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Clinical Characteristics of the Elderly Patients with Guillain-barré Syndrome: a10-year Retrospective Comparative Study

Author: ZhangZuo
Tutor: LiSheng
School: Dalian Medical University
Course: Neurology
Keywords: Guillain-Barré syndrome Elderly Clinical characteristics Short-termoutcome
CLC: R745.43
Type: Master's thesis
Year: 2012
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Abstract


Objective: Guillain-Barré syndrome (GBS) is an acute immune-mediatedpolyneuropathy commonly characterized by rapidly progressive, symmetric weakness inlimbs or cranial nerve-innervated muscles, associated decreased or absent deep tendonreflexes. Recent epidemiological studies have suggested that GBS incidence increasedby20%for every10-year increase in age. However, there is a paucity of information onthe characteristics of elderly GBS patients. The purpose of this study was to comparethe epidemiological characteristics,clinical presentations and short-term outcome inelderly as compared to younger GBS patients in this region.Methods: A retrospective review of medical records of237GBS patients admittedto our neurology ward in the First Affiliated Hospital of Dalian Medical Universityduring a10year period (2002-2011) was performed. Based on the age, the patients weredivided into two groups:59patients aged60years or above (elderly group) and178patients below age60years (younger group). We collected data in each group regardingthe epidemiological characteristics including gender, age, urban/rural residence,seasonal distribution, and preceding events,clinical manifestations including initialsymptoms, neurological findings during the course, respiratory failure andcomplications, results of electrophysiological study, laboratory indicators, and specifictreatments including intravenous immunoglobulin, plasmapheresis, and steroids. Theseverity of neurological deficits on admission, at nadir, and on the day of dischargefrom hospital was assessed using the Medical Research Council (MRC) score. Intervalsbetween symptom onset and hospitalization or nadir (the maximal severity) were alsoanalyzed to evaluate the patterns of disease progression. The electrophysiologicalclassification of GBS was carried out using the electrodiagnostic criteria proposed byHo and colleagues. The primary outcome measures included the duration of hospitalization, in-hospital mortality rate, and the MRC score at the hospital discharge.Results: There were more female patients in the elderly group (55.9%) than in theyounger group (40.4%, P﹦0.038). Neither the urban/rural nor the seasonal distributiondiffered significantly for the two age groups. The preceding infections such as upperrespiratory tract infection and diarrhea were equally frequent in both elderly andyounger groups. No significant differences between the elderly and younger groupswere observed in the constitution ratios of various clinico-electrophysiologic subtypesof GBS such as demyelinating type, axonal type, and Miller-Fisher syndrome. Thefrequency of initial symptoms, sensory deficits, hyporeflexia/areflexia did not differsignificantly between the two groups. Symptoms of cranial nerve involvement includingbilateral facial palsy, bulbar weakness and extraocular muscle palsy were identified in ahigher proportion of patients in the elderly group, but these differences did not reachstatistical significance. The elderly patients tended to develop not only cardiovascularautonomic dysfunction (27.1%VS.6.7%, P=0.000) but also respiratory failure (27.1%vs.11.8%, P﹦0.005) more frequently. Various complications, mostly pneumonia,occurred more often in the elderly group (25.4%) than in the younger group (11.8%, P﹦0.011). While either the mean interval from onset to hospital admission (8.3VS.6.3days) or the duration of hospitalization (17.7VS.13.5days) was longer in the elderlygroup, these differences failed to reach the level of significance (P>0.0.05,respectively). The mean interval from onset to nadir for the elderly group (8.4days) wasmuch longer when compared to the younger group (6.8days, P<0.05). The MRCscores obtained on admission, at nadir, and on the day of discharge from hospital were47.0±12.6,42.7±16.5, and51.4±15.1in the younger group, and39.2±18.0,34.1±20.0and40.6±21.7in the elderly group, respectively. Each group had significantly lowerMRC scores at nadir than that at hospital admission, and had much higher MRC scoresat discharge than that at nadir (P<0.05, respectively). In addition, comparison of theelderly and younger groups at each time point showed statistically significantdifferences in the MRC scores (P<0.05, respectively). Protein level in cerebrospinalfluid was significantly higher in the elderly group (10.9±7.9vs.8.3±7.5g/dL, P=0.048).The treatment was similar between both groups (P=0.870). Five (8.5%) elderly patientsand three (1.7%) younger patients died during the hospital stay (P=0.012).Conclusions: The female sex was predominant in the elderly patients with GBScompared with the younger patients. Most clinical symptoms and signs were similarbetween the younger and elderly patients, but the elderly patients tended to show relatively slower progression, higher frequency in the development of cardiovascularautonomic dysfunction, respiratory failure and complications, higher in-hospitalmortality rate and more severe functional deficits at hospital discharge demonstratingworse short-term outcome. Increased awareness in disease recognition and bettermedical care are therefore needed for the elderly patients with GBS.

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CLC: > Medicine, health > Neurology and psychiatry > Neurology > Peripheral nerves and ganglia disease > Spinal cord disease > Acute multiple Radiculitis ,
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