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Dysautonomia in Guillain–Barré Syndrome: Prevalence, Clinical Spectrum, and Outcomes

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An Invited Editorial Commentary to this article was published on 23 July 2019

Abstract

Background

Guillain–Barré syndrome (GBS), when severe, involves the autonomic nervous system; our objective was to assess the spectrum and predictors of dysautonomia, and how it may impact functional outcomes.

Methods

A retrospective review of patients admitted to the Mayo Clinic in Rochester, MN between January 1, 2000, and December 31, 2017, with GBS and dysautonomia was performed. Demographics, comorbidities, parameters of dysautonomia, clinical course, GBS disability score, and Erasmus GBS Outcome Score (EGOS) at discharge were recorded.

Results

One hundred eighty seven patients were included with 71 (38%) noted to have at least one manifestation of dysautonomia. There are 72% of patients with a demyelinating form of GBS and 36% of patients with demyelination had dysautonomia. Ileus (42%), hypertension (39%), hypotension (37%), fever (29%), tachycardia or bradycardia (27%), and urinary retention (24%) were the most common features. Quadriparesis, bulbar and neck flexor weakness, and mechanical ventilation were associated with autonomic dysfunction. Patients with dysautonomia more commonly had cardiogenic complications, syndrome of inappropriate antidiuretic hormone, posterior reversible encephalopathy syndrome, and higher GBS disability score and EGOS. Mortality was 6% in patients with dysautonomia versus 2% in the entire cohort (P = 0.02).

Conclusions

Dysautonomia in GBS is a manifestation of more severe involvement of the peripheral nervous system. Accordingly, mortality and functional outcomes are worse. There is a need to investigate if more aggressive treatment is warranted in this category of GBS.

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Abbreviations

GBS:

Guillain–Barré syndrome

AIDP:

Acute demyelinating polyradiculoneuropathy

ICU:

Intensive care unit

PRES:

Posterior reversible encephalopathy syndrome

SIADH:

Syndrome of inappropriate antidiuretic hormone

EGOS:

Erasmus GBS Outcome Score

CIDP:

Chronic inflammatory polyradiculoneuropathy

CMAP:

Compound muscle action potential

mV:

Millivolts

CSF:

Cerebrospinal fluid

IVIG:

Intravenous immunoglobulin

PLEX:

Plasmapheresis

PE:

Pulmonary embolism

DVT:

Deep vein thrombus

IQR:

Interquartile range

OR:

Odds ratio

CI:

Confidence interval

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Authors and Affiliations

  1. Mayo Clinic Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Tia Chakraborty, Eelco F. M. Wijdicks & Alejandro A. Rabinstein

  2. Department of Neurology, The University of Chicago, Chicago, IL, USA

    Christopher L. Kramer

Authors
  1. Tia Chakraborty
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  2. Christopher L. Kramer
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  3. Eelco F. M. Wijdicks
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  4. Alejandro A. Rabinstein
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Contributions

This study required no sponsorship or funding. Tia Chakraborty MD authored, conceptualized, acquired data, performed all statistical analyses, drafted, and revised the manuscript. She had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Christopher Kramer MD analyzed and acquired data, conceptualized, drafted, and revised the manuscript. Eelco Wijdicks MD PhD authored, conceptualized, drafted, and revised the manuscript. Alejandro A. Rabinstein MD authored, conceptualized, drafted, and revised the manuscript.

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Correspondence to Tia Chakraborty.

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The Mayo Clinic Institutional Review Board approved this study.

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Chakraborty, T., Kramer, C.L., Wijdicks, E.F.M. et al. Dysautonomia in Guillain–Barré Syndrome: Prevalence, Clinical Spectrum, and Outcomes. Neurocrit Care 32, 113–120 (2020). https://doi.org/10.1007/s12028-019-00781-w

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