The sural-sparing pattern in clinical variants and electrophysiological subtypes of Guillain-Barré syndrome

Abstract

Background Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide and can be classified into electrophysiological subtypes and clinical variants.

Objective This study aimed to compare the frequency of the sural-sparing pattern (SSP) in subtypes and variants of GBS.

Methods This retrospective cohort study analyzed clinical and electrophysiological data of 171 patients with GBS hospitalized in public and private hospitals of Natal, Rio Grande do Norte, Brazil, between 1994 and 2018; all cases were followed up by the same neurologist in a reference neurology center. Patients were classified according to electrophysiological subtypes and clinical variants, and the SSP frequency was compared in both categories. The exact Fisher test and Bonferroni correction were used for statistical analysis.

Results The SSP was present in 53% (57 of 107) of the patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), 8% (4 of 48) of the patients with axonal subtypes, and 31% (5 of 16) of the equivocal cases. The SSP frequency in the AIDP was significantly higher than in the axonal subtypes (p < 0.0001); the value was kept high after serial electrophysiological examinations. Only the paraparetic subtype did not present SSP.

Conclusion The SSP may be present in AIDP and axonal subtypes, including acute motor axonal neuropathy, but it is significantly more present in AIDP. Moreover, the clinical variants reflect a specific pathological process and are correlated to its typical electrophysiological subtype, affecting the SSP frequency.

Resumo

Antecedentes A síndrome de Guillain-Barré (GBS) é a causa mais comum de paralisia flácida aguda em todo o mundo e pode ser classificada em subtipos eletrofisiológicos e variantes clínicas.

Objetivo Este estudo teve como objetivo comparar a frequência do padrão de preservação do sural (SSP) em subtipos e variantes de GBS.

Métodos É um estudo de coorte retrospectivo que analisou dados clínicos e eletrofisiológicos de 171 pacientes com GBS internados em hospitais públicos e privados de Natal, Rio Grande do Norte, Brasil, entre 1994 e 2018. Todos os casos foram acompanhados pelo mesmo neurologista em centro de referência em neurologia. Os pacientes foram classificados de acordo com os subtipos eletrofisiológicos e variantes clínicas e a frequência do SSP foi comparada em ambas as categorias. O teste exato de Fisher e a correção de Bonferroni foram utilizados para análise estatística.

Resultados O SSP esteve presente em 53% (57 de 107) dos pacientes com polirradiculoneuropatia desmielinizante inflamatória aguda (PDIA), em 8% (4 de 48) dos pacientes com subtipos axonais e em 31% (5 de 16) dos casos não definidos. A frequência do SSP no AIDP foi significativamente maior do que nos subtipos axonais (p < 0,0001); o valor manteve-se elevado após exames eletrofisiológicos seriados. Apenas o subtipo paraparético não apresentou SSP.

Conclusão O SSP pode estar presente na PDIA e nos subtipos axonais, incluindo a neuropatia axonal motora aguda, mas está significativamente mais presente na PDIA. Além disso, as variantes clínicas refletem um processo patológico específico e estão correlacionadas ao seu subtipo eletrofisiológico típico, afetando a frequência do SSP.

Keywords

Guillain-Barré Syndrome - Nerve Conduction Studies - Sural Nerve - Neurophysiology - Peripheral Nervous System Diseases

Palavras-chave

Síndrome de Guillain-Barré - Estudos de Condução Nervosa - Nervo Sural - Neurofisiologia - Doenças do Sistema Nervoso Periférico

Ethical Considerations

The study was approved by the research ethics committee of the Onofre Lopes University Hospital of Rio Grande do Norte (no. 4.948.823).

Authors' Contributions

VFSC: formal analysis, investigation, methodology, project administration, validation, visualization, writing – original draft, writing – review & editing; RTGO: formal analysis, investigation, methodology, validation, visualization, writing – original draft, writing – review & editing; JDLS: investigation, methodology, visualization, writing – original draft, writing – review & editing; RSM: Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing; ADPN: investigation, project administration, visualization, writing – original draft, writing – review & editing; ECF: data curation, investigation, project administration, validation, visualization, writing – original draft, writing – review & editing; MED: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.

Publikationsverlauf

Eingereicht: 15. November 2023

Angenommen: 01. Februar 2024

Artikel online veröffentlicht:
19. April 2024

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