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Very low peroneal nerve compound muscle action potential amplitude predicts poor outcome in patients with Guillain-Barré syndrome: a prospective cohort

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Abstract

Introduction

Twenty percent of patients with Guillain-Barré syndrome (GBS) have poor outcomes despite proper management. The aim of the study was to characterize electrophysiological factors related to poor outcome in patients with GBS.

Methods

We conducted an observational study from a prospective cohort of 91 patients with GBS in a tertiary healthcare center in Mexico, from 2017 to 2019. Demographics and nerve conduction studies were performed on admission, and a 3-month follow-up for GBS disability score was ensued, allocating patients in good (GBS disability score ≤ 2) and poor outcome (GBS disability score ≥ 3) groups. A logistic regression analysis for independent walk at 3 months was performed. Kaplan–Meier estimator curves for independent walk in very low (< 20% LLN) and low-normal ( ≥20% LLN) peroneal nerve CMAPs are presented.

Results

From the 91 GBS patients included, 37 (40.6%) did not regain independent walk at 3 months. Axonal variants were more common in the poor outcome group (31.4% vs 59.4%, p = 0.01) as well as AIDP variants with motor conduction block (6.6% vs 42.4%, p = 0.018). Univariable analysis was statistically significant for very low median, ulnar, tibial, and peroneal CMAP amplitudes in poor outcome patients; however, multivariable analysis was only significant for very low peroneal nerve CMAP amplitude (OR 3.6 [1.1–11.5, p = 0.024]). Conversely, a greater proportion of GBS patients with low-normal CMAPs recovered independent walk at 90 days (75% vs 30%, p < 0.001).

Conclusion

Severe axonal injury of the peroneal nerve, axonal, and AIDP with motor conduction block variants predicts worse functional outcome regarding independent walk at 3 months.

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References

  1. Sejvar J, Baughman A, Wise M et al (2011) Population incidence of Guillain- Barré syndrome: a systematic review and meta- analysis. Neuroepidemiology 36:123–133

    Article  Google Scholar 

  2. van den Berg B, Walgaard C, Drenthen J et al (2014) Guillain-Barré syndrome: pathogenesis, diagnosis, treatment, and prognosis. Nat Rev Neurol 10(8):469–482

    Article  Google Scholar 

  3. Chio A et al (2003) Guillain-Barré syndrome: a prospective, population-based incidence and outcome survey. Neurology 60:1146–1150

    Article  CAS  Google Scholar 

  4. van Koningsveld R et al (2007) A clinical prognostic scoring system for Guillain– Barré syndrome. Lancet Neurol 6:589–594

    Article  Google Scholar 

  5. Walgaard C, Lingsma HF, Ruts L et al (2011) Early recognition of poor prognosis in Guillain-Barre syndrome. Neurology 76(11):968–975

    Article  CAS  Google Scholar 

  6. Hughes RA, Cornblath DR (2005) Guillain Barré syndrome. Lancet 366(9497):1653–1666

    Article  CAS  Google Scholar 

  7. Kuwabara S, Yuki N (2013) Axonal Guillain-Barré syndrome: concepts and controversies. Lancet Neurol 12(12):1180–1188

    Article  Google Scholar 

  8. Berciano J. Axonal degeneration in Guillain-Barré syndrome: a reappraisal. J Neurol. 2020. https://doi.org/10.1007/s00415-020-10034-y. Online ahead of print.

  9. Dimachkie MM, Barohn RJ (2013) Guillain-Barré syndrome and variants. Neurol Clin 31(2):491–510

    Article  Google Scholar 

  10. Chan YC, Punzalan-Sotelo AM, Kannan TA et al (2017) Electrodiagnosis of reversible conduction failure in Guillain-Barré syndrome. Muscle Nerve 56(5):919–924

    Article  Google Scholar 

  11. Cornblath DR, Mellits ED, Griffin JW et al (1988) Motor conduction studies in Guillain-Barré syndrome: description and prognostic value. Ann Neurol 23(4):354–359

    Article  CAS  Google Scholar 

  12. Uncini A, Kuwabara S (2012) Electrodiagnostic criteria for Guillain-Barré syndrome: a critical revision and the need for an update. Clin Neurophysiol 123(8):1487–1495

    Article  Google Scholar 

  13. Hadden RDM, Cornblath DR, Hughes RAC et al (1998) Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Ann Neurol 44:780–788

    Article  CAS  Google Scholar 

  14. Rajabally YA, Durand M-C, Mitchell J et al (2014) Electrophysiological diagnosis of Guillain-Barré syndrome subtype: could a single study suffice? J Neurol Neurosurg Psychiatry 86(1):115–119

    Article  Google Scholar 

  15. Asbury AK, Cornblath DR (1990) Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 27(Suppl):S21–S24

    Article  Google Scholar 

  16. Butler K, Morris J, Scott K, et al. Neuroanatomy for nerve conduction studies. AANEM Course. 2010. Pp: 1–36

  17. Mallik A, Weir A. Nerve conduction studies: essentials and pitfalls in practice. J Neurol Neurosurg Psychiatry 2005;76(Suppl II):ii23–ii31.

  18. Collins GS, Reitsma JB, Altman DG et al (2015) Transparent reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement. Ann Intern Med. 162(1):55–63

    Article  Google Scholar 

  19. Hosokawa T, Nakajima H, Unoda K et al (2014) An electrophysiological classification associated with Guillain-Barré syndrome outcomes. J Neurol 261(10):1986–1993. https://doi.org/10.1007/s00415-014-7452-2

    Article  PubMed  Google Scholar 

  20. Niu J, Liu M, Sun Q et al (2018) Motor nerve conduction block predicting outcome of Guillain-Barre syndrome. Front Neurol 9:399. https://doi.org/10.3389/fneur.2018.00399

    Article  PubMed  PubMed Central  Google Scholar 

  21. Verma R, Chaudhari TS, Raut TP, Garg RK (2013) Clinico-electrophysiological profile and predictors of functional outcome in Guillain-Barre syndrome (GBS). J Neurol Sci 335(1–2):105–111

    Article  Google Scholar 

  22. Uncini A, Manzoli C, Notturno F, Capasso M (2010) Pitfalls in electrodiagnosis of Guillain-Barré syndrome subtypes. J Neurol Neurosurg Psychiatry 81(10):1157–1163. https://doi.org/10.1136/jnnp.2010.208538

    Article  PubMed  Google Scholar 

  23. Susuki K, Yuki N, Schafer DP et al (2012) Dysfunction of nodes of Ranvier: a mechanism for anti-ganglioside antibody-mediated neuropathies. Exp Neurol 233(1):534–542. https://doi.org/10.1016/j.expneurol.2011.11.039

    Article  CAS  PubMed  Google Scholar 

  24. Kokubun N, Nishibayashi M, Uncini A et al (2010) Conduction block in acute motor axonal neuropathy. Brain 133(10):2897–2908. https://doi.org/10.1093/brain/awq260

    Article  PubMed  Google Scholar 

  25. Willison HJ, Jacobs BC, van Doorn PA (2016) Guillain-Barré syndrome. Lancet 388(10045):717–727

    Article  Google Scholar 

  26. Kuwabara S, Uncini A (2013) Multiple mechanisms for distal axonal loss in Guillain- Barré syndrome. Clin Neurophysiol 124(4):821–822. https://doi.org/10.1016/j.clinph.2012.08.008

    Article  PubMed  Google Scholar 

  27. Walgaarr C, Lingsma HFM, Ruts L, van Doorn PA et al (2011) Early recognition of poor prognosis in Guillan-Barre syndrome. Neurology. 76(11):968–75

    Article  Google Scholar 

  28. Rajabally YA, Hiew FL (2017) Optimizing electrodiagnosis for Guillain-Barré syndrome: clues from clinical practice. Muscle Nerve 55(5):748–751. https://doi.org/10.1002/mus.25433

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neuromuscular Diseases Department, Instituto Nacional de Neurología Y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico

    Juan Carlos López-Hernández, Adib Jorge de Saráchaga, María Eugenia Briseño-Godínez, Esther Pérez-Valdez, Raúl Nathanael May-Mas, Lisette Bazán-Rodríguez, Elizabeth León-Manriquez & Edwin Steven Vargas-Cañas

  2. Neurology Department, Instituto Nacional de Neurología Y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico

    Javier Andrés Galnares-Olalde & José Luis Arista-Ramírez

  3. Neurophysiology Department, Instituto Nacional de Neurología Y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico

    Jorge Burgos-Centeno

Authors
  1. Juan Carlos López-Hernández
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  2. Javier Andrés Galnares-Olalde
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Correspondence to Edwin Steven Vargas-Cañas.

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López-Hernández, J.C., Galnares-Olalde, J.A., Jorge de Saráchaga, A. et al. Very low peroneal nerve compound muscle action potential amplitude predicts poor outcome in patients with Guillain-Barré syndrome: a prospective cohort. Neurol Sci 43, 3923–3928 (2022). https://doi.org/10.1007/s10072-021-05834-7

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