Published: 2016-12-29

Electrophysiological study to detect serial changes and prognosis in patients of Guillain Barre syndrome from North-West Rajasthan, India

Arvind Vyas, Sarika Swami Sarika Swami, Kartik Jaiswal


Background: The Guillain Barre syndrome (GBS) is the commonest cause of acute flaccid paralysis in much of the world, after the introduction of vaccine for poliomyelitis. Electrophysiological study may play an important role in further investigation of the pathogenesis and assessment of prognosis. This study was undertaken to see any changes in electrophysiological pattern at one month follow up and prognosis of patients with Guillain Barre syndrome.

Methods: The study included 28 patients of Guillain Barre syndrome admitted between the period of July 2014 to June 2015 in the department of medicine and neurology, SP Medical College and AG Hospitals, Bikaner, India. The clinical diagnosis was based on criteria proposed by the national institute of neurological, and communicative disorders and stroke (NINCDS). Each patient was assessed both clinically (including disability score) and electrophysiologically at the time of presentation and at one month±seven days of follow up.

Results: GBS was more common in early decades. Male to female ratio was 4.6:1. On electrophysiological study mixed pattern was most common (42.86%) followed by axonal (32.14%) and demyelinating (25%) patients. Mean disability score at the time of presentation was maximum for axonal pattern and the same group had minimum score at one month follow up indicating better recovery. Sequential electrophysiological changes were seen in this study. Axonal pattern had better recovery (77.78%) than demyelinating and mixed was worst with 16.67% mortality.

Conclusions: Mixed pattern is predominant pattern on electrophysiological studies. Axonal pattern has better recovery. Secondary changes of electrophysiological finding in some of our cases suggest that primary demyelinating and mixed subtype could, be misinterpreted as primary axonal pathology without timely serial studies.


Guillain Barre syndrome, Serial electrophysiological pattern, Prognosis, North-West Rajasthan

Full Text:



Stephan L, Hauser, Asbury A. Guillain Barre syndrome and other immune mediated neuropathies. Harrison Principles Internal Medicine. 2005;2(16):2513-6.

Feasby TE. Axonal Guillain Barre syndrome. Muscle Nerve. 1994;17(6):678-9.

Mckhann GM, Cornblath DR, Griffm JW, Ho Tw, Li CY, Jiang Z, Wu HS, Zhaori G, Liu Y, Jou LP. Acute motor axonal neuropathy: a frequent cause of acute flaccid paralysis in China. Ann Neurol. 1993;33:333-42.

Griffin JW, Li CY, Ho TW, Xue P, Macko C, Gao CY. Guillain Barre syndrome in Northern China: the spectrum of neuropathological changes in clinical defined cases. Brain. 1995;118:577-95.

Ho TW, Mishu B, Li CY, Gao CY, Cornblath DR, Griffin JW, et al. Guillain Barre syndrome in northern China. relationship to campylobacter, jejuni infection and anti glycolipid antibodies. Brain. 1995;28:597-605.

Giovannoi G, Hartung HP. The immune pathogenesis of multiple sclerosis and Guillain Barre syndrome. Curr Opin Neurol. 1996;9:165-77.

Mcleod JG. Electrophysiological studies in Guillain Barre syndrome. Ann Neurol. 1981;9:20-7.

Cornblath DR. Electrophysiology in GB syndrome. Ann Neurol. 1990;27:517-20.

Honavar M, Tharakan JKJ, Hughes RAC, Leibowitz S, Winer JB. A clinicopathological study of Guillain Barre syndrome: nine case and literature review. Brain. 1991;114:1245-70.

Hadden RDM, Cornblath DR, Hughes BAC, Zielasek J, Hartung HP, Toyka KV, et al. The plasma exchange/sandoglobulin Guillain Barre syndrome trial group. Electrophysiological classification of Guillain Barre syndrome: clinical associations and outcome. Ann neural. 1998;44:780-8.

Mckhann GM, Cornblath DR, Ho TW, Li CY, Bia AY, Wu HS. Clinical and electrophysiological aspect of acute paralytic diseases of children and young adults in Northern China. Lancet. 1991;338:593-7.

Guo YP, Wand CD, Gao SF, Ren HT. Guillain Barre syndrome: clinical analysis and pathological study on sural nerve biopsy of 40 cases. Chin Med J. 1997;110:690-3.

Shin JH, Choi KD. Electrophysiological classification of Guillain Barre syndrome sequential changes in electrophysiologic findings. J Korean Neurol Assoc. 2002;20(6):630-3.

Hiraga A, Mori M, Ogawara K, Recovery patterns and long term prognosis for axonal Guillain Barre syndrome. J Neurol Neurosorg Psychiatry. 2005;76:719-22.

Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain Barre syndrome. Ann Neurol. 1990;27:521-4.

Hughes RAC, Newsom Davis JM, Perkin GD. Controlled trial of prednisolone in acute polyneuropathy. Lancet. l978;2:750-3.

Kaur U, Chopra JS, Prabhakar S. Guillain Barre syndrome; a clinical electrophysiological and biochemical study. Acta Neurol Scand. 1986;73(4):394-402.

Hadden RDM, Karch H, Hartung HP. Preceding infections, immune factors and outcome in Guillain Barre syndrome. Neurology. 2001;56:758-65.

Ropper A, Wijdicks E, Truax, B. Guillain Barre syndrome. Contemporary neurology series. F.A. Davies company Philadelphia; 1991:3.

Jiang W, Wang HD, Huang YG. Wan Q, Xu Y, Wu BR. Guillain Barre syndrome in northern China. Electromyogr Clin Neuroph'ysiol. 2001;41:387-91.

Rees JH, Thompson RD, Smeeton NC. Epidemiological study of Guiallain Bare syndrome in south east England. J Neurol Neurosurg Psychiatry. 1998;64:74-7.

Italian Guillain Barre study group. The prognosis and main prognostic indicators of Guillain Barre syndrome. Brain. 1996;119:2053-61.

Arami MA, Yazdchi M. Epidemilogy and characteristics of Guillain Barre syndrome in the northwest of Iran. Ahn Saudi Med. 2006;26:1.

Winer JB, Hughes RAC, Osmond C. A prospective study of acute clinical idiopathic neuropathy. I clinical features and their prognostic value. J neurol Neurosurg Psychiat. 1988;51:605-12.

Loffel NB, Rossi LN, Mumenthaler M. The landry Guillain Barre syndrome: complications, prognosis, and natural history in 123 cases. J Neurol Sci. 1977;33:71-9.

Hiraga A, Mori M, Ogawara K, Recovery patterns and logn term prognosis for axonal Guillain Barre syndrome. J Neurol Neurosorg Psychiatry. 2005;76:719-22.

Kuwabara S, Ogawara K, Isolated absence of F waves and proximal axonal dysfunction in Guin Barre syndrome with anti gangliside antibodies. J Neurol Neurosurg Psychiatry. 1999;191-5.

Tekgul H, Sedaroglu G. Outcome of axonal and emyelinating forms of Guillain Barre syndrome in children. Pediatr Neurol. 2003;28(4):295-9.

Alessandro RD. Guillain Barre syndrome variants in Emillia Romagna, Italy: clinical features, and prognosis. Neurol Neurosurg Psychiatry. 1998;65:218-24.

Smith TA. Prognosis in guilain bane syndrome assessed by clinical and neurophysiological features. Ugeskr Laeger. 2000;162(36):4805-7.

Massaro ME, Rodriguez EC, Pociecha J, Arroyo HA, Sacolitti M, Taratuto AL et al. Nerve biopsy in children with severe Guillain-Barre syndrome and inexitable motor nerves. Neurology. 1998;51:394-8.

Kim SH, Hong SB, Lee KW. Sequential changes and prognostic values of electrophysiological parameters in Guillain Barre syndrome. J Korean Neurol Assoc. 1991;9(1):49-56.