Prevalence of fatigue in Guillain-Barre syndrome in neurological rehabilitation setting

Abstract

Background:Fatigue contributes significantly to the morbidity and affects the quality of life adversely in Guillain-Barre Syndrome (GBS).Objective:To determine the prevalence of fatigue in GBS in neurological rehabilitation setting and to study its clinical correlates.Materials and Methods:We performed secondary analysis of data of patients with GBS admitted in neurological rehabilitation ward of a tertiary care centre, recorded at both admission and discharge. Assessment of fatigue was done by Fatigue Severity Scale (FSS), disability-status by Hughe's Disability Scale (HDS), functional-status by Barthel Index, anxiety/depression by Hospital Anxiety Depression Scale, sleep disturbances by Pittsburgh Sleep Quality Index and muscle weakness by Medical Research Council sum scores.Results:A total of 90 patients (62 men) with mean age 34 years (95% CI 32.2, 37.7) were included. Median duration of, stay at neurological rehabilitation ward was 30 days, while that of symptoms was 18.5 days. Presence of fatigue at admission (FSS ≥ 4 in 39% patients) was associated with ventilator requirement (P = 0.021) and neuropathic pain (P = 0.03). Presence of fatigue at discharge (FSS ≥ 4 in 12% patients) was associated with disability- HDS (≥3) (P = 0.008), presence of anxiety (P = 0.042) and duration of stay at rehabilitation ward (P = 0.02). Fatigue did not correlate with age, gender, antecedent illness, muscle weakness, depression and sleep disturbances.Conclusion:Fatigue is prevalent in GBS during early recovery phase of illness. Despite motor recovery fatigue may persist. Knowledge about fatigue as burden of disease in these patients will improve patient care.

Psychiatric Sequelae of Guillain-Barré Syndrome: Towards a Multidisciplinary Team Approach

“…Two case studies reported that psychiatric symptoms preceded onset of physical disability, including stress, depression, anxiety and amnesia [16,17]. Table 2 includes 24 studies, including a total of 6,984 patients, that collectively reported that GBS causes psychiatric symptoms, including stress, anxiety, depression, fatigue, sleep abnormalities, visual hallucinations, paranoid delusions, disorientation, terror, and psychosis [11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Two studies concluded that close relatives of GBS patients also experience problems of daily living and social dysfunction and have psychological needs requiring consideration and support [23,37].…”

“…Another study by Cochen et al that included 139 GBS patients admitted to ICU, reported that 19% of patients experienced vivid dreams, 30% experienced illusions, 60% experienced hallucinations, and 70% experienced delusions [36]. The presence of residual anxiety during the recovery phase has been associated with the presence of fatigue at discharge [28].…”

“…Conflicting reports have failed to conclusively establish whether age and sex are risk factors for fatigue in GBS patients [28,31,33,41]. However, if an association of fatigue with age or sex does exist, this may be explained by higher rates of endocrine dysfunction (i.e., hypothalamicpituitary-adrenal (HPA) axis dysfunction) among female patients over 50 years of age [31].…”

“…Fear and anxiety associated with the suddenness in onset and severity of physical disability during the acute phase of GBS may impact on the psychological status of the patient and, although most patients experience improvement in physical symptoms, many experience longterm severe residual anxiety, depression, and fatigue [10,28]. The prevalence of anxiety and depression in GBS patients is higher in comparison to other patients admitted to ICU for other conditions [12].…”

“…A lack of improvement in residual fatigue may not be easy to rationalise, due to the absence of an underlying pathophysiological mechanism (such as nerve dysfunction, anaemia, hypothyroidism, diabetes, or chronic illness) [7,30]. However, it is important to consider whether persistent fatigue may be due to a psychiatric mechanism (e.g., depression) that hampers recovery independent of exercise-induced improvements in muscle strength [28].…”