Validity of brighton criteria in the diagnosis of guillain–barré syndrome (gbs) in pakistan

V O L . Validity of brighton criteria in the diagnosis of guillain-barré syndrome (gbs) in pakistan Abubakar Siddique 0 1 0 Services Institute of Medical Sciences and Services Hospital , Lahore , Pakistan 1 Services Institute of Medical Sciences and Services Hospital , Lahore , Pakistan. 2 PGR, Department of Neurology, Services Institute of Medical Sciences and Services Hospital , Lahore, 54600 , Pakistan 3 Associate Professor, Department of Neurology, Services Institute of Medical Sciences and Services Hospital , Lahore, 54600 , Pakistan 4 Department of Neurology, Services Institute of Medical Sciences and Services Hospital , Lahore, 54600 , Pakistan - VALIDITY OF BRIGHTON CRITERIA IN THE DIAGNOSIS OF GUILLAIN–BARRÉ SYNDROME (GBS) IN PAKISTAN Guillain–Barré syndrome (GBS) is a common cause of acute flaccid paralysis, characterized by symmetrical weakness of the limbs, and hyporeflexia or areflexia, which reaches a maximum severity within 4 weeks. Sensory symptoms, such as paraesthesia or numbness, usually start distally and have a symmetrical pattern. It is an immune mediated disorder of peripheral nerves with incidence of 1-2 cases per 100,000 populations.1,2 and is more common in men than in women (ratio 3:2).3 Worldwide, its incidence and prevalence vary; for example, a low rate of 0.40 per 100,000 person–years was reported in Brazil, in contrast to a high rate of 2.5 per 100,000 person–years in Curaçao and Bangladesh.3 GBS seems to occur less frequently in children (0.34–1.34 per 100,000 person– years) than in adults, and its incidence increases with age. Based on electrophysiological findings, the most common subtypes of GBS are acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN). A less common subtype is Miller Fisher syndrome (MFS), which is characterized by ophthalmoplegia, ataxia and areflexia.4 Overall, the clinical course, severity and outcomes of GBS are highly variable. GBS typically occurs after an infectious disease in which the immune response generates antibodies that crossreact with gangliosides at nerve membranes. This autoimmune response results in nerve damage or functional blockade of nerve conduction. True and early diagnosis of GBS could impact on its prognosis, as the benefit of immunotherapy is greatest when introduced early, in the first few weeks of disease.2 In November, 2005, a Brighton Collaboration GBS Working Group was established with a total of 34 members from different backgrounds including public health, regulatory, clinical and academic, and industry. The Working Group identified the key clinical and epidemiologic features required for diagnosis of GBS.4 Some previous studies (e.g. Sejvar et al.4 and Mateen et al.7) have reported these guidelines as useful tool for the correct diagnosis of GBS and its major subtypes. In the present study, we have aimed to test the validity of guidelines of Brighton working group criteria in the diagnosis of GBS in local settings of Pakistan. P A K I S T A N J O U R N A L O F N E U R O L O G I C A L S C I E N C E S The present study was conducted in Department of Neurology at Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan. This prospective 1-year study (from July 2014 to July 2015) identified 30 patients who were admitted with the primary diagnosis of Guillain Barré Syndrome (GBS). The study included the patients of all ages with no diabetes diagnosis and excluded the patients with concurrent factors (drug addiction, alcohol intake) and having weaknesses due to diseases other than GBS. The patients were also excluded with Fisher syndrome. We fulfilled the diagnostic criteria from the National Institute of Neurological Disorders and Stroke (NINDS) from 1990.5 The diagnosis of GBS in these patients was made on the basis of clinical presentation, CSF findings, electromyography and nerve conduction studies. A structured questionnaire was used to record the following demographic and clinical variables as part of this study: sex, date of birth, place of residence, date and site of AFP onset, number of limbs affected at nadir, presence of fever, clinical descriptive history, and complete neurological examination. Each patient’s nerve conduction study report including data and wave forms was reviewed by at least one qualified neurologist and assigned a classification based on the criteria published by the Plasma Exchange/ Sandoglobulin Guillain–Barré Syndrome Trial Group (1998).6 In addition, blood studies, cerebrospinal fluid examination, and radiographs for each case were also conducted as per discretion of the treating physicians. The Brighton Collaboration GBS Working Group 2010 guidelines reported in Sejvar et al.4 were applied to each case (see Table 1). All cases in which GBS was considered to be the final diagnosis and met our inclusion criteria of having both CSF and NCS were analyzed for sensitivity. Statist (...truncated)