Clinical spectrum and outcome of guillain-barré syndrome with plasmapheresis

Abstract

Context: Guillain-Barré syndrome (GBS) is an acute inflammatory neuropathy and has several electrophysiological subtypes and clinical variants. Treatment is mainly supportive and immunotherapy is given to shorten the disease course. Aims: The aim of this study was to define the outcome of GBS with plasmapheresis and to determine its clinical spectrum. Materials and Methods: The prospective study was done at Mayo Hospital, Lahore, for 1 year from November 2020 to November 2021. The diagnosis of GBS was made on Brighton criteria for GBS. The outcome of therapy was assessed at 3 and 6 months, using the Medical Research Council Scale and Hughes Functional Grading Scale (HFGS). Results: A total of 50 patients were enrolled in the study. Twenty-seven (54%) were males and 23 (46%) were females. Seventeen (34%) had acute motor axonal neuropathy, 16 (32%) had acute motor and sensory axonal neuropathy, 15 (30%) had acute inflammatory demyelinating polyradiculoneuropathy, and 2 (4%) had Miller-Fisher syndrome. Plasmapheresis was done in all patients. HFGS score was assessed at discharge, at 3 months, and after 6 months of illness onset. The improvement in mean HFGS score was 2.79 ± 0.41 at 3 months and 1.94 ± 0.25 at 6 months of symptoms onset from the mean score of 3.46 ± 0.93 at the time of discharge from the hospital. Conclusion: Excellent outcome was observed after plasmapheresis. Majority of participants were able to walk without support at the 6-month follow-up. Plasmapheresis should be initiated early in the management of GBS where intravenous immunoglobulins are costly.