Diagnosis, Prognosis, Treatment and Outcome of Guillain-Barré Syndrome in Bangladesh

Demography, clinical features, electrophysiological spectrum, preceding infections/events and outcome were assessed in 556 Bangladeshi patients with GBS enrolled between 2010 and 2016 in Dhaka Medical College Hospital and National Institute of Neurosciences in Dhaka area. The diagnosis of GBS was based on the NINDS criteria. In Bangladesh GBS is a severe and rapidly progressive disease, affects relatively younger people and only one out of ten patients received either IVIg or plasma exchange (PE). Antecedent infections were documented in 80% of cases, of which half had preceding diarrhea. CSF albuminocytologic dissociation was commonly observed (84%) and most patients (>99%) had abnormal nerve electrophysiology. As per the recently proposed Brighton criteria (BC) for GBS, 58% patients met level 1 of the BC, 28% patients met level 2, 12% patients met level 3, and 2% patients met level 4. Nerve electrophysiology was assessed in 312 patients with acute phase of GBS. As per the eight sets of neurophysiological criteria sets applied, half of the Bangladeshi patients had an axonal subtype of GBS. The presence of anti-GM1 antibodies was strongly associated with axonal forms of GBS. However anti-GM1 antibodies were also detected in a subset of patients with GBS having demyelinating subtype. In total, 14% of patients died, 29% required mechanical ventilation and poor outcome (GBS disability score >2) was observed in 31% at 6 months from the onset of disease. Advanced age, severity of muscle weakness, pure motor involvement, need for mechanical ventilation, autonomic dysfunction, the axonal subtype and the presence of anti-GM1 or anti-LOS antibodies were independently associated with a poor outcome. Treatment with small volume plasma exchange (SVPE) was evaluated in 20 adult patients with GBS and found to be feasible and safe in resource poor setting. Further studies of clinical efficacy for SVPE in low-income and middle-income countries are warranted.

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