Characteristics and acute rehabilitation of Guillain-Barré syndrome in Singapore
Annals of the Academy of Medicine, Singapore
The objectives of this study are to describe the demographics, clinical characteristics, complications and functional outcomes in patients with Guillain-Barr é syndrome (GBS) or the Miller-Fisher syndrome (MFS) variant admitted to our institution. We also aim to identify prognostic outcome indicators. A retrospective review of the case records of all patients discharged from our hospital with a diagnosis of GBS or MFS over a 2- year period was performed. The clinical characteristics charted
... ristics charted included the time of symptom onset to nadir. The Modified Barthel Index (MBI) and Expanded Grading Scale (EGS) for GBS were the functional outcome measures used. Thirty-one cases were reviewed and 8 (25.8 %) had the MFS variant. Twenty-two (71 %) patients were male, with a mean age of 42.3 years. Weakness and numbness (74 %) were the most common initial symptoms; 9 (29 %) patients were paraparetic and 7 (22.6 %) were tetraparetic. Ten (32.3 %) patients had respiratory involvement and 8 (25.8 %) had urinary retention. Intravenous immunoglobulin (IVIG) was prescribed in 13 (41.9 %) patients. The mean duration to disease nadir was 8.1 days. The mean MBI scores at nadir and discharge were 54.7 and 77.3, respectively, and this gain was highly significant (P <0.01). The majority (84 %) of patients were employed at admission and although most returned to work, 63 % (17/27) of the patients had residual symptoms or signs 3 months after discharge. The clinical characteristics and complication frequency closely follows that previously described in Western populations, although our cohort was younger and had a higher proportion of the MFS variant. Predictors of a poorer functional outcome include a high EGS score at nadir, tetraparesis, respiratory involvement, urinary retention and the need for nasogastric enteral feeding. Patients who had MFS or received IVIG had greater functional gains. Good functional outcomes occurred in a large majority of patients.