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

Tia Chakraborty, Christopher L. Kramer, Eelco F.M. Wijdicks, Alejandro A. Rabinstein

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
JournalNeurocritical care
DOIs
StateAccepted/In press - Jan 1 2019

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Primary Dysautonomias
Posterior Leukoencephalopathy Syndrome
Quadriplegia
Urinary Retention
Mortality
Ileus
Autonomic Nervous System
Peripheral Nervous System
Demyelinating Diseases
Bradycardia
Vasopressins
Artificial Respiration
Tachycardia
Hypotension
Comorbidity
Fever
Neck
Demography
Hypertension

Keywords

  • Acute inflammatory demyelinating polyradiculoneuropathy
  • Autonomic dysfunction
  • Dysautonomia
  • Guillain–Barré syndrome

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Dysautonomia in Guillain–Barré Syndrome : Prevalence, Clinical Spectrum, and Outcomes. / Chakraborty, Tia; Kramer, Christopher L.; Wijdicks, Eelco F.M.; Rabinstein, Alejandro A.

In: Neurocritical care, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Guillain–Barr{\'e} 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.",
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