Document Type : Original Article

Authors

1 Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran

2 Hamadan University of Medical Sciences, Hamadan, Iran

3 Hearing Disorder Research Center, Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran

4 Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

Abstract

Background and aims: Guillain-Barré syndrome (GBS) has several types, some of which damage myelin and some others cause axonal damage. Detecting the type of GBS is important in determining the type of treatment and its prognosis. This study was conducted to investigate the epidemiological characteristics of GBS and its variants in patients referred to Sina hospital in Hamadan, Iran, in 2018.
 
Methods: In this cross-sectional study, 51 patients who were admitted to Sina hospital and diagnosed with GBS in 2018 were examined. Demographic data, GBS type, disease outcomes, and pre-clinical and clinical findings of patients were collected. Data were then analyzed using the Stata software version 12, and P value < 0.05 was considered statistically significant.
 
Results: Of the 51 investigated patients, 34 (66.66%) were male. The most common variant type was acute inflammatory demyelinating polyneuropathy (AIDP) with 27.45% of cases followed by acute motor axonal neuropathy (AMAN) with 19.61% of cases. Further, the highest average hospitalization days (11.1 ± 11.7 days) were for chronic inflammatory demyelinating polyneuropathy (CIDP) patients, while the lowest (6.85 ± 1.91 days) was for AIDP patients (P < 0.001). All CIDP cases occurred in spring, and 71.43% of AIDP cases occurred in summer. Moreover, all 7 cases with acute motor and sensory axonal neuropathy (AMSAN) syndrome and the only case with the miller-fisher syndrome (MFS) occurred in fall (P < 0.001).
 
Conclusion: According to the results of this study, most variants of GBS in Hamadan province were AIDP in demyelinating form and AMAN variant in the axonal deterioration form. However, studies with a larger sample size are recommended in the west of Iran to better understand the epidemiology and to ensure common types of GBS.

Keywords

1. Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet. 2021;397(10280):1214-28. doi: 10.1016/ s0140-6736(21)00517-1. 
2. Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016;388(10045):717-27. doi: 10.1016/ s0140-6736(16)00339-1. 
3. Webb AJ, Brain SA, Wood R, Rinaldi S, Turner MR. Seasonal variation in Guillain-Barré syndrome: a systematic review, meta-analysis and Oxfordshire cohort study. J Neurol Neurosurg Psychiatry. 2015;86(11):1196-201. doi: 10.1136/ jnnp-2014-309056.
4. Schessl J, Luther B, Kirschner J, Mauff G, Korinthenberg R. Infections and vaccinations preceding childhood Guillain-Barré syndrome: a prospective study. Eur J Pediatr. 2006;165(9):605-12. doi: 10.1007/s00431-006-0140-1. 
5. Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019;15(11):671-83. doi: 10.1038/s41582-019-0250-9. 
6. Esposito S, Longo MR. Guillain-Barré syndrome. Autoimmun Rev. 2017;16(1):96-101. doi: 10.1016/j.autrev.2016.09.022. 
7. Živković S. Intravenous immunoglobulin in the treatment of neurologic disorders. Acta Neurol Scand. 2016;133(2):84-96. doi: 10.1111/ane.12444. 
8. Israeli E, Agmon-Levin N, Blank M, Chapman J, Shoenfeld Y. Guillain-Barré syndrome--a classical autoimmune disease triggered by infection or vaccination. Clin Rev Allergy Immunol. 2012;42(2):121-30. doi: 10.1007/s12016-010- 8213-3. 
9. Lebrun G, Chadda K, Reboux AH, Martinet O, Gaüzère BA. Guillain-Barré syndrome after chikungunya infection. Emerg Infect Dis. 2009;15(3):495-6. doi: 10.3201/eid1503.071482. 
10. Stowe J, Andrews N, Wise L, Miller E. Investigation of the temporal association of Guillain-Barré syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database. Am J Epidemiol. 2009;169(3):382-8. doi: 10.1093/aje/kwn310. 
11. Sanz Fadrique R, Martín Arias L, Molina-Guarneros JA, Jimeno Bulnes N, García Ortega P. Guillain-Barré syndrome and influenza vaccines: current evidence. Rev Esp Quimioter. 2019;32(4):288-95. 
12. Liu GF, Wu ZL, Wu HS, Wang QY, Zhao-Ri GT, Wang CY, et al. A case-control study on children with Guillain-Barré syndrome in North China. Biomed Environ Sci. 2003;16(2):105-11. 
13. Kinnunen E, Junttila O, Haukka J, Hovi T. Nationwide oral poliovirus vaccination campaign and the incidence of Guillain-Barré Syndrome. Am J Epidemiol. 1998;147(1):69-73. doi: 10.1093/oxfordjournals.aje.a009369. 
14. Loly JP, Rikir E, Seivert M, Legros E, Defrance P, Belaiche J, et al. Guillain-Barré syndrome following hepatitis E. World J Gastroenterol. 2009;15(13):1645-7. doi: 10.3748/ wjg.15.1645. 
15. Morris K, Rylance G. Guillain-Barré syndrome after measles, mumps, and rubella vaccine. Lancet. 1994;343(8888):60. doi: 10.1016/s0140-6736(94)90917-2. 
16. Gervaix A, Caflisch M, Suter S, Haenggeli CA. Guillain- Barré syndrome following immunisation with Haemophilus influenzae type b conjugate vaccine. Eur J Pediatr. 1993;152(7):613-4. doi: 10.1007/bf01954093. 
17. Melnick SC, Flewett TH. Role of infection in the Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 1964;27(5):395- 407. doi: 10.1136/jnnp.27.5.395. 
18. De Wals P, Deceuninck G, Toth E, Boulianne N, Brunet D, Boucher RM, et al. Risk of Guillain-Barré syndrome following H1N1 influenza vaccination in Quebec. JAMA. 2012;308(2):175-81. doi: 10.1001/jama.2012.7342. 
19. Lin JJ, Hsia SH, Wang HS, Lyu RK, Chou ML, Hung PC, et al. Clinical variants of Guillain-Barré syndrome in children. Pediatr Neurol. 2012;47(2):91-6. doi: 10.1016/j. pediatrneurol.2012.05.011. 
20. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27 Suppl:S21-4. doi: 10.1002/ana.410270707. 
21. Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol. 1998;44(5):780-8. doi: 10.1002/ ana.410440512. 
22. Ropper AH. Unusual clinical variants and signs in Guillain- Barré syndrome. Arch Neurol. 1986;43(11):1150-2. doi: 10.1001/archneur.1986.00520110044012. 
23. Emilia-Romagna Study Group on Clinical and Epidemiological Problems in Neurology. Guillain-Barré syndrome variants in Emilia-Romagna, Italy, 1992-3: incidence, clinical features, and prognosis. J Neurol Neurosurg Psychiatry. 1998;65(2):218- 24. doi: 10.1136/jnnp.65.2.218. 
24. Yuan CL, Wang YJ, Tsai CP. Miller fisher syndrome: a hospital-based retrospective study. Eur Neurol. 2000;44(2):79-85. doi: 10.1159/000008201. 
25. Ansari B, Basiri K, Derakhshan Y, Kadkhodaei F, Okhovat AA. Epidemiology and clinical features of Guillain-Barré syndrome in Isfahan, Iran. Adv Biomed Res. 2018;7:87. doi: 10.4103/ abr.abr_50_17. 
26. Yadegari S, Kazemi N, Nafissi S. Clinical and electrophysiological features of Guillain-Barré syndrome in Iran. J Clin Neurosci. 2014;21(9):1554-7. doi: 10.1016/j. jocn.2013.11.041. 
27. Salehiomran MR, Nikkhah A, Mahdavi M. Prognosis of Guillain-Barré syndrome in children. Iran J Child Neurol. 2016;10(2):38-41. 
28. Nagasawa K, Kuwabara S, Misawa S, Fujii K, Tanabe Y, Yuki N, et al. Electrophysiological subtypes and prognosis of childhood Guillain-Barré syndrome in Japan. Muscle Nerve. 2006;33(6):766-70. doi: 10.1002/mus.20520. 
29. Mazaheri S, Rezaie AA, Hossein Zadeh A. The ten years survey on clinical and epidemiologic features of Guillain-Barré syndrome in Sina hospital, Hamadan, Iran. Avicenna J Clin Med. 2007;14(2):56-60. [Persian]. 
30. Rahimi Jaberi A, Manafi A, Mossallaiepoor A, Ebrahimi MM, Khazforoosh S, Shirazizadeh Mehraban SH, et al. The epidemiologic, clinical and laboratory findings of patients with Guillain-Barré syndrome in Southern Iran since 2007 to 2012. J Fasa Univ Med Sci. 2014;3(4):343-7. [Persian]. 
31. de la O-Peña D, Robles-Figueroa M, Chávez-Peña Q, Bedolla- Barajas M. [Features of Guillain-Barré syndrome in adults: results of a university hospital]. Rev Med Inst Mex Seguro Soc. 2015;53(6):678-85. 
32. Blaser MJ, Olivares A, Taylor DN, Cornblath DR, McKhann GM. Campylobacter serology in patients with Chinese paralytic syndrome. Lancet. 1991;338(8762):308. doi: 10.1016/0140- 6736(91)90447-w. 
33. Yazdchi M, Arami M A, Najmi S, Mansoorpoor L. Evaluation of Heart Rate Variation In the Acute Phase of Guilain-Barre Syndrome And Its Relation to Disease Severity. Feyz 2005; 9 (2) :11-14