CLINICAL-EPIDEMIOLOGICAL CHARACTERIZATION OF GUILLAIN BARRÉ SYNDROME IN A CUBAN CASE SERIE.
Keywords:Guillain Barrè Syndrome, Case serie, Prognosis
Background: The broad spectrum of Guillain Barré Syndrome (GBS) includes different pathological phenotypes, with a heterogeneous distribution. The reports, by country and region, have shown its great variability and clarified its behavior.
Objective: Characterize GBS and define the most frequent phenotypes.
Methods: A time series was constructed to analyze the epidemiological behavior of GBS. The demographic, epidemiological, clinical and complementary aspects of 167 patients were retrospectively described. The severity was analyzed and the patients were classified.
Results: The mean age was 33 years, 22.8% were children. The incidence decreased with age and a seasonal preference was seen for the month of August, that usually coincides with higher rates of respiratory and digestive infections. Dengue preceded some GBS outbreaks. The Acute Inflammatory Demyelinating Polyradiculopathy (AIDP) variant predominated and was most severe. Regional variants, a recurrent GBS and a family one were detected. Age, personal history of autoimmune disease, preceding infectious phenomenon, latency between the preceding phenomenon and the onset of the clinical picture, the extent of the motor disorder, facial involvement, gait impairment, ventilatory compromise, and degradation of the osteotendinous reflexes, significantly correlated with the severity.
Conclusions: The predominance of AIDP coincides with some countries in the area, with varying geographical location and climatic conditions. The incidence decreases with age. The relationship between the severity and the personal history of autoimmune disease, the preceding infectious phenomenon, and the latency between the preceding phenomenon and the onset of the clinical picture, could be reflecting an underlying autoimmune mechanism in each case.
Lestayo O´Farrill Z, Hernández Cáceres J.L. Guillain Barre Syndrome behavior. Agreements and discrepancies. Rev Neurol 2008; 46(4):230-237.
Mathis S, Soulages A, Vallat JM and Le Masson G. History of acute polyradiculoneuropathy (part 1) The prehistory of Guillain-Barre Syndrome. Neurology 2020; 94:1-8.
Theodore L. Munsat and James E. Barnes. Relation of multiple cranial nerve dysfunction to the Guillain-Barre Syndrome. Neurol. Neurosurg. Psychiat. 1965; 28:115.
Asbury AK, Arnason BG, Adams RD. The inflammatory lesion in idiopathic polyneuritis. Its role in pathogenesis. Medicine (Baltimore) 1969; 48(3):173-215.
Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol. 1998;44(5):780–8.
Hughes RA, Cornblath DR: Guillain-Barre syndrome. Lancet 2005; 366:1653–1666.
CEA Gabriel, Jara Paula, Quevedo Fernando. Epidemiological characteristics of Guillain Barre Syndrome in the Chilean population: hospital study in a period of 7 years. Rev. Med. Chile 2015; 143(2):183-189.
Palmezano Díaz JM, Rodríguez Amaya RM, Rangel Rivera Diego Alejandro, Galvis Blanco Silvia Juliana, Camargo Ariza William Alejandro, Figueroa Pineda Claudia Lucia. Clinical profile of Guillain Barre Syndrome in a university hospital in Colombia. Archivos de Medicina 2017; 13(4):1-6.
De la O-Peña D, Robles-Figueroa M, Chávez-Peña Quetzalcóatl, Bedolla-Barajas Martín. Characteristics of Guillain Barre Syndrome in adults: results from university hospital. Rev Med Inst Mex Seguro Soc. 2015; 53(6):678-85.
Jackson B. R., Alomía Zegarra J., López-Gatell H, Sejvar J., Arzate F., Waterman S. Binational outbreak of Guillain–Barré syndrome associated with Campylobacter jejuni infection, Mexico and USA, 2011. Epidemiol. Infect. 2014; 142:1089–1099.
Ballón-Manrique Benigno, Campos-Ramos Neptalí. Clinical and paraclinical characteristics of Guillain Barre Syndrome in the regional hospital of Lambayeque. Rev Neuropsiquiatr. 2017; 80(1):22-26.
Levison L.S, Thomsen R.W, Christensen D.H, Mellemkjær T, Sindrup SH, Andersen H. Guillain-Barré Syndrome in Denmark: validation of diagnostic codes and a population-based nationwide study of the incidence in a 30-year period. Clinical Epidemiology [Internet] 2019; 11:275-283.
Mohammad Ali Arami, Mohammad Yazdchi, Reza Khandaghi. Epidemiology and characteristics of Guillain-Barré Syndrome in the northwest of Iran. Ann Saudi Med 2006; 26(1):22-27.
Kumar M, Aroor S, Mundkur S, Kumar S. Guillain-barré syndrome: a clinical study of twenty children. J Clin Diagn Res. 2015; 9(1):9-12.
Hung P-L, Chang W-N, Huang L-T, Huang S-C, Chang Y-C, Chang C-J, et al. A clinical and electrophysiologic survey of childhood Guillain-Barré syndrome. Pediatr Neurol. 2004; 30(2):86-91.
Akbayram S, Doğan M, Akgün C, Peker E, Sayιn R, Aktar F, et al. Clinical features and prognosis with Guillain-Barré syndrome. Ann Indian Acad Neurol. 2011; 14(2):98-102.
Estrada González J.R., Goyenechea Ángel, Herrera C. Outbreak of Polyradiculoneuritis, LGBS type, during a Dengue epidemic. Rev Cub Hig Epidem. 1981; 19(3):252-265.
Rafael Estrada González. On the neurological syndromes that have occurred during our two recent Dengue virus epidemics and their possible relationships. Rev. Cub. Hig Epid 1983; 21:105-113.
Sacks JJ, Lieb S, Baldy LM, Berta S, Patton CM, White MC, et al. Epidemic campylobacteriosis associated with a community water supply. Am J Public Health. 1986; 76(4):424-8.
Naik KR, Saroja AO, and Patil BP. Familial Guillain-Barré syndrome: First Indian report. Ann Indian Acad Neurol. 2012; 15(1):44-47.
Pandey Shweta, Garg Ravindra Kumar, Malhotra Hardeep Singh, Kumar Neeraj and Uniyal Ravi. Simultaneous Occurrence of Axonal Guillain–Barré Syndrome in two siblings following Dengue infection. Ann Indian Acad Neurol. 2018; 21(4):315–317.
Gunatilake SSC, Gamlath Rohitha and Wimalaratna Harith. An unusual case of recurrent Guillain-Barré syndrome with normal cerebrospinal fluid protein levels: a case report. BMC Neurology 2016; 161(16):1-5.
Hernandez BA, Mendez FM, Elosegui IM. Recurrent Guillain Barre Syndrome. J Neurol Neurosci 2018; 9(4):266.
Verma Rajesh, Chaudhari Tejendra S, Giri Prithvi. Unilateral facial palsy in Guillain-Barre syndrome (GBS): a rare occurrence. BMJ Case Reports 2012; doi:10.1136/bcr-2012-007077.
Dimachkie MM. and Barohn RJ. Guillain-Barré Syndrome and Variants. Neurol Clin. 2013; 31(2):491–510.
Yuki N, Kokubun N, Kuwabara S, Sekiguchi Y, Ito M, Odaka M, et al. Guillain-Barré syndrome associated with normal or exaggerated tendon reflexes. J Neurol. 2012; 259(6):1181-90.
Lawn ND, Fletcher DD,Henderson RD, Wolter TD, Wijdicks EF. Anticipating mechanical ventilation in Guillain-Barre Syndrome. Arch Neurol 2001; 58:893-8.
Soysal A, Aysal F, Calıskan B, Dogan Ak P, Mutluay B, Sakallı N, Baybas S, Arpacı B. Clinico-electrophysiological findings and prognosis of Guillain-Barre syndrome - 10 years’ experience. Acta Neurol Scand 2011; 123: 181–186.
Ropper AH. The Guillain-Barre Syndrome. NEJM 1992; 326 (17):1130-1136.
González-Quevedo A, Carriera RF, O'Farrill ZL, Luis IS, Becquer RM, Luis Gonzalez RS. An appraisal of blood-cerebrospinal fluid barrier dysfunction during the course of Guillain Barré syndrome. Neurol India 2009; 57(3):288-94.
Hense S, Schink T, Kreisel SH, Marcelon L, Simondon F, Tahden M, Garbe E. Estimation of background incidence rates of Guillain-Barré syndrome in Germany - a retrospective cohort study with electronic healthcare data. Neuroepidemiology. 2014; 43(3-4):244-52.
Hahn AF. Guillain-Barré syndrome. Lancet. 1998; 352(9128):635-41.
Al Hakem Helle, Sindrup Soren H, Andersen Henning, Dornonville de la Cour Charlotte, Lassen Lisbeth L, Bianca Van den Berg et all. Guillain–Barré syndrome in Denmark: a population-based study on epidemiology, diagnosis and clinical severity. J Neurol. 2019; 266(2):440-449.
Varkal MA, Uzunhan TA, Aydınlı Nur, Ekici Barış, Çalışkan Mine and Özmen Meral. Pediatric Guillain-Barré syndrome: Indicators for a severe course. Ann Indian Acad Neurol. 2015; 18(1):24-28.
Willison HJ, Jacobs BC, Van Doorn PA. Guillain-Barré syndrome. Lancet 2016; 388:717-27.
Govoni V, Granieri E. Epidemiology of the GuillainBarre syndrome. Curr Opin Neurol. 2001; 14 (5): 605-13
Hariharan U, Chaudhary L and Bhasin N. Guillain-Barre Syndrome following combined Chikungunya and Dengue Infection: Critical Care Management and Future Research. Exploratory Research and Hypothesis in Medicine 2017; 2(1):30-32.
Webb AJ, Brain SA, Wood R, Rinaldi S, Turner MR. Seasonal variation in Guillain-Barré syndrome: a systematic review, meta-analysis and Oxfordshire cohort study. J Neurol Neurosurg Psychiatry 2015; 86(11):1196-201.
Verboon C, van Berghem H, van Doorn PA., Ruts L and Jacobs BC. Prediction of disease progression in Miller Fisher and overlap syndromes. Journal of the Peripheral Nervous System 2017; 22:446–450.
Chae CS, Kwon KM, Lee JS and Kim YH. A Case Report of Overlapping Miller Fisher Syndrome de Guillain-Barré Syndrome and the Bickerstaff Brainstem Encephalitis.The Neurologist 2018; 23:128–130.
Sekiguchia Y., Moria M., Misawaa S., Sawaia S., Yuki N., Beppua M. et al. How often and when Fisher syndrome is overlapped by Guillain-Barre sndrome or Bickerstaff brainstem encephalitis? European Journal of Neurology 2016; 23:1058-1063.
Walgaard C., Lingsma H.F., Ruts L., Van Doorn P.A., Steyerberg E.W., and Jacobs B.C. Early recognition of poor prognosis in Guillain-Barré syndrome. Neurology. 2011; 76(11):968–975.
Soo-Hyun Park, Nam-Hee Kim. Early Prediction Factors of Poor Outcome in Guillain-Barre Syndrome. Soonchunhyang Medical Science 2016; 22(2):79-82.
Van Koningsveld R, Van Doorn PA, Schmitz PIM, et al. Mild forms of Guillain-Barre syndrome in an epidemiologic survey in the Netherlands. Neurology 2000; 54(3):620-625.
Altaweel YA, Abdelaziz S, Fathy HA, AbdelBadea S. Correlative study between C-reactive protein, clinical severity, and nerve conduction studies in Guillain-Barrè syndrome. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):4.
J Kalita, UK Misra, Goyal G, Das M. Guillain-Barré syndrome: subtypes and predictors of outcome from India. JPNS. 2014; 19(1):36-43.
Petzold A., Hinds N., Murray N.M.F., Hirsch N.P., Grant D., Keir G. et all. CSF neurofilament levels: A potential prognostic marker in Guillain-Barré syndrome. Neurology 2006; 67:1071-1073.
Mokuno K, Kiyosawa K, Sugimura K, et al. Prognostic value of cerebrospinal fluid neuron-specific enolase and S-100b protein in Guillain-Barré syndrome. Acta Neurol Scand 1994; 89:27-30.
Bech E, Orntoft TF, Andersen LP. IgM anti-GM1 antibodies in the Guillain-Barré syndrome: a serological predictor of the clinical course. J Neuroimmunol 1997; 72:59-66.
Van der Pol W.L., Van den Berg L.H., Scheepers R.H. M., Van der Bom J.G., Van Doorn P.A., Van Koningsveld R. et all. IgG receptor IIa alleles determines susceptibility and severity of Guillain-Barré syndrome. Neurology 2000; 54(8):1661-1665.
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