Risk of cancer in patients with Guillain-Barre syndrome (GBS) (original) (raw)
Related papers
Journal of the Peripheral Nervous System, 2001
Subacute sensory neuronopathy (SSN) is most commonly seen in association with small cell carcinoma of the lung (SCLC), however lower motor neuron syndrome with or without upper motor neuron involvement may occur. Antineuronal antibodies, called "anti-Hu" , can be frequently demonstrated. Other antibodies that react with the carbohydrate epitope of ganglioside GM1, associated with primary motor PN, are not frequent. We describe a 73-year-old man with subacute onset of paraesthesiae starting in his finger and toes and spreading proximally. A few months later he developed generalized muscle weakness and was admitted to another hospital. On examination he was unable to write, as well as to stand or walk without support. Tendon reflexes were absent. He had no cranial nerve involvement and had no complain of pain. Pinprick, vibration and four limb positions were impaired distally. CSF study revealed increased protein (90 mg/dl) and lymphocytes (14/mm 3). SCLC was identified in paratracheal lymphnodes and treated with chemotherapy (Carboplatinum and Etopoxide) and mediastinum irradiation (36 Gray). No clinical improvement was observed after i.v. immunoglobulins (400 mg/kg/day for 5 days). He was wheelchair-bound and unable to feed himself or to recognize the four limb position when he was admitted in the Neurological Department, University of Verona. Eye movements and winking were markedly reduced. Median (48.6 m/s) and ulnar (46 m/s) nerve study revealed slow conductions. ESP were undetectable. SSEP could not be evoked from the four limbs. Cyclophosphamide (250 mg/day for 5 days), monthly plasma exchange associated with prednisone for six months, and Azatioprine were used. Ambigous low titre of antibodies against neuronal nuclei was identified but anti-Hu antibodies were not detected. The serum antibody titres against glycolipids (GM1, GM2, GM3, GQ1b, GD1a, GD1b, sulfatides) were elevated (Ͼ 1:720) and had no substantial change at the bimonthly controls in the last 36 months. As negative control case for GLa, we used the Hu-negative serum from a patient who had electrophysiologically confirmed selective sensory involvement associated with SCLC and long survival (29 months). We hypothesized that the neurological course with prominent motor deficit is probably related to serum anti-GL antibody specificities. The presence of ganglioside mimicry in the SCLC (Fuentes et al., Lung Cancer, 1997) appears to be determinant for the induction of anti-GLa. However the antineural immune-response may be related to host factors.
Cancer Diagnosis and Prognosis After Guillain–Barré Syndrome: A Population-Based Cohort Study
Clinical Epidemiology
It is unclear whether Guillain-Barré syndrome (GBS) can be a marker of a paraneoplastic syndrome. We examined whether GBS is associated with cancer and whether the prognosis of GBS patients with cancer differs from that of other cancer patients. Materials and Methods: We conducted a population-based cohort study of patients diagnosed with GBS between 1978 and 2017 using Danish registry-data. Main outcome measures were cancer incidence and mortality after cancer diagnosis. We calculated absolute risks of a cancer diagnosis, treating death as competing risk, and standardized incidence ratios (SIRs) as measures of relative risk. We matched each GBS cancer patient with up to 10 cancer patients without a GBS diagnosis and examined the six-month survival after cancer diagnosis using Cox regression analysis. Results: We identified 7897 patients (58% male, median age 57 years) with GBS. During a median follow-up of 9.5 years, the oneyear risk of cancer was 2.7% (95% confidence interval (CI), 2.4-3.1). The SIR was increased throughout follow-up, but most noticeably during the first year after diagnosis (SIR: 3.35, 2.92-3.83). SIRs were particularly elevated for hematologic cancers (SIR: 8.67, 6.49-11.34), smoking-related cancers (SIR: 3.57, 2.81-4.47), and cancers of neurological origin (SIR: 8.60, 5.01-13.77). Lung cancer was the main contributor to the overall excess risk, which persisted after 36 months of follow-up (SIR: 1.17, 1.09-1.25). The mortality rate ratio comparing patients diagnosed with any cancer within one year of their GBS diagnosis and matched GBS-free cancer cohort members was 1.56 (95% CI, 1.27-1.90). Conclusion: GBS patients had a threefold increased risk of cancer diagnosis in the first year of follow-up. The absolute cancer risk was almost 3.0%. A GBS diagnosis was an adverse prognostic marker for survival following cancer diagnosis. Clinicians should consider occult cancer in patients hospitalized with GBS.
Guillain Barre Syndrome: A Retrospective Study of Ten Years
Purpose: Guillain-Barre Sydrome(GBS) is one of the reasons of acute polyneuropathy causing severe morbidity and mortality. Twenty nine patients with GBS were included in our study. Clinical, laboratory, electrophysiological and prognostic features of the patients were evaluated retrospectively. Method: Twenty-nine patients with GBS according to Asburys criteria were retrospectively evaluated for about ten years from 1993 to 2002. The patients were clinically classified according to the criteria of Hughes and Italian GBS study group. Patients were divided in to four groups due to their electrophysiological evaluation: acute inflammatory demyelinating polyneuropathy (AIDP), axonal forms (AMAN, AMSAN), Miller Fishers Syndrome (MFS) and unclassified. All patients were evaluated for age, gender, type of GBS, antecedent events, initial symptoms, CSF features, treatment, scores of GBS and complications. Findings: AIDP were found in 45% of patients, axonal form in 34.5%, MFS in 3.5% and u...
EPRA International Journal of Multidisciplinary Research (IJMR)
Introduction: Guillain-Barre syndrome is an uncommon, yet potentially fatal, immune-mediated disease affecting peripheral nerves and nerve roots that is commonly generated by infections. Recent studies have shown a strong relationship between Guillain-Barre syndrome and SARS-CoV-2, making SARS-CoV-2 a potential trigger for GBS. Objective: to detail the current information related to Guillain-Barre syndrome, causes, epidemiology, immunopathogenic mechanisms, diagnosis, evaluation, differential and treatment. Methodology: a total of 42 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 33 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Guillain-Barre, peripheral nerves, SARS-CoV-2, nerve roots, epidemics, inflammatory disease of the per...
Factors Associated with Prognosis in Patients with Guillain-Barré Syndrome
Turkish Journal Of Neurology, 2019
Objective: We aimed to evaluate the demographic, clinical, laboratory and electrophysiological findings of patients with inpatient Guillain-Barré syndrome in our clinics and to investigate the effect of these parameters on the prognosis of the disease. Materials and Methods: Between January 2014 and April 2018, file records of patients admitted to our clinics with the diagnosis of Guillain-Barré syndrome were retrospectively reviewed. Demographic characteristics, clinical, laboratory and electrophysiological findings of the patients at the time of admission were recorded. Patients were clinically graded according to the Hughes classification at the time of admission and on the 3 rd month after discharge. Results: In the study, 25 of the 51 patients were male (49%) and 26 were female (51%) and the mean age was 54.21±17.32 years. According to clinical and electrophysiologic diagnosis, 34 patients (66.7%) had acute inflammatory demyelinating polyradiculoneuropathy, 9 patients (17.6%) had acute motor axonal neuropathy, 6 patients (11.8%) had acute motor sensory axonal neuropathy and 2 patients (3.9%) had Miller Fisher syndrome. According to Hughes scoring on the 3 rd month after discharge, 31 patients (60.8%) had in good prognosis (Hughes score ≤2) and 20 patients (39.2%) had in poor prognosis group (Hughes score >2). In the comparison between the two groups according to clinical, demographic, and laboratory parameters, older age (≥50), high Hughes score at admission, weakness in extremities as first complaint, the presence of complications, need for mechanical ventilation and presence of gastroenteritis as a leading infection were evaluated as prognostic factors. Conclusion: The most common variant of Guillain-Barré syndrome in our study was acute inflammatory demyelinating polyradiculoneuropathy. Older age (≥50), high Hughes score at admission, weakness in extremities as the first symptom, presence of complications, need for mechanical ventilation, and presence of gastroenteritis as a precursor infection were poor prognostic factors.
Guillain-Barre Syndrome and its Variants: Clinical Course and Prognostic Factors
Noro Psikiyatri Arsivi, 2017
Introduction: We aimed to analyze the frequency, clinical characteristics, medical treatment options and final functional status of Guillain-Barré syndrome (GBS) and its variants in a population from a tertiary hospital setting. Methods: All medical records of patients with acute inflammatory polyneuropathy between the years of 1998-2013 were retrospectively screened. Demographic, clinical and laboratory information, treatment options and the rate of recovery of the patients were gathered. Results: A total of 183 patients met the study criteria. Subtypes were typical demyelinating form (n=102, 79.1%), acute motor sensory axonal variant (n=11, 8.5%), acute motor axonal variant (n=10, 7.8%), Miller-Fisher syndrome (n=5, 3.9%), and pure sensory subtype (n=1, 0.8%). Remaining patients had the diagnosis of acute-onset chronic inflammatory demyelinating polynuropathy. The data of treatment option were available for 70 patients. Most of the patients received intravenous immunoglobulin (IVIg) treatment or the combination of IVIg and methylprednisolone. One patient died, there was no improvement in eight patients and rest showed improvement with varying degrees. Conclusions: We did not observe major change of recovery between different treatment options, however, most of the patients using methylprednisolone required IVIg because of inadequate response.
Clinical and serological studies in a series of 45 patients with Guillain-Barré syndrome
Journal of the Neurological Sciences, 1991
We retrospectively reviewed the clinical files of 45 Guillain-Barr6 syndrome (GBS) patients admitted to our Department between 1979 and 1989. The age distribution was bimodal with a first peak in young adults (20-40 years), and a second one between 60 to 70 years. Seasonal distribution showed a late fall and a hivernal predominance. Three patients experienced a second attack of GBS 2-9 years after the first one. Thirty-one (69~o) presented antecedent events, most often a respiratory tract infection (n = 20) or enteritis (n = 6). Serological studies were systematically performed, including antibody titers against herpes simplex virus, Epstein-Barr virus, cytomegalovirus (CMV), respiratory syncytial virus, human immunodeficiency virus, Mycoplasma pneumoniae, Campylobacterjejuni/coli and cardiolipin. These studies showed the presence of antibodies indicative ofa CMV primary infection in 22~o cases and ofa Campylobacter jejuni/coli infection in 13 ~o. Co-infection was observed in 3 cases. Serology remained negative in 12 patients with a preceding respiratory infection. There was no correlation between serology and the severity of the disease. Absence of antecedent events and of positive anti-infectious serology was observed in only 10 patients.
Factors associated with prognosis of Guillain-Barre syndrome
2018
40 patients diagnosed with GBS recruited from neuropsychiatry department of Nasser Institute Hospital. They were assessed clinically using the Hughes scale at onset and 3-6 months later. In follow up patients were divided into GBS with good and those with poor prognosis according to their score, Good prognostic group has only 2 or less in the Hughes score while above two patients were considered having poor prognosis At presentation, some lab studies were done to them including CSF examination. Nerve conduction study was done to all the 40 patients. They were treated with plasma pharesis sessions with different number of sessions (6 or less versus more than 6). Reassessment of patients using Hughes GBS disability scale, and nerve conduction study; done 3-6 months after onset.
Clinical Features and Outcome of the Guillain–Barre Syndrome: A Single-Center 11-Year Experience
Frontiers in Neurology
BackgroundClinical presentation, electrophysiological subtype, and outcome of the Guillain–Barre' Syndrome (GBS) may differ between patients from different geographical regions. This study aims to assess clinical–neurophysiological features of an adult, Italian GBS cohort over 11 years.MethodsRetrospective (from 1 January 2011 to 31 December 2021) analysis was carried out on patients admitted to the Siena University Hospital who fulfilled the GBS diagnostic criteria. Demographic data, clinical characteristics, treatment, need of mechanical ventilation (MV), laboratory and electrophysiological tests, preceding infections/vaccination/other conditions, and comorbidities were collected for each patient.ResultsA total of 84 patients (51 men, median age of 61 years), were identified. GBS subtype was classified as acute inflammatory demyelinating polyneuropathy (AIDP) in the 66.6% of patients, acute motor/sensory axonal neuropathy (AMAN/AMSAN) in 20.2%, and the Miller Fisher syndrome i...
Cureus, 2021
Paraneoplastic neurological syndromes (PNS) are a group of rare immune-mediated disorders with neurological sequela in cancer patients. It usually occurs when an immune response against a systemic tumor is incorrectly directed to the nervous system. Compared to other reported manifestations of PNS in breast cancer, Guillain Barre syndrome (GBS) is exceedingly rare. There is only one other reported case in the literature of GBS that was diagnosed in a breast cancer patient. We report the second recorded case of a 61-year-old female with a history of early-stage breast cancer, who presented with symptoms of lower extremity weakness initially suspected to be GBS but later found to have been recurrent breast cancer. No specific guidelines are available for the treatment of PNS. Treatment of underlying malignancy with chemotherapy and immunotherapies are usually recommended.