Journal of the Korean neurological association (대한신경과학회지)

Korean Neurological Association (대한신경과학회)
권호 표지

Prognostic Factors for Recovery of Walking in Guillain-Barr$\'{e}$syndrome

길랑-바레 증후군 환자의 보행회복과 관련된 예후 인자

Kim, Sun-Kuk;Lee, Ae-Young;Oh, Sang-Kuen;Kim, Jae-Moon
김선국;이애영;오상근;김재문

  • Published : 20020100
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Abstract

Background : Guillain-Barr$\'{e}$ syndrome (GBS) is an acute autoimmune demyelinating inflammatory polyneuropathy from which most patients ultimately recover satisfactorily. However, up to 22% of patients remain disabled and there is a mortality rate of 3-5%. Identification of prognostic factors for the recovery of walking in GBS is important in counseling individual patients and for earlier therapeutic interventions. Therefore, we analyzed the case-records of patients with GBS to determine features that might be of value in determining outcomes. Methods : Patients with GBS were recruited according to the GBS diagnostic inclusion and exclusion criteria from 1985 to 1999. The factors including: age, interval from onset to maximal disability, degree of maximal functional disability at onset, presence and duration of artificial ventilation, presence of autonomic dysfunction, cranial nerve dysfunction, leukocytosis, and elevated CSF protein, were analyzed to evaluate the determinant indicators for independent walking. Results : Forty-four cases out of 83 GBS patients were selected. The mean duration of recovery to independent walking was 239 days. The severe maximal functional disability at onset, the order age, the shorter interval from onset to maximal disability and the presence of autonomic dysfunction were found to be significant factors on poor outcome. Conclusions : The degree of maximal functional disability is the most determining factor for the recovery of walking in GBS. The older age at onset and the shorter time-interval from onset to maximal disability and the presence of autonomic dysfunction indicate poor prognostic factors in the recovery of walking in GBS.

Keywords

References

  1. Loffel NB, Rossi LN, Mumenthaler M, Lutschg J, Ludin HP. The Landry-Guillain-Barre syndrome: complication prognosis and natural history in 123 cases, J Neurol Sci 1977;33:71-79
  2. Pleasure DE, Lovelace RE, Duvoisin RC. The prognosis of acute polyradiculoneuritis. Neurology 1968;18:1143-1148 https://doi.org/10.1212/WNL.18.12.1143
  3. Plasma Exchange Sandoglobulin Trial Group. Randomized trial of plasma exchanges, intravenous immunoglobulin,and combined treatments in Guillain-Barré syndrome.Lancet 1997;349:225-230 https://doi.org/10.1016/S0140-6736(96)09095-2
  4. Ropper AH, Wijdick EM, Truax BT. Guillain-Barré syn -drome. 1st ed. Philadelphia: F.A. Davis Company, 1991:35-37
  5. Ropper AH. Severe acute Guillain-Barré syndrome.Neurology 1986;36:429-432 https://doi.org/10.1212/WNL.36.3.429
  6. French Co-Operative group on Plasma Exchange in Guillain-Barr syndrome. Plasma exchange in Guillain-Barré syndrome:one-year follow-up. Ann Neurol 1992;32:94-97 https://doi.org/10.1002/ana.410320115
  7. The Italian Guillain-Barré Study group. The prognosis and main prognostic indicators of Guillain-Barré syndrome. A multicenter prospective study of 297 patients. Brain 1996;119:2053-2061 https://doi.org/10.1093/brain/119.6.2053
  8. Feasby TE, Gilbert JJ, Brown WF, Bolton CF, Hahn AF, Koopman WF. An acute axonal form of Guillain-Barré polyneuropathy. Brain 1986;109:1115-1126 https://doi.org/10.1093/brain/109.6.1115
  9. Yuki N, Yoshino H, Sato S, Miyataka T. Acute axonal polyneuropathy associated with anti-GM1 antibodies following Campylobacter enteritis. Neurology 1990;40:1900-1902 https://doi.org/10.1212/WNL.40.12.1900
  10. Ho TW, Mishu B, Li CY, Gao CY, Cornblath DR, Griffin JW. Guillain-Barré syndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain 1995;118:597-605 https://doi.org/10.1093/brain/118.3.597
  11. Winer JB, Hughes RAC, Osmond C. A prospective study of acute idiopathic neuropathy. I. Clinical features and their prognostic value. J Neurol Neurosurg Psychiatry 1988;51:605-612 https://doi.org/10.1136/jnnp.51.5.605
  12. Fletcher DD, Lawn ND, Wolter TD, Wijidicks EFM, Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation. Neurology 2000;24:2311-2315
  13. Asbury AK, Arnason BG, Karp HR, McFarlin DE. Criteria for diagnosis of Guillain-Barré syndrome. Ann Neurol 1978;3:565-566 https://doi.org/10.1002/ana.410030628
  14. Asbury AK, Cornblath DR. Assessment of Current Diagnostic Criteria for Guillain-Barré Syndrome. Ann Neurol 1990;27(suppl):s21-s24 https://doi.org/10.1002/ana.410270707
  15. Guillain-Barré Study Group: Plasmapheresis and acute Guillain-Barré syndrome. Neurology 1985;35:1096-1104 https://doi.org/10.1212/WNL.35.8.1096
  16. Kleyweg RP, Meche FG, Loonen MC. The natural history of the Guillain-Barré syndrome in 18 children and 50 adults. J Neurol Neurosurg Psychiatry 1989;52:853-856 https://doi.org/10.1136/jnnp.52.7.853
  17. McFarland HR, Heller GL. Guillain-Barré disease complex. Arch Neurol 1996;14:196-201
  18. Osler ID, Sidell AD. The Guillain-Barré syndrome: the need for exact diagnostic criteria. N Eng J Med 1960;262:964-969 https://doi.org/10.1056/NEJM196005122621905
  19. Marshell J. The Landry-Guillain-Barré syndrome. Brain 1963;86:56-66
  20. Beghi E, Ricerche ID. The prognosis and main prognostic indications of Guillain-Barré syndrome. A multicentre prospective study of 297 patients. Brain 1996;119:2053-2061 https://doi.org/10.1093/brain/119.6.2053
  21. Alter M. The epidemiology of Guillain-Barré syndrome. Ann Neurol 1990;27(suppl):7-12 https://doi.org/10.1002/ana.410270704
  22. Rho JK, Kwon OS, Lee KH, Myong HJ. A Clinical Study on Guillain-Barré Syndrome. J Korean Neurol Assoc 1984;2:3-13
  23. Epstein MA, Sladky JT. The role of plasmapheresis in childhood Guillain-Barré syndrome. Ann Neurol 1989;26:448
  24. Soffer D, Feldman S, Alter M. Clinical features of the Guillain-Barré syndrome. J Neurol Sci 1978;37:135-143 https://doi.org/10.1016/0022-510X(78)90234-4
  25. Beghi E, Kurland LT, Mulder DW, Wiederholt WC. Guillain-Barré syndrome: clinicoepidemiologic features and effect of influenza vaccine. Arch Neurol 1985;42:1053-1057 https://doi.org/10.1001/archneur.1985.04060100035016
  26. Griffin JW, Ho TW. The Guillain-Barré syndrome at 75: the campylobacter connection. Ann Neurol 1993;34:125-127 https://doi.org/10.1002/ana.410340204
  27. Mcleod JG. Electrophysiological studies in the Guillain-Barré syndrome. Ann Neurol 1981;9(suppl):20-27 https://doi.org/10.1002/ana.410090705
  28. Paradiso G, Tripoli J, Galicchio S, Fejerman N. Epidemiological, Clinical, and Electrodiagnostic Findings in Childhood Guillain-Barré Syndrome: A Reappraisal. Ann neurol 1999;46:701-707 https://doi.org/10.1002/1531-8249(199911)46:5<701::AID-ANA4>3.0.CO;2-7
  29. Kaur RP, Chopra JS, Prabhakar S, Radhakrishnam K, Rana S. Guillain-Barré syndrome. A clinical electrophysiological and biochemical study. Acta Neurol Scand 1986;73:394-402 https://doi.org/10.1111/j.1600-0404.1986.tb03295.x
  30. Raphael JC, Masson C, Morice V, Brunel D, Gados P. Le syndrome Landry-Guillain-Barré syndrome. Etude des facteurs pronostiques dans 223 cas. Rev Neurol (paris) 1986;142:613-624
  31. Pestronk A, Drachman DB, Griffin JW. Effects of aging on nerve sprouting and regeneration. Exp Neurol 1980;70:65-80 https://doi.org/10.1016/0014-4886(80)90006-0
  32. Ropper AH, Marmarou, A. Guillain-Barré syndrome:Management of respiratory failure. Neurology 1985;35:1662-1665 https://doi.org/10.1212/WNL.35.11.1662
  33. Raj DH, Jack ER, Gerald RH. Age and Guillain-Barré syndrome severity. Muscle & Nerve 1996;16:375-377
  34. Lawn ND, Wijdicks EFM. Fatal Guillain-Barré syndrome. Neurology 1999;52:635-638 https://doi.org/10.1212/WNL.52.3.635
  35. Singh NK, Jaiswal AK, Misra S. Assessment of autonomic dysfunction in Guillain-Barré syndrome and its prognostic implications. Acta Neurol Scand 1987;75:101-105 https://doi.org/10.1111/j.1600-0404.1987.tb07902.x
  36. Feiden W, Gerhard L, Borchard F. Neuritis cordis due to the acute polyneuritis of the Guillain-Barré syndrome. Virchows Arch 1988;413:573-580 https://doi.org/10.1007/BF00750399
  37. Kalimo H, Molnar GK, Saksa M, Riekkinen PJ. Involvement of autonomic nervous system in experimental allergic neuritis. J Neuroimmunol 1982;2:9-19 https://doi.org/10.1016/0165-5728(82)90071-6
  38. Ropper AH, Wijdick EM, Truax BT. Guillain-Barré syn - drome.1st ed. Philadelphia: F.A. Davis Company, 1991:73-79
  39. Ravn H. The Landry-Guillain-Barré syndrome: Asurvey and a clinical report of 127 cases. Acta Neurol Scand (suppl) 1967;43:1-64 https://doi.org/10.1111/j.1600-0404.1967.tb05714.x
  40. Dehaene I, Martin JJ, Geens K, Gras P. Guillain-Barré syndrome with ophthalmoplegia: Clinicopathological study of the central and peripheral nervous system, including the oculomotor nerves. Neurology 1986;36:851-854 https://doi.org/10.1212/WNL.36.6.851
  41. Winer JB, Hughes RAC, Greenwood RJ, Perkin GD. Prognosis in Guillain-barré syndrome. Lancet 1985;1202-1203
  42. Visser LG, Schmitz PIM, Meulstee J, Doorn PA, Meche FGA. Prognostic factors of Guillain-Barré syndrome after intravenous immunoglobulin or plasma exchange. Neurology1999;53:598-604 https://doi.org/10.1212/WNL.53.3.598