Respiratory Involvement in Guillain–Barre Syndrome: The Uncharted Road to Recovery

Garg, Montey

doi:10.4103/jnrp.jnrp_96_17r1

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…GBS has a worldwide annual incidence of 1.2-2.3 per 100,000 [25] that increases to 3.3 per 100,000 in adults over 50 years [26], and it is associated with significant complications, mortality, and severe residual functional disability [27,28]. Of particular interest during the COVID-19 pandemic, GBS is one of the leading causes of neuromuscular respiratory failure, necessitating mechanical ventilation in approximately 17 to 30% of afflicted patients [29]. Respiratory failure is most common in patients with a rapid rate of disease progression, autonomic dysfunction, bulbar dysfunction, or bilateral facial weakness [30].…”

Section: Introductionmentioning

confidence: 99%

COVID-19-Associated Guillain-Barre Syndrome: Atypical Para-infectious Profile, Symptom Overlap, and Increased Risk of Severe Neurological Complications

Kajumba

Kolls

Koltai

et al. 2020

SN Compr. Clin. Med.

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The concurrence of COVID-19 with Guillain-Barre syndrome (GBS) can increase the likelihood of neuromuscular respiratory failure, autonomic dysfunction, and other life-threatening symptoms. Currently, very little is known about the underlying mechanisms, clinical course, and prognostic implications of comorbid COVID-19 in patients with GBS. We reviewed COVID-19associated GBS case reports published since the outbreak of the pandemic, with a database search up to August 2020, including a manual search of the reference lists for additional relevant cases. Fifty-one (51) case reports of COVID-19 patients (aged 23-84 years) diagnosed with GBS in 11 different countries were included in this review. The results revealed atypical manifestations of GBS, including para-infectious profiles and onset of GBS without antecedent COVID-19 symptoms. Although all tested patients had signs of neuroinflammation, none had SARS-CoV-2 in the cerebrospinal fluid (CSF), and only four (4) patients had antiganglioside antibodies. The majority had a 1-to 10-day time interval between the onset of COVID-19 and GBS symptoms, and many had a poor outcome, with 20 out of the 51 (39.2%) requiring mechanical ventilation, and two deaths within 12 to 24 h. The atypical manifestations of COVID-19-associated GBS, especially the para-infectious profile and short time interval between the onset of the COVID-19 and GBS symptoms, increase the likelihood of symptom overlap, which can complicate the treatment and result in worsened disease progression and/or higher mortality rates. Inclusion of a neurological assessment during diagnosis of COVID-19 might facilitate timely identification and effective management of the GBS symptoms and improve treatment outcome.

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Section: Introductionmentioning

confidence: 99%

COVID-19-Associated Guillain-Barre Syndrome: Atypical Para-infectious Profile, Symptom Overlap, and Increased Risk of Severe Neurological Complications

Kajumba

Kolls

Koltai

et al. 2020

SN Compr. Clin. Med.

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“…Respiratory failure is the most serious complication of GBS and occurs in 14% to 30% of patients. 1,2 Mortality in GBS occurs in 3% to 13%, with respiratory failure being the primary etiology. Patients who develop respiratory failure tend to progress rapidly and may represent a more severe subset.…”

Section: Discussionmentioning

confidence: 99%

“…Between 14% and 30% of Guillain-Barré syndrome (GBS) patients develop respiratory failure that requires mechanical ventilatory support. 1,2 Electrophysiological studies of the phrenic nerve are frequently abnormal in patients with GBS compared with healthy controls. 3,4 Studies have shown that amplitudes 4 and latencies [5][6][7] differ in patients with respiratory failure when compared with their counterparts.…”

Section: Introductionmentioning

confidence: 99%

Sensitivity and specificity of phrenic nerve electrophysiology to predict mechanical ventilation in the Guillain‐Barré syndrome

et al. 2023

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Introduction/Aims In Guillain–Barré syndrome (GBS), the sensitivity and specificity of phrenic compound muscle action potential (CMAP) measurements to predict endotracheal mechanical ventilation are unknown. Hence, we sought to estimate sensitivity and specificity. Methods We performed a 10‐year retrospective analysis of adult GBS patients from our single‐center laboratory database (2009 to 2019). The phrenic nerve amplitudes and latencies before ventilation were recorded along with other clinical and demographic features. Receiver operating curve (ROC) analysis with area under the curve (AUC) was used to determine the sensitivity and specificity with 95% confidence interval (CI) for phrenic amplitudes and latencies in predicting the need for mechanical ventilation. Results Two hundred five phrenic nerves were analyzed in 105 patients. The mean age was 46.1 ± 16.2 years, with 60% of them being male. Fourteen patients (13.3%) required mechanical ventilation. The average phrenic amplitudes were lower in the ventilated group (P = .003), but average latencies did not differ (P = .133). ROC analysis confirmed that phrenic amplitudes could predict respiratory failure (AUC = 0.76; 95% CI, 0.61 to 0.91; P < .002), but phrenic latencies could not (AUC = 0.60; 95% CI, 0.46 to 0.73; P = .256). The best threshold for amplitude was ≥0.6 mV, with sensitivity, specificity, and positive and negative predictive values of 85.7%, 58.2%, 24.0%, and 96.4%, respectively. Discussion Our study suggests that phrenic CMAP amplitudes can predict the need for mechanical ventilation in GBS. In contrast, phrenic CMAP latencies are not reliable. The high negative predictive value of phrenic CMAP amplitudes ≥0.6 mV can preclude mechanical ventilation, making these a useful adjunct to clinical decision‐making.

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“…As one of the most common causes of neuromuscular respiratory failure with 30% patients requiring mechanical ventilation 1 , Guillain-Barré syndrome (GBS) is a post-infectious peripheral polyneuropathy consisting of a group of rare and acute immune-mediated disorders of the peripheral nervous system characterised by progressive weakness and diminished or absent reflexes as well as elevated protein in cerebrospinal fluid with low white blood cell count. A triggering respiratory or gastrointestinal infection is often reported before the GBS symptom onset.…”

Section: Introductionmentioning

confidence: 99%

Estimated incubation period for mosquito-borne disease-related Guillain-Barre syndrome

Leung

2020

Clinical Epidemiology and Global Health

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Guillain-Barre syndrome (GBS) is a rare post-infectious peripheral polyneuropathy. Following the Zika virus epidemic in 2016, the WHO called for understanding Zika associated GBS through epidemiological studies. However, the incubation period of GBS remains little known and its characterisation is needed. Methods: Articles reporting the data of lag time between the symptom onset of Chikungunya or Zika and GBS were included for pooled analysis. Maximum likelihood estimation was adopted to estimate the incubation period distribution of GBS conditioned to that of the antecedent infection. Results: A total of 89 Chikungunya-and Zika-related GBS cases from 23 articles were identified. The incubation period distribution of GBS is lognormal distributed with the median of 13-14 days and does not depend on the antecedent infection. Conclusions: The incubation period of GBS follows Sartwell's model. It should be useful in confirming the association between infection and GBS in epidemiologic studies as well as to assist diagnosis and prognosis such as clinically assessing respiratory failure. It is also found that viral symptoms can occur prior to neurological symptoms, suggesting that GBS may be a parainfectious disease.

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Respiratory Involvement in Guillain–Barre Syndrome: The Uncharted Road to Recovery

Cited by 6 publications

References 9 publications

COVID-19-Associated Guillain-Barre Syndrome: Atypical Para-infectious Profile, Symptom Overlap, and Increased Risk of Severe Neurological Complications

COVID-19-Associated Guillain-Barre Syndrome: Atypical Para-infectious Profile, Symptom Overlap, and Increased Risk of Severe Neurological Complications

Sensitivity and specificity of phrenic nerve electrophysiology to predict mechanical ventilation in the Guillain‐Barré syndrome

Estimated incubation period for mosquito-borne disease-related Guillain-Barre syndrome

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