Autonomic Function Testing and Ganglioside Antibody Testing In Correlation with Short Term Outcome in Guillain -Barre Syndrome (original) (raw)
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Autonomic involvement in Guillain-Barre syndrome: A review
Muscle & Nerve, 1994
Autonomic neuropathy is an important and common complication of Guillain-Barre syndrome (GBS). Manifestations be present in cardiovascular, sudomotor, gastrointestinal and other systems involving both sympathetic and parasympathetic fibers. Some apparently selective acute autonomic neuropathies may be subvarieties of GBS. Experimental work in animal models, pathological studies of GBS patients, and autonomic function studies have provided some help in the understanding of this complication. In managing GBS patients with autonomic dysfunction there are important practical considerations that can improve their care. In this article we review the literature on autonomic neuropathy in GBS and propose a management scheme to accommodate it in the overall treatment of the neuropathy.
Cureus, 2020
Introduction Guillain-Barré syndrome (GBS) is defined as a syndrome manifesting as an acute inflammatory demyelinating polyradiculoneuropathy (AIDP) with coexistent weakness and absent or diminished reflexes clinically. Autonomic dysfunction (AD) or dysautonomia is a common finding in GBS. Autonomic dysfunction usually occurs in the acute phase of the illness but can also be seen in the recovery phase. The rationale of our study is to determine the frequency of autonomic dysfunction in patients of GBS admitted to the Neurology department of Civil Hospital, Karachi. Methods A total of 118 admitted patients at a tertiary care hospital in Pakistan who fulfilled the inclusion criteria were enrolled in the study after informed consent. The study was conducted for six months at the department of neurology, Civil Hospital, Karachi. Patients were assessed for autonomic dysfunction by recording blood pressures and pulse rate hourly (both lying and standing positions) by resident doctors. Urinary retention, diarrhea, and constipation were also recorded in a separate chart. All values entered in the pre-approved performa by researchers. The data was collected and analyzed on Statistical Package for Social Sciences (SPSS) version 18.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics included mean, standard deviation (SD) of continuous data, like age, duration of illness, motor weakness assessment by Medical Research Council (MRC) Scale, protein content in cerebrospinal fluid (CSF), pulse, and blood pressure at the time of presentation. Frequencies and percentages were calculated from the categorical data, like gender and patients with autonomic dysfunction (outcome variable). Effect modifiers were controlled by stratification of age, gender, duration of illness. Post-stratification chi-square test was applied with a pvalue of ≤ 0.05 taken as significant. Results In our study, the average age of the patients was 39.90±9.91 years. Frequency of autonomic dysfunction among patients with GBS was 41.53% (49/118). The most frequent autonomic manifestations were constipation and diarrhea; 22% and 21.2% respectively. Additional manifestations included urinary retention (15.3%) and fluctuation of blood pressure and heart rate at 13.6% each. Conclusion This study showed that the frequency of autonomic dysfunction among patients of Guillain Barre Syndrome was significant, consistent with previous studies. Our study explored the adverse outcomes of autonomic dysfunction in patients with GBS. This will help physicians increase their understanding of dysautonomia so that effective management plans can be formulated for patients with GBS to prevent adverse outcomes and hence provide better patient care.
Assessment of autonomic dysfunction in Guillain-Barré syndrome and its prognostic implications
Acta Neurologica Scandinavica, 1987
ABSTRACT— Twenty-four patients with Guillain-Barré syndrome were prospectively evaluated for evidence of autonomic dysfunction. It occurred in 16 (66.7%) patients, usually during the peak period of paralysis, in the form of either excess or inadequate activity of sympathetic and/or parasympathetic nervous systems. Its clinical manifestations comprised of sinus tachycardia (33.3%), bradycardia (8.3%), hypertension (33.3%), postural hypotension (35%), urinary sphincteric disturbances (20.8%) and anhydrosis of lower limbs (12.5%). Assessment of cardiovascular responses to autonomic function tests revealed impaired alterations in heart rate during deep breathing (31.6%), Valsalva's manoeuvre (28.6%), sustained handgrip (25%), cold-pressor test (36.4%), postural change (35%) and atropine test (20%); and impaired rise in blood pressure during firm handgrip (25%) and cold-pressor test (36.6%). ECG abnormalities were noticed in 8 (33.3%) patients. They comprised of depressed ST segment in 5, inverted T wave in 3, tall T wave in 2 and prolonged QTc in 2 patients. Two patients died of respiratory failure. Autonomic dysfunction in Guillain-Barré syndrome did not appear to have any prognostic significance as there was no significant difference in autonomic dysfunction between good—and bad—outcome groups of patients.
Guillain-BarrÉ syndrome subtype diagnosis: A prospective multicentric European study
Muscle & nerve, 2018
There is uncertainty as to whether the Guillain-Barré syndrome (GBS) subtypes, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN), can be diagnosed electrophysiologically. We prospectively included 58 GBS patients. Electrodiagnostic testing (EDX) was performed at means of 5 and 33 days after disease onset. Two traditional and one recent criteria sets were used to classify studies as demyelinating or axonal. Results were correlated with anti-ganglioside antibodies and reversible conduction failure (RCF). No classification shifts were observed, but more patients were classified as axonal with recent criteria. RCF and anti-ganglioside antibodies were present in both subtypes, more frequently in the axonal subtype. Serial EDX has no effect on GBS subtype proportions. The absence of exclusive correlation with RCF and anti-ganglioside antibodies may challenge the concept of demyelinating and axonal GBS subtypes based upon electrophysiol...