Clinical Features And Electrophysiological Study Of Guillain-Barre Syndrome In Zhejiang Province Of China

Objection:The purpose of this study was to assess the clinical features and electrophysiological characteristics of Guillain-Barre Syndrome (GBS) in Zhejiang Province of China and compared them with those of other regions at home and abroad.Methods:Fifty-eight GBS patients who hospitalized in our hospital since January2008to December2013were recruited. Clinical information of all patients was retrospectively reviewed with electrophysiological parameters evaluated among48patients, including motor conduction velocity (MCV), distal motor latency (DML), distal compound muscle action potential (dCMAP), sensory conduction velocity (SCV), sensory nerve action potential (SNAP), F wave and H reflex. According to the electrophysiological diagnosis criteria, patients were classified into AIDP, AMAN and equivocal groups. Clinical and electrophysiological features of patients between AIDP and AMAN groups were compared, as well as the findings of this study were compared with those of other regions at home and abroad.Results:Fifty-eight GBS cases were identified, including40male and18female patients, and the mean age was43.9±16.1years old. Excluding3patients of Miller-Fisher Syndrome,45patients who had finished electrophysiological examinations in our hospital were classified into three groups,27patients (60.00%) in AIDP group,9(20.00%) in AMAN group and9(20.00%) in equivocal group.This study didn’t show a seasonal preponderance. Twenty-one patients (36.2%) had respiratory infection1to4weeks before the onset of the syndrome, while9patients (15.5%) had gastrointestinal infection and1patient (1.7%) had chicken pox. Forty-three patients (74.1%) had weakness and49patients (84.5%) had areflexia or hyporeflexia. Forty patients (69.0%) complained of paresthesia, but only22patients (39.7%) were proved paresthesia by electrophysiological examinations. Thirty-two patients (55.2%) had symptoms of cranial nerves. Unilateral facial paralysis and facial diplegia were observed in11patients (19.0%), respectively. Twenty-one patients (36.2%) had cough while drinking water, dysphagia and hoarseness. Nine patients (15.5%) had eyelid ptosis or limitation of eye movement. Fifty-six patients completed lumbar puncture, and44patients (78.9%) showed albuminocytologic dissociation in CSF. The albuminocytologic dissociation in CSF were observed from the second day to over a month from the onset. The total response rate was94.77%. The median time of hospitalization of the whole study population was18.9±13.0days.Compared to AMAN group, higher incidence of cranial nerves involvement and respiratory prodromic infection were observed in AIDP group (P<0.05), with statistical significance. AMAN group had a higher incidence of gastrointestinal infection than that of AIDP group (P<0.05), with statistical significance. Those of median time of hospitalization, Hughes grade at different time, response rate and the number of patients with rapid recovery between AIDP and AMAN were not statistically significant.The electrophysiological abnormalities could be found as early as on the third day of the course. This study found that prolonged DML and decreased dCMAP were most common in peroneal nerve (72.92%,91.67%), while slowed MCV was the most common in ulnar nerve (43.48%). Decreased SNAP was most frequently found in median nerve (50.00%) and tibial nerve (51.64%) while slowed SCV was most common in superficial peroneal nerve (59.57%) and peroneal nerve (45.83%).In comparison with AMAN group, the MCV of median nerve, ulnar nerve and peroneal nerve as well as the SCV of superficial peroneal nerve in AIDP group were slower (P<0.05), and the DML of median nerve, ulnar nerve and peroneal nerve were longer (P<0.05). There were more patients with abnormal SNAP or SCV in AIDP group than AMAN group. The decreased dCMAP shows no difference with statistical significance between AIDP and AMAN group.Conclusions:The main subtype of GBS in Zhejiang Province is AIDP. In comparison with AMAN group, the incidences of respiratory prodromic infection and involvement of cranial nerves in AIDP group are higher. There is no significant difference of the prognosis between AIDP and AMAN. The phenomenon of albuminocytologic dissociation as well as electrophysiological abnormalities could be observed as early as on the second and third day, respectively.Slowed MCV and prolonged DML of AIDP group are more prominent than those of AMAN group. Sensory nerve is more frequently involved in AIDP group. Decreased dCMAP could be observed in both AIDP and AMAN group. To precisely distinguish AIDP and AMAN, it had better to pay more attention to finding out if there is prolonged DML or slowed MCV other than decreased dCMAP.The primary differences of GBS in Zhejiang Province compared to northern regions of China were:(1) no high incidence in summer,(2) respiratory infection is the main type of prodromic infection, and (3) the proportion of AMAN in all GBS patients is lower and the AMAN patients don’t show a poorer prognosis than AIDP. However, compared with North American and some European Countries, the proportion of AMAN is higher in Zhejiang Province but respiratory infection is the main type of prodromic infection in these regions.