Guillain-Barré syndrome (GBS) and its clinical variants (paraparetic variant, Miller Fisher syndrome, bifacial weakness with paresthesias) are rather well-known medical afflictions nowadays. Disease management has become more efficient in recent years, and creation of several clinical scales helps to predict patients’ clinical and especially respiratory outcomes. In the present retrospective study we describe the basic epidemiological, clinical, nosological and some of the prognostic features of GBS and its clinical subtypes in a study cohort of 162 patients admitted to University hospital Saintt-Luc between 1978 and 2013. The majority of analyses were performed both in the overall cohort and in separate clinical subgroups.
The median age of GBS patients (typical and pararetic confounded) was 51 years. A bimodal age distribution has been observed in our study: a peak incidence was observed between ages 30-35 and another one was detected between ages 55-75. Male:female ratio in our cohort was 1,3:1. Most of the cases of GBS and its variants occurred during the winter, but no statistically significant seasonal variation was detected. More than a half (53,7%) of the patients reported having suffered from an infection within 30 days before onset of disease. The most frequent preceding infectious event in this study was respiratory infection, followed by gastrointestinal infection in the second place. Paresthesias before onset of weakness were rather frequent with 56,3% of typical GBS patients describing this symptom. Pain before onset of weakness was reported by 37% of patients and was associated mainly with typical GBS. Cranial nerve dysfunction might be one of the symptoms of GBS. In our study, 43% of patients developped such a dysfunction, the facial nerve being most commonly affected. All patients included in this study reached their nadir within 4 weeks after onset of weakness. The median time interval between onset and nadir was 7 days. Sixteen cases of dysautonomia were detected in our study and autonomic dysfunction was associated with intensive care unit admission. GBS was strongly associated with anti-GM1 antibodies, whereas serum of Miller Fisher syndrome patients contained mainly anti-GQ1b antibodies. Low MRC sum scores and high GBS disability scores at hospital admission, rapid disease progression, cranial nerve deficiency, areflexia and dysautonomia were all associated with the need for mechanical ventilation. Treatment-related fluctuations (TRF) concerned 4% of patients treated by intravenous immunoglobulins (IVIg) and were considered as a monophasic course of disease.
This retrospective study reviews a large variety of epidemiological, clinical and prognostic features of GBS and its clinical variants.