Regional variation of Guillain-Barré syndrome
Journal
Brain
Journal Volume
141
Journal Issue
10
Pages
2866
Date Issued
2018-10-01
Author(s)
Doets A.Y.
Verboon C.
van den Berg B.
Harbo T.
Cornblath D.R.
Willison H.J.
Islam Z.
Attarian S.
Barroso F.A.
Bateman K.
Benedetti L.
Marchesoni C.
Marfia G.A.
Márquez Infante C.
Martinez Hernandez E.
Mataluni G.
Casasnovas C.
McDermott C.J.
Meekins G.D.
Monges M.S.
Montero M.C.J.
Kusunoki S.
Morís de la Tassa G.
Mozzoni J.
Nascimbene C.
Nowak R.J.
Orizaloa Balaguer P.
Osei-Bonsu M.
Cavaletti G.
Lee Pan E.B.
Pasnoor M.
Rajabally Y.A.
Kuwabara S.
Ritter C.
Roberts R.C.
Rojas-Marcos I.
Rudnicki S.A.
Ruiz M.
Sachs G.M.
Samijn J.P.A.
Chavada G.
Santoro L.
Schenone A.
Lehmann H.C.
Schwindling L.
Sedano Tous M.J.
Sekiguchi Y.
Sheikh K.A.
Silvestri N.J.
Sommer C.L.
Stein B.
Stino A.M.
Claeys K.G.
Spyropoulos A.
Miller J.A.L.
Srinivasan J.
Suzuki H.
Tankisi H.
Tigner D.
Twydell P.T.
van Damme P.
van der Kooi A.J.
van Dijk G.W.
van der Ree T.
Dardiotis E.
Mohammad Q.D.
van Koningsveld R.
Varrato J.D.
Vermeij F.H.
Visser L.H.
Vytopil M.V.
Waheed W.
Wilken M.
Wilkerson C.
Wirtz P.W.
Yamagishi Y.
Monges S.
Davidson A.
Zhou L.
Zivkovic S.
The IGOS Consortium
van Doorn P.A.
Feasby T.E.
Galassi G.
Gorson K.C.
Hartung H.-P.
Nobile Orazio E.
Hughes R.A.C.
Illa I.
Islam B.
Pardo J.
Pereon Y.
Rinaldi S.
Kimpinski K.
Querol L.
Reddel S.W.
Reisin R.C.
Shahrizaila N.
Sindrup S.H.
Waqar W.
Jacobs B.C.
van Woerkom M.
Roodbol J.
Péréon Y.
Kleyweg R.P.
Addington J.M.
Ajroud-Driss S.
Andersen H.
Antonini G.
Ariatti A.
Badrising U.A.
Beronio A.
Bianco M.
Binda D.
Briani C.
Kokubun N.
Bunschoten C.
Bürmann J.
Bella I.R.
Bertorini T.E.
Bhavaraju-Sanka R.
Brannagan T.H.
Busby M.
Butterworth S.
Chetty S.
Kolb N.A.
Conti M.E.
Cosgrove J.S.
Dalakas M.C.
Derejko M.A.
Dimachkie M.M.
Doppler K.
Dornonville de la Cour C.
Echaniz-Laguna A.
Eftimov F.
Faber C.G.
Kuitwaard K.
Fazio R.
Fujioka T.
Fulgenzi E.A.
Garcia-Sobrino T.
Garnero M.
Garssen M.P.J.
Gijsbers C.J.
Gilchrist J.M.
Goldstein J.M.
Granit V.
Kwan J.Y.
Grapperon A.
Gutiérrez G.
Hadden R.D.M.
Holbech J.V.
Holt J.K.L.
Homedes Pedret C.
Htut M.
Jericó Pascual I.
Kaida K.
Karafiath S.
Ladha S.S.
Katzberg H.D.
Kiers L.
Kieseier B.C.
Landschoff Lassen L.
Lawson V.
Ledingham D.
van den Bergh P.
Léon Cejas L.
Lucy S.T.
Lunn M.P.T.
Magot A.
Manji H.
Abstract
Guillain-Barr? syndrome is a heterogeneous disorder regarding the clinical presentation, electrophysiological subtype and outcome. Previous single country reports indicate that Guillain-Barr? syndrome may differ among regions, but no systematic comparative studies have been conducted. Comparative studies are required to identify factors determining disease susceptibility, variation and prognosis, and to improve diagnostic criteria. The International Guillain-Barr? Syndrome Outcome Study is a prospective, observational cohort study including all patients within the diagnostic spectrum, aiming to describe the heterogeneity of Guillain-Barr? syndrome worldwide. The current study was based on the first 1000 inclusions with a follow-up of at least 1 year and confirmed the variation in clinical presentation, course and outcome between patients. The full clinical spectrum of Guillain-Barr? syndrome was observed in patients from all countries participating in the International Guillain-Barr? Syndrome Outcome Study, but the frequency of variants differed between regions. We compared three regions based on geography, income and previous reports of Guillain-Barr? syndrome subtypes: Europe/Americas', Asia' (without Bangladesh), and Bangladesh'. We excluded 75 (8%) patients because of alternative diagnoses, protocol violations, or missing data. The predominant clinical variant was sensorimotor in Europe/Americas (n = 387/562, 69%) and Asia (n = 27/63, 43%), and pure motor in Bangladesh (n = 74/107, 69%). Miller Fisher syndrome and Miller Fisher-Guillain-Barr? overlap syndrome were more common in Asia (n = 14/63, 22%) than in the other two regions (Europe/Americas: n = 64/562, 11%; Bangladesh: n = 1/107, 1%) (P < 0.001). The predominant electrophysiological subtype was demyelinating in all regions (Europe/Americas: n = 312/573, 55%; Asia: n = 29/65, 45%; Bangladesh: n = 38/94, 40%). The axonal subtype occurred more often in Bangladesh (n = 34/94, 36%) than in Europe/Americas (n = 33/573, 6%) and other Asian countries (n = 4/65, 6%) (P < 0.001). In all regions, patients with the axonal subtype were younger, had fewer sensory deficits, and showed a trend towards poorer recovery compared to patients with the demyelinating subtype. The proportion of patients able to walk unaided after 1 year varied between Asia (n = 31/34, 91%), Europe/Americas (n = 334/404, 83%) and Bangladesh (n = 67/97, 69%) (P = 0.003). A similar variation was seen for mortality, being higher in Bangladesh (n = 19/114, 17%) than in Europe/Americas (n = 23/486, 5%) and Asia (n = 1/45, 2%) (P < 0.001). This study showed that factors related to geography have a major influence on clinical phenotype, disease severity, electrophysiological subtype, and outcome of Guillain-Barr? syndrome. ? 2018 The Author(s).
Subjects
axonal degeneration; clinical course; demyelination; outcome; polyradiculoneuropathy
Other Subjects
adult; areflexia; Article; artificial ventilation; Asia; autonomic dysfunction; Bangladesh; bulbar paralysis; chronic inflammatory demyelinating polyneuropathy; clinical feature; disease severity; electrophysiology; Europe; female; follow up; functional disease; gastroenteritis; geography; Guillain Barre syndrome; human; hyperreflexia; hyporeflexia; leukocyte count; limb weakness; major clinical study; male; middle aged; nerve conduction; outcome assessment; paraplegia; priority journal; quadriplegia; upper respiratory tract infection; Western Hemisphere; adolescent; aged; child; clinical trial; Guillain Barre syndrome; multicenter study; pathophysiology; preschool child; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Guillain-Barre Syndrome; Humans; Male; Middle Aged; Young Adult
Publisher
Oxford University Press
Type
journal article