Guillain-Barré Syndrome: Clinical Case

Guillain-Barré syndrome (GBS) is a paralytic peripheral neuropathy with an annual incidence of 0.81 to 1.89 cases (median: 1.11) per 100,000 people worldwide. The in-hospital mortality rate from GBS is approximately 2.6-2.8%. Risk factors include the severity of weakness at admission, time to reach maximum disability, the need for mechanical ventilation (MV), advanced age, as well as the presence of pulmonary and cardiac complications. Positive treatment outcomes are presented for one of the most common acute polyneuropathies—acute inflammatory polyradiculoneuropathy of autoimmune origin, or
Guillain-Barré syndrome. The pathomorphology is described in detail, the characteristics of various clinical variants are provided, and the diagnostic criteria and treatment methods for Guillain-Barré syndrome are presented. A case of acute inflammatory demyelinating polyradiculoneuropathy with the development of lower paraparesis is described. Clinical improvement was noted from the third day, and complete recovery of neurological deficits, both clinically and according to ENMG data, was observed after 3 months.

1. Benedetti, L., Briani, C., Beronio, A., Massa, F., Giorli, E., Sani, C. et al. (2019). Increased incidence of axonal Guillain-Barre syndrome in la spezia area of Italy: a 13-year follow-up study. Journal of the Peripheral Nervous System, 24, 80-86, DOI: 10.1111/jns.12292.

2. Van Den Berg, B., Bunschoten, C., Van Doorn, P. A. and Jacobs, B. C. (2013). Mortalityin Guillain-Barre syndrome // Neurology, 80, 1650-1654, DOI: 10.1212/wnl.0b013e3182904fcc.

3. Alshekhlee, A., Miles, J. D., Katirji, B., Preston, D. C. and Kaminski, H. J. (2009). Incidence and mortality rates of myasthenia gravis and myasthenic crisis in US hospitals. Neurology, 72, 1548-1554, DOI: 10.1212/wnl.0b013e3181a41211.

4. Sejvar, J. J., Baughman, A. L., Wise, M. and Morgan, O. W. (2011). Population incidence of Guillain-Barre syndrome: a systematic review and meta-analysis. Neuroepidemiology, 36, 123-133, DOI: 10.1159/000324710.

5. Wakerley, B. R. and Yuki, N. (2013). Infectious and noninfectious triggers in Guillain-Barre syndrome. Expert Review of Clinical Immunology, 9, 627-639, DOI: 10.1586/1744666x.2013.811119.

6. Khan, F., Pallant, J. F., Ng, L. and Bhasker, A. (2010). Factors associated with long-term functional outcomes and psychological sequelae in Guillain-Barre syndrome. Journal of Neurology, 257, 20242031, DOI: 10.1007/s00415-010-5653-x.

7. Khan, F. and Amatya, B. (2012). Rehabilitation interventions in patients with acute demyelinating inflammatory polyneuropathy: a systematic review. European Journal of Physical and Rehabilitation Medicine, 48, 507-522.

8. Van Den Berg, B., Storm, E. F., Garssen, MJP., Blomkwist-Markens, P. H. and Jacobs, B. C. (2018). Clinical outcome of Guillain-Barre syndrome after prolonged mechanical ventilation. Journal of Neurology, Neurosurgery and Psychiatry, 89, 949-954, DOI: 10.1136/jnnp-2018-317968.

9. Oladiran, O., Shi, X. Q., Yang, M., Fournier, S. and Zhang, J. (2021). Inhibition of TLR4 signaling protects mice from sensory and motor dysfunction in an animal model of autoimmune peripheral neuropathy. Journal of Neuroinflammation, 1-17.

10. Leonhard, S. E. et al. (2019). Diagnosis and management of Guillain-Barré syndrome in ten steps. Nature Reviews Neurology, 15 (11), 671-683, DOI: 10.1038/s41582-019-0250-9.

11. Berciano, J. (2020). Axonal degeneration in Guillain–Barré syndrome: a reappraisal. Journal of Neurology, 268(10), 3728-3743, DOI: 10.1007/s00415-020-10034-y.

12. Martín-Aguilar, L., Pascual-Goñi, E. and Querol, L. (2019). Autoantibodies in immune-mediated inflammatory neuropathies. Medicina Clínica (English Ed.), 153(9), 360-367, DOI: 10.1016/j.medcle.2019.06.015.

13. Sindrom Gijena Barre (2022). Teledoctor 24. [Website]. Retrieved October 11, 2023, from https://teledoctor24.ru/libpage/26-sindrom-giyena-barre/ (In Russian).

14. Cao-Lormeau, V. M. et al. (2016). Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: A case-control study. Lancet, 387(10027), 1531-1539, DOI: 10.1016/S01406736(16)00562-6.

15. Van Den Berg, B. et al. (2014). Guillain-Barré syndrome associated with preceding hepatitis E virus infection. Neurology, 82(6), 491-497, DOI: 10.1212/WNL.0000000000000111.

16. Keddie, S. et al. (2021). Epidemiological and cohort study finds no association between COVID-19 and Guillain-Barré syndrome. Brain, 144(2), 682693, DOI: 10.1093/brain/awaa433.

17. Restrepo-Jiménez, P., Rodríguez, Y., González, P., Chang, C., Gershwin, M. E. and Anaya, J. M. (2018). The immunotherapy of Guillain-Barré syndrome. Expert Opinion on Biological Therapy, 18(6), 619-631, DOI: 10.1080/14712598.2018.1468885.

18. Koike, H. et al. (2020). Ultrastructural mechanisms of macrophage-induced demyelination in Guillain-Barré syndrome. Journal of Neurology, Neurosurgery and Psychiatry, 91(6), 650-659, DOI: 10.1136/jnnp-2019–322479.

19. Griffin, J. W. et al. (1996). Early nodal changes in the acute motor axonal neuropathy pattern of the Guillain-Barré syndrome. Journal of Neurocytology, 25(1), 33-51, DOI: 10.1007/BF02284784.

20. Piradov, M. A., Avdjunina, I. A. (1996). Sindrom Gijena-Barre: problemy lechenija i terminologii. Neurological Journal, 3, 33-36 (In Russian).

21. Ruts, L., Drenthen, J., Jongen, J. L., Hop, W. C., Visser, G. H., Jacobs, B. C. et al. (2010). Pain in Guillain-Barre syndrome: a long-term follow-up study. Neurology, 75, 1439-1447, DOI: 10.1212/wnl.0b013e3181f88345.