Mild Form of Guillain Barre Syndrome, Clinical Characteristics and Outcome with or Without Plasmapheresis: A Local Experience

Abstract

Background: Guillain-Barre syndrome is an immune mediated poly-radiculo-neuropathy with a variable clinical presentation and prognosis. Plasma exchange and Intravenous immunoglobulin are treatment options with proven efficacy by various clinical trials. But these trials demonstrate improvement in a classical and moderate to severe GBS. In clinical setting, problem may occur in treatment of those patients who present with mild symptoms & signs, clinical variants of GBS, or when the duration of weakness is > 2 weeks from onset of symptoms. Objective:  To determine the frequency of mild GBS, its clinical characteristics & to compare clinical outcome of patients treated with or without plasmapheresis.  Methods: Prospective, Quasi experimental study was done in Neurology, MHL from June, 2020 to June, 2022. Diagnosis of mild GBS was made on basis of patient ability to walk without support/ GBS disability score is ≤ 2. Outcome in these patients was assessed by using MRC sum score at presentation one and 3month post treatment. Results: Patients with diagnosis of GBS (n=154) were admitted and treated during 2years.out of these patients, 22(14.28%) were diagnosed as mild GBS, 18 males and 4 females. MRC Sum score at presentation 18.5, at 1-month 19.7 and at 3 month it was 19.5 on average. MRC sum score improvement noted in patients treated with plasma-pheresis at one and three months with p value less than 0.01. There was no difference in recovery with increased number of sessions of plasma-pheresis 3 versus 5 sessions at one month and 3months with p value 0.18 &0.32 respectively. Conclusion:  Mild GBS is not uncommon, remained under-reported in clinical scenario. Plasma-pheresis seems to have a beneficial role in mild form of GBS