Single-Center Study On The Electrophysiological Subtypes And Prognostic Factors Of Guillain-barre Syndrome

Objective: To assess the epidemiology of different electrophysiological subtypes of Guillain-Barre syndrome(GBS)and investigate the effects of factors including electrophysiological results on the prognosis of the acute motor axonal neuropathy(AMAN)subtype in our area..Methods: According to the National Institute of Neurological Disorders and Stroke diagnostic criteria for GBS,104 consecutive GBS patients were recruited from the Department of Neurology of the Second Hospital of Hebei Medical University,China from 2014 to 2018.Results: Based on nerve conduction studies(NCSs),AMAN was the most common subtype in Northern China,accounting for 55.8%(58 patients),AIDP only accounts for 21.2%(22 patients).Patients with AIDP are more likely to have cranial nerve paralysis(P=0.02)and more smokers(P=0.01),and electrophysiological examination results are more likely to show extended DML(Distal Motor Latency)(P<0.0001)and slower nerve conduction(P<0.0001).AMAN patients had significantly higher prevalence of antecedent diarrhea(P=0.02),more frequently occur in summer and autumn(P=0.02)and longer duration of hospitalization(P=0.01)than those with acute inflammatory demyelinating polyneuropathy(AIDP).However,there were no statistical differences between the two subtypes of d CMAP(compound muscle action potential with distal stimulation),disease severity and short-term prognosis.Based on multivariate regression analysis of prognosis in all subtypes showed that d CMAP<0.4(OR=8.67,95% CI: 2.33-32.27,P=0.01),and the time from onset to treatment>9 days(OR=4.34,95% CI: 1.28-14.66,P=0.018),Hughes Functional Grading Scale(HFGS)score>3 on admission(OR=6.88,95% CI: 1.49-31.79,P=0.013)were independently associated with poor short-term prognosis.AMAN patients with antecedent diarrhea(OR = 0.16,95% CI: 0.03–0.756,P=0.021)or conduction blocks(CBs)(OR = 0.033,95% CI: 0.001–0.787,P=0.035)had dramatically better short-term prognosis.Regardless of the subtype of patient,d CMAP less than 40% of the lower limit of normal indicates a slower clinical recovery(OR = 6.78,95% CI: 2.02–27.72,P = 0.002).Conclusions: AMAN is still the most common subtype of GBS in our area.Patients with AIDP subtypes are more likely to have cranial nerve involvement,DML is longer and the conduction speed is slower in electrophysiological results,while patients with AMAN subtype are more likely to have diarrhea,which occurs frequently in summer and autumn.However,the clinical severity and the short-term prognosis of the two subtypes were not significantly different.A decline in d CMAP amplitude is predictive factor of a slow recovery and poor outcome of GBS.Diarrhea and CBs may be the factors for better short-term prognosis in AMAN patients in Northern China.