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Prognostic Implications of Early Albuminocytological Dissociation in Guillain–Barré Syndrome

Published online by Cambridge University Press:  18 August 2022

Edwin Steven Vargas-Cañas ,
Javier Andrés Galnares-Olalde Open the ORCID record for Javier Andrés Galnares-Olalde [Opens in a new window] ,
Fausto León-Velasco ,
Miguel García-Grimshaw Open the ORCID record for Miguel García-Grimshaw [Opens in a new window] ,
Alonso Gutiérrez  and
Juan Carlos López-Hernández Open the ORCID record for Juan Carlos López-Hernández [Opens in a new window]
Edwin Steven Vargas-Cañas
Affiliation:
Neuromuscular diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Javier Andrés Galnares-Olalde
Affiliation:
Neuromuscular diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Fausto León-Velasco
Affiliation:
Neurology Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Miguel García-Grimshaw
Affiliation:
Neurology Department, Neurology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Alonso Gutiérrez
Affiliation:
Neurology Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Juan Carlos López-Hernández*
Affiliation:
Neuromuscular diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
*
Corresponding author: Juan Carlos López-Hernández, Insurgentes Sur 3877, LA Fama, Tlalpan, Mexico City, Mexico. Email: juanca9684@hotmail.com
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Abstract:

Background:

Half of Guillain–Barré syndrome (GBS) present elevated cerebrospinal fluid (CSF) protein levels within 1 week since symptom onset and 80% within 2 weeks. Our objective was to determine the clinical and prognostic implication of albuminocytological dissociation in early GBS.

Methods:

An ambispective cohort study was conducted. Good outcome was considered if the patient was able to walk unaided (Guillain-Barré disability score [GDS] ≤ 2 points) at 3-month follow-up. Patients were classified into two groups: with and without albuminocytological dissociation; we compared clinical and paraclinic characteristics between the groups. We analyzed clinical and electrophysiological factors related to presenting early dissociation through a multivariate model.

Results:

We included 240 patients who fulfilled Asbury criteria for GBS. On further selection, only 94 patients fulfilled inclusion. Mean age was 45.94 ± 17.1 years and 67% were male. Median time from symptom onset to admission was 5 days (IQR 3–6). Regarding albuminocytological dissociation and electrophysiological variants, we found a significant difference: acute inflammatory demyelinating polyneuropathy (AIDP) [60.6% vs 26.2%, p = 0.002], acute motor axonal neuropathy (AMAN) [21.2% vs 49.1%, p = 0.009] and acute motor sensory axonal neuropathy (AMSAN) [12.1% vs 1.6%, p = 0.05]. We did not observe significant differences in recovery of independent walking in short term between both groups. The presence of conduction block in any variant (OR 3.21, 95% CI 1.12–9.16, p = 0.02) and absence of sural registration (OR 5.69, 95% CI 1.48–21.83, p = 0.011) were independent factors related to early dissociation.

Conclusions:

Early dissociation (<7 days) is not associated with any particular clinical feature or unfavorable outcome. It is more common to see in AIDP rather than axonal variants.

Résumé :

RÉSUMÉ :

Implications pronostiques de la dissociation albumino-cytologique précoce dans le cas du syndrome de Guillain-Barré.

Contexte :

La moitié des cas de syndrome de Guillain-Barré (SGB) présentent des taux élevés de protéines dans le liquide céphalo-rachidien (LCR) dans la semaine suivant l’apparition des symptômes et 80 % d’entre eux dans les deux semaines. Notre objectif est ici de déterminer l’implication clinique et pronostique de la dissociation albumino-cytologique à un stade précoce du SGB.

Méthodes :

Une étude de cohorte ambispective a ainsi été effectuée. Un résultat a été considéré « bon » dans la mesure où un patient était capable de marcher sans aide (GDS ≤ 2 points) lors d’un suivi effectué au bout de 3 mois. Les patients à l’étude ont été classés en deux groupes : avec et sans dissociation albumino-cytologique. Nous avons ensuite comparé entre elles les caractéristiques cliniques et paracliniques des deux groupes. Au moyen d’un modèle multivarié, nous avons en outre analysé les facteurs cliniques et électro-physiologiques liés à la présentation d’une dissociation précoce.

Résultats :

Nous avons inclus 240 patients qui remplissaient les critères d’Asbury pour le SGB. Après une nouvelle sélection, seuls 94 patients ont été inclus. L’âge moyen de ces derniers était de 45,94 ± 17,1 ans tandis que 67 % étaient des hommes. Le délai médian entre l’apparition des symptômes et l’admission était de 5 jours (EI 3-6). En ce qui concerne la dissociation albumino-cytologique et les variantes électro-physiologiques, nous avons constaté une différence notable : PDIA [60,6 % contre 26,2 %, p = 0,002], NAMA [21,2 % contre 49,1 %, p = 0,009] et NAAMS [12,1 % contre 1,6 %, p = 0,05]. Précisons que nous n’avons pas observé entre les deux groupes de différences significatives dans la récupération autonome à court terme de la marche. La présence d’un bloc de conduction nerveux dans n’importe quelle variante (RC 3,21 ; IC 95 % 1,12-9,16; p = 0,02) et l’absence d’enregistrement des triceps suraux (RC 5,69 ; IC 95 % 1,48-21,83 ; p = 0,011) étaient des facteurs indépendants liés à une dissociation précoce.

Conclusions :

La dissociation précoce (< 7 jours) n’est associée à aucune caractéristique clinique particulière ni à une issue défavorable. Elle est plus fréquente dans le cas de la PDIA que dans les autres variantes axonales.

Keywords

CSFAlbuminocytological dissociationGuillain barreNeuropathyPrognosisElectrophysiological variantsAIDPAMANEarly lumbar puncture
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 50 , Issue 5 , September 2023 , pp. 745 - 750
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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Footnotes

†

These authors contributed equally to this work.

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