Clinical features of Guillain–Barré syndrome patients with elevated serum creatine kinase levels

Abstract

Background: It is not well defined whether Guillain-Barré syndrome (GBS) patients with elevated serum creatine kinase (CK) levels have characteristic clinical features and are related to the subgroups of GBS. Methods: We retrospectively studied 51 consecutive patients with GBS, who visited our hospital, and compared clinical, laboratory and electrophysiological findings between patients with and without elevated CK levels. Results: Of 51 patients, 14 patients (27%) showed an elevation of serum CK levels. When compared with patients with the normal CK levels, the ratios of male, antecedent infections, and anti-GM1 antibody positivity were significantly higher in patients with elevated CK levels. The ratios of hypoesthesia, cranial nerve involvement, and urinary retention were significantly less in patients with elevated CK levels. There were no significant differences in disability at peak between two groups. In the electrophysiological examination, sensory nerve abnormalities were not observed. Although some patients with elevated CK levels showed prolongation of distal motor latencies (DMLs) and increase of durations in the initial examination, development of the prolongation of DMLs and increase of durations was not observed in the follow-up examinations. The findings were consistent with acute motor axonal neuropathy (AMAN) with reversible conduction failure (RCF) but not acute inflammatory demyelinating polyneuropathy (AIDP). Conclusions: The results suggest that the GBS patients with elevated CK levels represent not a group of AIDP but a group of AMAN with axonal degeneration or RCF even though the initial electrophysiological examination shows AIDP pattern.

Flaccid quadriparesis with raised creatine kinase in Guillain-Barré syndrome: a case report with review of literature

“…In a retrospective study of 72 patients, transient hyperCKemia in GBS was significantly associated with male sex and non-demyelinating electrodiagnostic subtype, but not with other clinical features, in- cluding disability or the nature of pain [9]. In another study of 51 patients, GBS patients with elevated CK levels represented a group of AMAN, and elevated CK tended to occur during the acute phase of AMAN following upper respiratory tract infection [10].…”

“…Table 2 highlights the published cases in the literature on GBS with hyperCKemia with/without other manifestations [4][5][6][7][8][9][10]. Satoh et al [7] reported a case of cramping pain with prolonged elevation of serum CK levels in a patient with GBS.…”

Late-Onset Guillain-Barré Syndrome and Right Facial Nerve Palsy after COVID-19 Infection

“…The patient also noted to have high CPK levels which was thought to be secondary to metabolic cause such as hypothyroidism. However, there is evidence in the current medical literature that CPK alterations may be seen in up to 27% of patients with GBS in the first 4 weeks after symptoms’ onset [ 18 ]. Moreover, patients presenting with CPK alterations usually have a form of AMSAN with reversible conduction failure (RCF).…”

“…Given the absence of brainstem involvement from PRES or other vascular insults, the unilateral facial paralysis in our patient may have been related to an immune-mediated facial neuropathy as a separate sequela of post-COVID-19 illness with GBS. Several case reports and series have described a relationship between COVID-19 and facial paralysis with and without association with GBS [ 3 , 17 , 18 , 19 ].…”

Guillain-Barré syndrome (GBS) complicated by rhabdomyolysis (RML): Case reports of 2 children and literature review

“…Some patients initially experience muscle pain or nerve root pain ( 2 ). During the course of GBS, 16–27% of patients show an elevation of serum creatine kinase (CK) levels ( 3 , 4 ) but only rarely is GBS complicated with rhabdomyolysis (RML) ( 5 – 9 ). The research history of GBS in Beijing Children's Hospital (BCH), which is affiliated with Capital Medical University, can be traced back to the 1990s.…”