre syndrome in a tertiary care centre

Abstract

Background: Guillain-Barre syndrome (GBS) is an acute, mostly demyelinating polyradiculoneuropathy of an autoimmune etiology. It is no longer called a pure demyelinating disorder and there are axonal variants of the same described as acute motor axonal neuropathy, acute sensory motor axonal neuropathy, and Miller Fisher variants. Materials and Methods: All patients above the age of 18 presenting with acute flaccid paralysis were evaluated. Asbury's criteria was used to diagnose GBS. They were subjected to nerve conduction study and cerebrospinal fluid analysis. GBS disability scoring system (Erasmus GBS outcome score) was also assessed. Events occurring during the period of hospitalization were noted. Results: A total of 50 patients with GBS were evaluated. Of these 76% were males and 24% were females. There were two peaks in the age wise distribution, one at 20-30 years and another at 40-60 years. The most common antecedent event was fever. The most common presenting signs and symptoms were motor weakness, followed by sensory symptoms such as tingling or numbness of the affected limbs. Respiratory difficulty as the presenting symptom was seen in 10 patients. Classical GBS was the most common presentation. A majority of the patients fulfilled 5-7 of Asbury's criteria. Evidence of protein cytological dissociation was seen in 88%. The majority of patients had demyelinating motor neuropathy with prolonged or absent F waves. 19 (38%) patients required intubation. Of these intubated patients, 26% died, 26% recovered, and 48% of them required tracheostomy. 42 patients received immunoglobulin therapy and eight patients underwent plasmapheresis. Six patients died in this study. Five of these patients died due to sepsis, predominantly respiratory. One person died due to intractable ventricular tachycardia. Conclusion: Atypical GBS was uncommon. Most of the patients were managed with immunoglobulin. Mortality rate was higher and occurred mostly with a secondary sepsis.