Guillain-Barré Syndrome In Jilin Province, Northeast China

Guillain-Barre syndrome (GBS) is an autoimmune disease affecting the peripheral nervous system. GBS is characterized by weakness, areflexia and numbness or a tingling sensation in the legs and arms. The patients may be chair or bed-bound, may need artificial ventilation. Early diagnosis, treatment and prognosis are very important to every patient while the mechanisms, clinical features and associated exams are important to early diagnosis and treatment. Some studies of GBS have been made in other countries but still many questions have been left such as:how much important of early or super-early neuroelectrophysiological examinations for GBS patients? Is it true that acute motor axonal neuropathy (AMAN) is the most common type in North China? If it is true that the damage of motor axon could be found in every AMAN and all AMAN patients had a bad recovery? Is there some special electrophysiological features in AIDP? Whether the effectiveness is the same between the mild and severe patients and treatment before or after 2 weeks? What is the difference between children and adult GBS patients? These questions have not been considered and we do not find systemic studies of GBS in our country. So we collected 138 sporadic GBS patients and 26 epidemic GBS patients who were admitted to the First Hospital of Jilin University between Jan 2006 and Dec 2010 in order to find some characteristics of GBS in Northeast China.Methods:A retrospective study were performed involving 138 sporadic GBS patients admitted to the First Hospital of Jilin University between Jan 2006 and Dec 2010 and 26 epidemic GBS patients broke out within 2 weeks in 2007. All patients come from Jilin province, Northeast China. Also we divided the sporadic patients into children and adult groups. The objective was to determine if there were some characteristics of GBS in Northeast China.Results:1. the sporadic patients group include 86 males and 52 females,33 children and 105 adults, there median age was 32 years.59% patients reported that they had an antecedent infection and 63% patients of them termed that they had suffered diarrhea. Notably,97% patients had motor weakness and reduced or absent deep tendon reflexes and 51% patients of them reported all limbs were involved simultaneously. Only 38% patients had sensory disturbances.72% patients could not walk independently.2. We divide 138 patients into 3 groups (within 1 week,8-14 days and after 2 weeks) according to the performing time of electrophysiological examinations. Low CMAP amplitude (70%,79% and 85%, retrospectively), abnormal F waves (47%,68% and 62%, retrospectively) and H reflexes (55%, 65% and 53%, retrospectively) were most common in all groups.3. electrophysiological findings subjected to the electrodiagnostic criteria, indicated that 33 patients (26%) exhibited features of AMAN and 66 patients (53%) were AIDP. Not only the low CMAP amplitude but also the slow CMAP latency and MCV were found in AIDP which were different notably from AMAN. Also the abnormal motor nerve conductive studies of lower extremities were most common in AIDP patients and with abnormal sensory nerve conductive studies of upper extremities without involvement of sural nerves.91% and 74% patients could not walk in AMAN and AIDP groups retrospectively.73% and 90% patients made some recovery after effective treatment in AMAN and AIDP groups.4.135 patients received IVIg treatment and 84% of them made some recovery. We divided them into 2 groups according to the time of treatment (within 2 weeks and after 2 weeks), also we divided them into mild group (could walk independently) and severe group. No significant difference were found between these groups.5.138 patients were divided into children and adult groups.23 of 33 children were older than 8 years. Only 36% of them while 66% adult patients had an antecedent infection. Symptoms onset with all limbs involvement were most common in two groups (43% and 53%). Sensory abnormalities were uncommon in children than in adult group (18% and 44%), but cranial nerve involvement were more common in children. Symptoms were more severe in children than in adult (82% and 69%), and the effective of IVIg were not significant in children than in adult (67% and 91%). Low CMAP amplitude, abnormal F waves and H reflexes were most common in two groups. The percent of AMAN were higher in children than in adult (38% and 23%). There were not significant difference between AMAN and AIDP children in recovery and also not different notably when compared with adult. But the AIDP children were not so effective with IVIg treatment when compared with adult patients. But IVIg treatment was more effective in AIDP children than in AMAN children.6. all 26 epidemic GBS patients with symptoms onset between 2 weeks in June and July of 2007 were residents of the Shuangyang District of Changchun City, Jilin province, China. All patients reported that they had drunk unboiled water and most,19/26 (73%) had suffered diarrhea within a month before GBS onset. 14 (54%) patients exhibited features of acute motor axonal neuropathy (AMAN) which associated with a longer illness. Only one patient tested positive for C. jejuni, and none tested positive for Salmonella, Shigella or fungi. Three patients'sera were positive for CMV antibodies; 2 patients'sera were positive for antibodies to EB virus; 8 patients'sera were positive for antibodies to Coxsackie virus. The abnormalities observable～1 month after GBS onset were similar to those evidenced at 10 days after onset, with the exception of F waves, which often recovered quickly, and fibrillation potentials and positive sharp waves which arose over time.Conclusion: 1. Most GBS patients were young males in Jilin province, Northeast China. And gastrointestinal infections were the most common antecedent infection. Clinically, all limbs were involved simultaneously were the most common features. The most common type of GBS was AIDP, which was the same as other countries. Most GBS patients were severe in Northeast China.2. As the electrophysiological features were almost the same in 3 groups (within 1 week,8-14 days and after 2 weeks), and the finding that the abnormal motor nerve conductive studies of lower extremities were most common in AIDP patients and with abnormal sensory nerve conductive studies of upper extremities without involvement of sural nerves. Electrophysiological examinations could be done in early even in super-early GBS.3. The percentage of AMAN was higher than in other countries, but there were not significant difference between AMAN and AIDP in recovery. Some AMAN patients could even make a significant recovery after given an effective treatment.4. Treatment with IVIg could be given regardless the time of GBS onset and the severe degree as there were not significant difference when compared between before and after 2 weeks and compared between mild and severe patients.5. There were many differences between children and adult patients. Most GBS children were older than 8 years, antecedent infection and sensory abnormalities were not so common, but cranial nerve involvement was more common than in adult patients. The percentage of AMAN was higher than adult patients and IVIg was not so effective in GBS children. But the electrophysiological features were almost the same. There were not significant difference between AMAN and AIDP in recovery and also not different notably when compared with adult. But the recovery of some GBS children was worse than adult patients. So as a clinician, we must give an early diagnosis and an effective treatment according to these clinical and electrophysiological characteristics.6. The outbreak of 2007 epidemic GBS may have been associated with various viral infections. The main subtype was AMAN, which was associated with a longer illness duration and a worse prognosis. F waves often recovered quickly than H reflexes, the development of fibrillation potentials and positives waves～1 month after GBS onset may accompany a longer duration of GBS disease.