Elsevier

Neuromuscular Disorders

Volume 31, Issue 8, August 2021, Pages 765-768
Neuromuscular Disorders

Characteristics of Guillain-Barré syndrome in a Lebanese tertiary care center

https://doi.org/10.1016/j.nmd.2021.05.012Get rights and content

Highlights

  • AIDP is the most prevalent GBS variant in Lebanon.

  • 60% of the patients had an infection prior to their presentation with GBS.

  • More than half of the patients were not able to walk independently at discharge.

Abstract

Guillain-Barré Syndrome (GBS) is a group of acute inflammatory disorders that share a clinical presentation of progressive polyradiculo-neuropathy. Data on GBS in the Middle East and Lebanon are scarce; hence, we explored the characteristics of patients presenting with GBS to a tertiary care center in Beirut, Lebanon. This was a single-centered retrospective study over a 12-year period. We reviewed the charts of patients presenting with GBS to the American University of Beirut medical center and examined their presentation, management and outcome. 61 patients were included, with the majority being males. 59% of the patients reported an infection prior to admission. 77% had sensory and motor symptoms and 69% were diagnosed with acute inflammatory demyelinating polyneuropathy (AIDP). 57% of patients had initial symptoms in the lower extremities, 25% experienced cranial neuropathies, and 26% complained of pain. 77% were managed by intravenous immunoglobulin with a median hospital stay of 6.5 days. AIDP was noted to be the most prevalent GBS variant in Lebanon. More than 50% had an unfavorable outcome at discharge, which raises the need for better treatment and management approaches.

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.

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