Clinical factors associated with Guillain-Barré syndrome following surgery

Hocker, Sara E.; Nagarajan, Elanagan; Rubin, Mark N.; Wijdicks, Eelco F. M.

doi:10.1212/cpj.0000000000000451

Cited by 28 publications

(40 citation statements)

References 24 publications

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“…1 Other preceding immunogenic events or conditions, including immunisation, malignancy and pregnancy, observed occasionally, have a less clear relationship to GBS pathogenesis. 8,[18][19][20] Recurrent GBS occurred rarely, in keeping with previous reports. 21 AIDP was most common, consistent with studies in primarily Caucasian cohorts in which demyelinating forms predominate.…”

Section: Discussionsupporting

confidence: 90%

Guillain–Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort

Barnes

Herkes

2020

Internal Medicine Journal

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Background: Guillain-Barré syndrome (GBS) causes acute neuromuscular weakness. Severe cases are life-threatening and many are left disabled. Intravenous immunoglobulin (IVIg) and plasma exchange (PE), along with supportive care, are the mainstays of treatment. Treatment choice is influenced by multiple factors. The clinicoepidemiological features of GBS in Australia have not been reviewed in 30 years and few studies have assessed contemporary treatment choices. Aims: To investigate the clinico-epidemiological features, choice of treatment, clinical course and outcomes of GBS patients in an Australian tertiary metropolitan hospital. Methods: A retrospective observational study was performed of GBS presentations to a tertiary hospital in Sydney, Australia, over 5 years. Clinico-epidemiological features, treatment choices, clinical course and outcomes were assessed. Results: We reviewed 46 GBS patients (54% male), average age 55 years. Antecedent infection was identified in 61%. Twenty-eight per cent had preceding immunogenic events or conditions. Acute inflammatory demyelinating polyradiculoneuropathy was the most common subtype (78%). Cerebrospinal fluid albumino-cytologic dissociation was present in 43%. Electrodiagnostic testing most frequently demonstrated demyelination (64%). Ninety-eight per cent received immunotherapy, mostly IVIg (93%). Twenty-two per cent received further treatment due to treatment-related fluctuations or lack of improvement. Thirteen per cent required ICU admission and 46% needed rehabilitation. There were no deaths or need for mechanical ventilation. Seventy-one per cent of the follow-up cohort had residual disability at 6 months, but this was generally mild. Conclusions: The clinico-epidemiological features are consistent with previous cohorts. Our experience in a large Australian tertiary centre demonstrates a clear preference for IVIg over PE.

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Section: Discussionsupporting

confidence: 90%

Guillain–Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort

Barnes

Herkes

2020

Internal Medicine Journal

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“…12 Another large consecutive series study showed postsurgical GBS was more common in patients with preexisting autoimmune disorders or active malignancies. 13 However, neither autoimmune diseases nor malignancies were found in this study. Prospective studies are still needed to determine whether autoimmune disorder and active malignancy can increase the risk of post-surgical GBS.…”

Section: Discussioncontrasting

confidence: 57%

<p>Surgery and Guillain-Barré Syndrome: A Single-Center Retrospective Study Focused on Clinical and Electrophysiological Subtypes</p>

Bao

Zhang

et al. 2020

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Background: Surgery-related Guillain-Barré syndrome (GBS) is often underestimated and sometimes difficult to diagnose. This study aimed to elucidate the clinical features and electrophysiological subtypes of post-surgical GBS. Methods: We retrospectively reviewed 17 patients who developed post-surgical GBS after a recent surgery between 2015 and 2019. Clinical characteristics, electrophysiological examinations, lumbar puncture results and prognosis were assessed. As controls, we selected 66 patients hospitalized with non-surgical GBS. Results: The median duration from the surgery to the onset of GBS symptoms was 16.0 days. The main types of surgeries preceding GBS were orthopedic, gastrointestinal and neurosurgery. Symmetrical distal limbs weakness was present in all 17 post-surgical GBS patients. The incidence of respiratory failure, autonomic dysfunction and muscle atrophy in post-surgical GBS patients was significantly higher than that in non-surgical GBS patients. Hughes Functional Grading Scale (HFGS) scores were also higher in the post-surgical GBS group both at the time of peak disease and 6 months after discharge. Electrophysiological studies revealed significant motor amplitudes reduction with relative preserved nerve conduction velocities and distal latencies, suggesting axonal subtypes of GBS. Conclusion: GBS should be considered in patients with rapidly progressive muscle weakness after surgery. Such patients often exhibit axonal subtypes of GBS with severe motor dysfunction, high risk of respiratory failure, and poor prognosis.

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“…Ninety-four studies involved a total of 136 patients diagnosed with GBS associated with trauma-related triggers, including injury, surgery, intracranial hemorrhage, and heatstroke, which were subjected to analysis ( Table 1). Six case series (15,(110)(111)(112)(113)(114) including trauma-related GBS patients with aggregated data were reviewed and generalized ( Table 2). Figure 1 shows the PRISMA flow diagram of the selection procedure of included studies.…”

Section: Resultsmentioning

confidence: 99%

Trauma-Related Guillain–Barré Syndrome: Systematic Review of an Emerging Concept

et al. 2020

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Guillain-Barré syndrome (GBS) is mainly associated with preceding exposure to an infectious agent, although the precise pathogenic mechanisms and causes remain unknown. Increasing evidence indicates an association between trauma-related factors and GBS. Here, we performed a systematic review, summarized the current scientific literature related to the onset of GBS associated with trauma, and explored the possible pathogenesis. A literature search of various electronic databases was performed up to May 2020 to identify studies reporting diverse trauma-related triggers of GBS. Data were extracted, summarized descriptively, and evaluated with respect to possible mechanisms. In total, 100 publications, including 136 cases and 6 case series involving GBS triggered by injury, surgery, intracranial hemorrhage, and heatstroke, met our eligibility criteria. The median age of the patients was 53 [interquartile range (IQR) 45-63] years, and 72.1% of the patients were male. The median number of days between the trigger to onset of GBS symptoms was 9 (IQR 6.5-13). Overall, 121 patients (89.0%) developed post-injury/surgical GBS, whereas 13 (9.6%) and 2 (1.5%) patients had preexisting spontaneous intracranial hemorrhage and heatstroke, respectively. The main locations of injury or surgeries preceding GBS were the spine and brain. Based on available evidence, we highlight possible mechanisms of GBS induced by these triggers. Moreover, we propose the concept of "trauma-related GBS" as a new research direction, which may help uncover more pathogenic mechanisms than previously considered for typical GBS triggered by infection or vaccination.

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Clinical factors associated with Guillain-Barré syndrome following surgery

Abstract: Surgery antedated GBS in 9.1% of patients. Postsurgical GBS was more common in patients with an active malignancy. A prospective study is needed to determine whether active malignancy represents an independent risk factor for the development of postsurgical GBS.

Cited by 28 publications

References 24 publications

Guillain–Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort

Guillain–Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort

<p>Surgery and Guillain-Barré Syndrome: A Single-Center Retrospective Study Focused on Clinical and Electrophysiological Subtypes</p>

Trauma-Related Guillain–Barré Syndrome: Systematic Review of an Emerging Concept

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