Clinical and epidemiological features of Guillain‐Barré syndrome in the Western Balkans

Abstract

The aim of this study was to define features of Guillain-Barré syndrome in a large cohort of patients from three Western Balkans countries. Data from adult Guillain-Barré syndrome (GBS) cases from 2009 to 2013 were retrospectively obtained from all tertiary health care centers. During the 5-year period, 327 new cases of GBS were identified with a male to female ratio of 1.7 : 1. The most common GBS variants were demyelinating (65%) and axonal (12%). At nadir 45% of patients were chair-bound, confined to bed, or required assisted ventilation, while 5% died. The crude incidence of GBS in Serbia and Montenegro was 0.93 per 100,000 population, and age-adjusted incidence according to the world standard population was 0.86 per 100,000. Incidence was particularly high in 50- to 80-year-old men. Statistically significant seasonal variations of GBS were not observed. This study of patients with GBS in the Western Balkans allows us to prepare the health system better and to improve the management of patients. This study also opens opportunities for international collaboration and for taking part in the multinational studies on GBS.

Increased incidence of axonal Guillain‐Barré syndrome in La Spezia area of Italy: A 13‐year follow‐up study

“…Axonal forms seem to be more common in Southern than in Northern latitudes. In Italy AMAN/AMSAN accounts for more than 15% of cases, similar to Greece (13%) and western Balcans (12%) …”

“…In Italy AMAN/AMSAN accounts for more than 15% of cases, 6 similar to Greece (13%) and western Balcans (12%). 26,27 Repeated electrodiagnostic study are necessary to reliably distinguish the two GBS subtypes, 28 since in the early stages of GBS the electrodiagnostic study could be negative or equivocal. We considered for the final classification the electrophysiological study performed at least 2 weeks after the disease onset, however, a high incidence of AMAN has already been demonstrated by the first study.…”

Incidence of Guillain‐Barré syndrome in Chile: a population‐based study

“…The most possible explanation is that incidence drop in old people could be due to the under ascertainment of GBS in this group, especially of atypical and mild GBS variants (McKhann et al, ; Cuadrado et al, ; Peric. et al, ) . In old people, symptoms of GBS may be mixed with other diseases more common in this age.…”

“…Interestingly, it seems that in Europe the incidence of GBS decreases from North (Sweden, UK, and Germany) to South (Spain, Italy, Western Balkans, and Greece) (Congia et al, ; Cheng et al, ; Cuadrado et al, ; Chroni et al, ; Hughes et al, ; Hense et al, ; Peric et al, ) . We found the opposite case in the southern hemisphere with an increase from the north of Chile (North and Far North) to the south (South and Far South).…”

A Multicentric Prospective Incidence Study of Guillain-Barré Syndrome in Italy. The ITANG Study

“…Axonal neuropathy AMAN/AMSAN accounted for more than 15% of cases, a higher frequency than classically estimated in Europe and the United States (5-10%), as GBS axonal subtypes have been reported much more frequently in South America and Asia (30-65% of cases) [1,2,3,4,5,21,22]. Apparently, axonal features are more common in the southern than in the northern parts of Europe (Italy: 7-25%, Greece: 13%, Western Balkans: 12%) [13,14,15,23,24]: the question of an underestimation of axonal GBS in Europe has been raised [25]. There is not yet consensus on GBS electrodiagnostic criteria, and it is known that in the initial stage of GBS demyelinating and axonal subtypes may be diagnostically misclassified through electrophysiology [26,27,28].…”