Doets, Alex Y., Verboon, Christine, van den Berg, Bianca, Harbo, Thomas ORCID: 0000-0003-2178-6076, Cornblath, David R., Willison, Hugh J., Islam, Zhahirul ORCID: 0000-0003-0935-8079, Attarian, Shahram, Barroso, Fabio A., Bateman, Kathleen, Benedetti, Luana, van den Bergh, Peter, Casasnovas, Carlos, Cavaletti, Guido, Chavada, Govindsinh, Claeys, Kristl G., Dardiotis, Efthimios ORCID: 0000-0003-2957-641X, Davidson, Amy, van Doorn, Pieter A., Feasby, Tom E., Galassi, Giuliana, Gorson, Kenneth C., Hartung, Hans-Peter, Hsieh, Sung-Tsang, Hughes, Richard A. C., Illa, Isabel, Islam, Badrul, Kusunoki, Susumu, Kuwabara, Satoshi ORCID: 0000-0002-4716-8578, Lehmann, Helmar C., Miller, James A. L., Mohammad, Quazi Deen, Monges, Soledad, Orazio, Eduardo Nobile, Pardo, Julio ORCID: 0000-0001-8807-1310, Pereon, Yann, Rinaldi, Simon ORCID: 0000-0003-2039-3457, Querol, Luis ORCID: 0000-0002-4289-8264, Reddel, Stephen W., Reisin, Ricardo C., Shahrizaila, Nortina, Sindrup, Soren H., Waqar, Waheed and Jacobs, Bart C. (2018). Regional variation of Guillain-Barre syndrome. Brain, 141. S. 2866 - 2878. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2156

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Abstract

Guillain-Barre syndrome is a heterogeneous disorder regarding the clinical presentation, electrophysiological subtype and outcome. Previous single country reports indicate that Guillain-Barre syndrome may differ among regions, but no systematic comparative studies have been conducted. Comparative studies are required to identify factors determining disease susceptibility, variation and prognosis, and to improve diagnostic criteria. The International Guillain-Barre Syndrome Outcome Study is a prospective, observational cohort study including all patients within the diagnostic spectrum, aiming to describe the heterogeneity of Guillain-Barre syndrome worldwide. The current study was based on the first 1000 inclusions with a follow-up of at least 1 year and confirmed the variation in clinical presentation, course and outcome between patients. The full clinical spectrum of Guillain-Barre syndrome was observed in patients from all countries participating in the International Guillain-Barre Syndrome Outcome Study, but the frequency of variants differed between regions. We compared three regions based on geography, income and previous reports of Guillain-Barre syndrome subtypes: 'Europe/Americas', 'Asia' (without Bangladesh), and 'Bangladesh'. We excluded 75 (8%) patients because of alternative diagnoses, protocol violations, or missing data. The predominant clinical variant was sensorimotor in Europe/Americas ( n = 387/562, 69%) and Asia (n = 27163, 43%), and pure motor in Bangladesh (n = 74/107, 69%). Miller Fisher syndrome and Miller Fisher-Guillain-Barre overlap syndrome were more common in Asia (n = 14/63, 22%) than in the other two regions (Europe/Americas: n = 641562, 11%; Bangladesh: n =11107, 1%) (P < 0.001). The predominant electrophysiological subtype was demyelinating in all regions (Europe/Americas: n = 312/573, 55%; Asia: n = 29/65, 45%; Bangladesh: n = 38/94, 40%). The axonal subtype occurred more often in Bangladesh (n = 34/94, 36%) than in Europe/Americas (n = 33/573, 6%) and other Asian countries (n = 4/65, 6%) (P < 0.001). In all regions, patients with the axonal subtype were younger, had fewer sensory deficits, and showed a trend towards poorer recovery compared to patients with the demyelinating subtype. The proportion of patients able to walk unaided after 1 year varied between Asia (n = 31/34, 91%), Europe/Americas (n = 334/404, 83%) and Bangladesh (n = 67/97, 69%) (P = 0.003). A similar variation was seen for mortality, being higher in Bangladesh (n = 19/114, 17%) than in Europe/Americas (n = 23/486, 5%) and Asia (n = 1/45, 2%) (P < 0.001). This study showed that factors related to geography have a major influence on clinical phenotype, disease severity, electrophysiological subtype, and outcome of Guillain-Barre syndrome.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Doets, Alex Y.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Verboon, ChristineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van den Berg, BiancaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Harbo, ThomasUNSPECIFIEDorcid.org/0000-0003-2178-6076UNSPECIFIED
Cornblath, David R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Willison, Hugh J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Islam, ZhahirulUNSPECIFIEDorcid.org/0000-0003-0935-8079UNSPECIFIED
Attarian, ShahramUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Barroso, Fabio A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bateman, KathleenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Benedetti, LuanaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van den Bergh, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Casasnovas, CarlosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cavaletti, GuidoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chavada, GovindsinhUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Claeys, Kristl G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dardiotis, EfthimiosUNSPECIFIEDorcid.org/0000-0003-2957-641XUNSPECIFIED
Davidson, AmyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Doorn, Pieter A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Feasby, Tom E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Galassi, GiulianaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gorson, Kenneth C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hartung, Hans-PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hsieh, Sung-TsangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hughes, Richard A. C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Illa, IsabelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Islam, BadrulUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kusunoki, SusumuUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuwabara, SatoshiUNSPECIFIEDorcid.org/0000-0002-4716-8578UNSPECIFIED
Lehmann, Helmar C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Miller, James A. L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mohammad, Quazi DeenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Monges, SoledadUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Orazio, Eduardo NobileUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pardo, JulioUNSPECIFIEDorcid.org/0000-0001-8807-1310UNSPECIFIED
Pereon, YannUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rinaldi, SimonUNSPECIFIEDorcid.org/0000-0003-2039-3457UNSPECIFIED
Querol, LuisUNSPECIFIEDorcid.org/0000-0002-4289-8264UNSPECIFIED
Reddel, Stephen W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reisin, Ricardo C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shahrizaila, NortinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sindrup, Soren H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Waqar, WaheedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jacobs, Bart C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-171381
DOI: 10.1093/brain/awy232
Journal or Publication Title: Brain
Volume: 141
Page Range: S. 2866 - 2878
Date: 2018
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1460-2156
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
CLINICAL-FEATURES; INFECTION; VALIDATION; DIAGNOSIS; CHINAMultiple languages
Clinical Neurology; NeurosciencesMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/17138

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