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Dysautonomia in Guillain–Barré Syndrome: Prevalence, Clinical Spectrum, and Outcomes

  • Tia ChakrabortyEmail author
  • Christopher L. Kramer
  • Eelco F. M. Wijdicks
  • Alejandro A. Rabinstein
Original Work

Abstract

Background

Guillain–Barré syndrome (GBS), when severe, involves the autonomic nervous system; our objective was to assess the spectrum and predictors of dysautonomia, and how it may impact functional outcomes.

Methods

A retrospective review of patients admitted to the Mayo Clinic in Rochester, MN between January 1, 2000, and December 31, 2017, with GBS and dysautonomia was performed. Demographics, comorbidities, parameters of dysautonomia, clinical course, GBS disability score, and Erasmus GBS Outcome Score (EGOS) at discharge were recorded.

Results

One hundred eighty seven patients were included with 71 (38%) noted to have at least one manifestation of dysautonomia. There are 72% of patients with a demyelinating form of GBS and 36% of patients with demyelination had dysautonomia. Ileus (42%), hypertension (39%), hypotension (37%), fever (29%), tachycardia or bradycardia (27%), and urinary retention (24%) were the most common features. Quadriparesis, bulbar and neck flexor weakness, and mechanical ventilation were associated with autonomic dysfunction. Patients with dysautonomia more commonly had cardiogenic complications, syndrome of inappropriate antidiuretic hormone, posterior reversible encephalopathy syndrome, and higher GBS disability score and EGOS. Mortality was 6% in patients with dysautonomia versus 2% in the entire cohort (P = 0.02).

Conclusions

Dysautonomia in GBS is a manifestation of more severe involvement of the peripheral nervous system. Accordingly, mortality and functional outcomes are worse. There is a need to investigate if more aggressive treatment is warranted in this category of GBS.

Keywords

Dysautonomia Guillain–Barré syndrome Acute inflammatory demyelinating polyradiculoneuropathy Autonomic dysfunction 

Abbreviations

GBS

Guillain–Barré syndrome

AIDP

Acute demyelinating polyradiculoneuropathy

ICU

Intensive care unit

PRES

Posterior reversible encephalopathy syndrome

SIADH

Syndrome of inappropriate antidiuretic hormone

EGOS

Erasmus GBS Outcome Score

CIDP

Chronic inflammatory polyradiculoneuropathy

CMAP

Compound muscle action potential

mV

Millivolts

CSF

Cerebrospinal fluid

IVIG

Intravenous immunoglobulin

PLEX

Plasmapheresis

PE

Pulmonary embolism

DVT

Deep vein thrombus

IQR

Interquartile range

OR

Odds ratio

CI

Confidence interval

Notes

Acknowledgements

No other acknowledgements.

Author Contributions

This study required no sponsorship or funding. Tia Chakraborty MD authored, conceptualized, acquired data, performed all statistical analyses, drafted, and revised the manuscript. She had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Christopher Kramer MD analyzed and acquired data, conceptualized, drafted, and revised the manuscript. Eelco Wijdicks MD PhD authored, conceptualized, drafted, and revised the manuscript. Alejandro A. Rabinstein MD authored, conceptualized, drafted, and revised the manuscript.

Source of Support

Not applicable.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval/Informed Consent

The Mayo Clinic Institutional Review Board approved this study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  1. 1.Mayo Clinic Department of NeurologyMayo ClinicRochesterUSA
  2. 2.Department of NeurologyThe University of ChicagoChicagoUSA

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