A study of prognostic predictors in guillain-barre syndrome

Sakthi Raja Guru, G (2018) A study of prognostic predictors in guillain-barre syndrome. Masters thesis, Coimbatore Medical College, Coimbatore.


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BACKGROUND: GBS causes very rapidly progressing diffuse proximal and distal muscle weakness of the four limbs, sensory loss symptoms with areflexia. The maximal weakness is reached within duration of 4 weeks as given by definition. Cranial nerve involvement with Facial, bulbar musclepalsy andweakness of respiratory muscle is frequent along with autonomic nerve involvement. GBS is best diagnosed clinically but it may be aided by electrophysiology with subtypes acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN), which is primarily axonal and thought to be purely motorand AMSAN. Inspite of the demonstrated efficacy of intravenous immunoglobulins (IVIg) and plasma exchange, GBS still remains a disabling disease in a significant proportion of patients. Long-term improving function is compromised in a significant proportion of patients. Prognosis of the disease and potential predictors of clinical outcome in the illness have been studied in Coimbatore medical college Hospital. AIMS AND OBJECTIVE: 1. To study the prognostic predictors in Guillain-Barre Syndrome for the functional outcome. 2. To assess the various predictors like Age, MRC score at the time of admission, Bulbar palsy autonomic dysfunction, neck flexor weakness, axonal variety on electrophysiological assessment, requirement of ventilator assistance. MATERIALS AND METHODS: Prospective observational studyof 50 patients with GBS diagnosed clinically as per Asbury and Cornblath criteria were enrolled and followed up for 1 year. Medical research council (MRC) sum score was used for valuing the muscle strength. Cranial nerve involvement was examined clinically and noted along with respiratory muscle weakness, which was assessed for the need of mechanical ventilation, Single breath count test-. Single breath count of less than 15 indicates a dangerous low forced vital capacity (FVC) Sensory system were examined by clinical examination and autonomic nervous system abnormalities like cardiovascular manifestations of GI motility, blood pressure and heart rate, ECG were measured. All the patients were uniformly treated with indigenous IVIg. Patients were evaluated throughout the course of disease from the time of admission, till time of discharge. GBS disability score was used for evaluation of functional impact during discharge of patients and during follow up. OBSERVATIONS: Commonest age group involved below 30 years. Males are the most common to present with GBS. Majority of patients were presented less than 24 hours from onset of symptoms to admission. 52% had MRC SUM SCORE of 20-29 at admission .63% had MRC SUM SCORE of ≥40 at discharge. 15 Patients had respiratory difficulty at time of presentation among them 9 needed ventillatory support. 38 patients were given IVIg for 5 days, 3 patients for 7 days, 9 patients for 3 days. AIDP were present in 45 patients and AMAN were present in 5 patients. Cranial Nerve involvement were present in 15 patients. Autonomic involvement in 9 patients. Total dead in the study group was four. 18% had improvement of power MRC SUM SCORE between 10-60. 40% had improvement of power MRC SUM SCORE between 20-60. There is significant influence of age with patient’s age less than 30 have better improvement in power. There is significant influence of time interval between onset to admission with patients admitted before 24 hrs have better improvement in power. There is significant influence of respiratory distress and ventillatory support with there is better improvement in patient who doesn’t has respiratory distress .There is no significant influence of no of days of IVIG over improvement of power. There is significant influence of type of neuropathy with patient’s with AIDP have better improvement than AMAN. AMAN has more chance of ending up in mortality. There is significant influence of cranial nerve involvement and autonomic involvement over final endpoint (Death). CONCLUSION: Our study has varied age and sex of presentation, the incidence of male population was more as similar to other study group. The time of onset of symptoms to admission to hospital with less than 24 hours had better improvement in the power. For patients without respiratory distress and mechanical ventilation had better outcome in prognosis than with the support of it. Further involvement of autonomic system should be diagnosed early to prevent morbidity which does not influence the motor system involvement and its prognosis. Cranial nerve involvement should be clinically diagnosed at the time of admission for earlier assessment for need of ventilator support. Electrophysiological diagnosis of the cases to delineate the sub types of GBS plays a pivotal role for supportive care and in-depth management of AMAN type of GBS. Our study brings out various predictors in GBS patients.

Item Type: Thesis (Masters)
Additional Information: Reg. No.: 201511314
Uncontrolled Keywords: Guillain barre syndrome ; Acute inflammatory demyelinating polyneuropathy ; Acute motor axonal neuropathy ; Intravenous immunoglobulin ; Medical Research Sum Score ; Electrophysiology.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 08 Aug 2018 17:15
Last Modified: 09 Aug 2018 02:08
URI: http://repository-tnmgrmu.ac.in/id/eprint/9189

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