Characteristics of Guillain-Barré syndrome in a Lebanese tertiary care center
Introduction
Though Guillain-Barré syndrome (GBS) is typically known to cause an acute rapidly progressing polyradiculo-neuropathy, it can also have diverse presentations including sensorimotor variant, pure motor variant, Miller-Fisher syndrome (MFS), and other much less common variants. Electrophysiological studies may help distinguish GBS subtypes [1]. 50–75% of patients with GBS report a preceding respiratory and gastrointestinal illness, most commonly caused by Campylobacter jejuni [2], [3], [4], [5]. Patients with GBS may have variable outcomes ranging from full recovery to severe disability and even death [6].
The prevalence of phenotypical variants and electrophysiological subtypes vary between geographical regions. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common variant in North America and Europe while acute axonal motor neuropathy (AMAN) and acute motor sensory axonal polyneuropathy (AMSAN) prevail in Eastern Asia and South America [1,[7], [8], [9]. Clinical information on patients with GBS in the Middle East region is scarce, with no studies reported in Lebanon up to this date. In this study, we describe the clinical presentation, electrophysiological subtypes, clinical course, as well as outcome of GBS in a sample of patients presenting to a Lebanese tertiary care center, aiming to shed light on the predominant GBS presentation in the Middle East.
Section snippets
Methods
This is a retrospective, single-centered, chart review-based study that was approved by the institutional review board at the American University of Beirut (ID: BIO-2020–0099). We included all patients who were admitted to the American University of Beirut Medical Center (AUBMC) between January 2008 and February 2020, who met the clinical and/or electro-diagnostic criteria for the diagnosis of GBS. AUBMC is located in Beirut (capital of Lebanon) and is considered a main tertiary referral center
Background
We excluded 30 patients who turned out to have alternative diagnosis such as chronic inflammatory demyelinating polyneuropathy, had missing electrophysiological studies when presentation was not conclusive, or had insufficient documented data. All 61 included patients were from the Middle-Eastern region; 54 (88.5%) were Lebanese, 3 (5%) were Iraqi, 3 (5%) were Syrian, and 1 (1.5%) was Turkish. Out of these patients, 43 (70.5%) were males, 11 (18%) were current smokers, and 6 (10%) were former
Discussion
This is the first study in Lebanon to report the presentation, management, and outcome of patients with GBS. The majority of patients in our cohort were males which is in agreement with previously reported data [11]. Our cohort was younger at symptom onset compared to European/American and Asian cohorts, but older than the Bangladeshi cohort [12]. More than half of our cohort had a recent infection (mostly respiratory and to a lesser extent gastrointestinal) prior to presentation. This
Conclusion
Based on our study, the majority of patients with GBS referred to our Lebanese medical center presented with AIDP variant and were mostly males. A preceding infection was noted as a major risk factor in more than half of the patients. Most patients with GBS in Lebanon had unfavorable outcomes at discharge from the hospital and at follow-up. This raises the need for better therapeutic and rehabilitative approaches to ensure a faster recovery and a better quality of life. This study sets the
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Funding
this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgment
none.
References (19)
- et al.
Guillain-Barre syndrome
Lancet
(2016) - et al.
Axonal Guillain-Barre syndrome: concepts and controversies
Lancet Neurol
(2013) - et al.
Optimizing the electrodiagnostic accuracy in Guillain-Barre syndrome subtypes: criteria sets and sparse linear discriminant analysis
Clin Neurophysiol
(2017) - et al.
Serologic evidence of previous Campylobacter Jejuni infection in patients with the Guillain-Barre syndrome
Ann Intern Med
(1993) - et al.
Mycoplasma pneumoniae triggering the Guillain-Barre syndrome: a case-control study
Ann Neurol
(2016) - et al.
Pathology of the motor-sensory axonal Guillain-Barré syndrome
Ann Neurol
(1996) - et al.
Guillain–Barre Syndrome
Seminars in neurology
(2019) - et al.
Epidemiological study of Guillain-Barré syndrome in south east England
J Neurol Neurosurg Psychiatry
(1998) - et al.
Guillain-Barre syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River
J Neurol Neurosurg Psychiatry
(2018)