Controversias en neuroinmunología: esclerosis múltiple, vacunación, SARS-CoV-2 y otros dilemas / Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas

La neuroinmunología es una disciplina que cada vez amplía más sus horizontes en la comprensión de las enfermedades neurológicas. Contemporáneamente, y a la luz de los nexos fisiopatológicos de las enfermedades neurológicas y la inmunología, se han planteado enfoques diagnósticos y terapéuticos específicos. A pesar de los importantes avances de esta disciplina, existen múltiples dilemas que le conciernen y se filtran en la práctica clínica. En esta revisión, se presentan y discuten 15 controversias, las cuales se construyen con la información clínica disponible más actualizada. Los temas incluidos son: disminución de esteroides en recaídas de esclerosis múltiple; recomendaciones terapéuticas en esclerosis múltiple a la luz de la pandemia por el SARS-CoV-2; evidencia de vacunación en esclerosis múltiple y en otras enfermedades desmielinizantes; panorama actual del síndrome clínico y radiológico aislado; y fallas terapéuticas en esclerosis múltiple; además, criterios para suspender las terapias modificadoras de la enfermedad; evidencia del manejo en recaídas leves; recomendaciones para la profilaxis contra Strongyloides stercolaris; utilidad de un segundo ciclo de inmunoglobulina en el síndrome de Guillain-Barré; criterios para diferenciar una polineuropatía crónica desmielinizante inflamatoria de inicio agudo de un síndrome de Guillain-Barré y, utilidad de la enzima convertidora de angiotensina en neurosarcoidosis. En cada una de las controversias, se presenta la problemática general y se ofrecen recomendaciones específicas que pueden adoptarse en la práctica clínica diaria.

Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.

Concurrencia entre el síndrome de Guillain-Barré y púrpura trombocitopénica inmune posiblemente inducidos por COVID-19 prolongado / Concurrence between Guillain-Barré syndrome and immune thrombocytopenic purpura possibly induced by long COVID-19

RESUMEN Durante la infección aguda por el SARVS-CoV-2 se produce una desregulación del sistema inmune que puede durar hasta ocho meses después de controlado el cuadro agudo. Esto, sumado a otros factores, posiblemente este asociado con un aumento del riesgo de aparición y concurrencia de enfermedades autoinmunes. La aparición simultanea del síndrome de Guillain-Barré (SGB) y púrpura trombocitopénica (PTI) se ha reportado poco en la literatura, y el SGB raramente se asocia con otra enfermedad autoinmune. Presentamos el caso de un varón que luego de un mes de tener un cuadro agudo de COVID-19 moderado, presentó concurrentemente SGB y PTI con respuesta adecuada al tratamiento.

ABSTRACT During acute SARS-CoV-2 infection, there is persistent deregulation of the immune system that can last up to 8 months after the acute condition is controlled. This, added to other factors, is possibly associated with an increased risk of the appearance and concurrence of autoimmune diseases. The simultaneous occurrence of GBS and ITP has been rarely reported in the literature, and GBS is rarely associated with another autoimmune disease. We present the case of a man who, one month after his recovery from acute moderate COVID-19, presented concurrent GBS and ITP with an adequate response to treatment.

Calidad de vida en pacientes con Síndrome de Guillain-Barre en un institución de tercer nivel / Quality of life in patients with Guillain-Barre syndrome in a third-level institution

Introducción: Desde la disciplina de enfermería, este artículo analiza las relaciones entre calidad de vida relacionada con la salud (CVRS) y el estado emocional, enfocándose en los casos de pacientes con síndrome de Guillain-Barré (SGB). La salud es un factor constitutivo de la calidad de vida (CV), a partir del cual se la puede considerar buena o mala. Por lo tanto, la enfermedad no sólo se limita a la afectación física, sino también a la psicológica, social y familiar, sobre las que tiene incluso mayor incidencia si la etiología es poco común. Al conocer la experiencia que los pacientes con SGB tienen de estos aspectos, se puede determinar cuáles son los patrones funcionales alterados según el modelo de Marjory Gordon. Objetivo: Evaluar la CV de pacientes con SGB en una institución de tercer nivel. Material y Métodos: Se utilizó una metodología cuantitativa de tipo analítica con un diseño observacional, prospectivo y longitudinal. Los estudios longitudinales de la CVRS en pacientes con SGB aún son escasos. Por lo tanto, se investigó la CVRS en pacientes con SGB en una institución de tercer nivel, específicamente el día 28 y el tercer mes desde el inicio de la enfermedad, tomando en cuenta la fase de progresión del trastorno neurológico y la fase de recuperación. El estudio se realizó durante once meses, desde septiembre de 2021 hasta julio de 2022, previa revisión y aceptación del protocolo del comité de investigación (CI) y del comité de ética en investigación (CEI). Participaron treinta pacientes adultos bajo un muestreo no probabilístico por conveniencia, cumpliendo con los criterios de inclusión y previo consentimiento informado. La CVRS se indagó mediante el cuestionario World Health Organization Quality of Life, versión breve (WHOQOLBREF), traducido al español y diseñado y validado por la OMS. Se determinó la distribución de normalidad de los datos con la prueba Shapiro Wilk. Para el análisis estadístico se hicieron descripciones de medias, estadísticos de dispersión y la prueba de chi-cuadrado con el programa SPSS statics V.25 Resultados: En las medidas de CV, la percepción de los sujetos con SGB en el día 28 fue "regular", con una media de 60.13 y una desviación típica de 7.26. En el tercer mes no hubo una mejoría significativa, pues la percepción de los participantes fue "normal", mostrando una media de 76.66 y una desviación de 11.21. Conclusiones: Durante el seguimiento de once meses a los pacientes con SGB se observó una recuperación en la CV gradual. Se lograron los objetivos planteados. Nuestro estudio confirma que el SGB sí interviene en la CV de los pacientes.

Introduction: From the discipline of nursing, this article analyzes the association between healthrelated quality of life (HRQOL) and emotional state, focusing on the case of patients with Guillain-Barré syndrome (GBS). Health is a constitutive factor of quality of life (QOL), from which it could be assessed as good or bad. Therefore, diseases are not only limited to physical involvement, but also to psychological, social and familiar, on which it has an even higher incidence if the etiology is uncommon. By knowing the experience that GBS patients have of these aspects, it is possible to determine which are the altered functional patterns according to the Marjory Gordon model. Objective: To evaluate the QOL in patients with GBS in a third-level institution. Material and Methods: A quantitative analytical methodology was used with an observational, prospective and longitudinal design. Longitudinal studies of HRQOL in patients with GBS are still scarce. Therefore, HRQOL was studied in patients with GBS in a third-level institution, specifically on day 28 and the third month from the onset of the disease, considering the neurological disorder progression phase and the recovery phase. After review and acceptance of the research committee and the research ethics committee protocol, the investigation was carried out for eleven months, from September 2021 to July 2022. Thirty adult patients participated through a convenience nonprobability sampling, fulfilling the inclusion criteria and prior informed consent. HRQOL was studied by means of the World Health Organization Quality of Life questionnaire, brief version (WHOQOL-BREF), translated into Spanish, designed and validated by the WHO. The normality distribution of the data was determined with the Shapiro Wilk test. In order to carry out statistical analysis, descriptions of median, dispersion statistics, and chi-square test were made with the SPSS statics V.25 program. Results: Regarding QOL measurements, the perception of patients at day 28 was "regular", with a medium of 60.13 and a standard deviation of 7.26. In the third month there was not meaningful improvement, since their perception was "normal", showing a medium of 76.66 and a deviation of 11.21. Conclusions: During the eleven-month follow up of GBS patients, a gradual recovery in QOL was observed. The objectives set were achieved. Our study confirms that GBS does intervene in the QOL of patients.

Reporte de un caso de Síndrome de Guillain Barré post vacuna Coronavac: ¿rol causal o asociación temporal? / Guillain Barre syndrome associated with Coronavac vaccine: report of one case

We report a 50-year-old woman with a history of celiac disease, who presented with lumbar pain and progressive flaccid tetraparesis 48 hours after the inoculation of the first dose of CoronaVac inactivated SARS-CoV-2 vaccine. CSF was normal and electrodiagnostic studies showed an axonal motor polyneuropathy. No other triggers were identified, and other etiologies were ruled out. The presentation was compatible with the AMAN (Acute Motor Axonal Neuropathy) subtype of GBS, and intravenous immunoglobulin halted the progression of symptoms. Intensive neurorehabilitation was performed. The patient was discharged five weeks after admission, walking with poles and climbing stairs with minimal assistance. To date no cases of inactivated SARSCoV-2 vaccine related GBS have been reported. Thus, description of its clinical presentation is relevant. We discuss the current evidence relating GBS with vaccines, highlighting that vaccine associated GBS is a controversial entity and causality must be interpreted cautiously given the actual COVID-19 pandemic context.

Ecocardiografia Tridimensional na avaliação de endocardite de válvula nativa: um relato de caso e semelhança entre achados ecocardiográficos e cirúrgicos / Three-Dimensional transesophageal echocardiography in native valve endocarditis: a case report and similarities between echocardiography and surgical findings

A endocardite de valva nativa é uma doença incomum, complexa, e de alta morbimortalidade. Requer tratamento clínico prolongado, com várias complicações possíveis, e o seu tratamento cirúrgico é complexo e tecnicamente difícil. O ecocardiograma transtorácico e transesofágico são fundamentais na avaliação da doença, inclusive seus achados são parte dos critérios diagnósticos de endocardite. Adicionalmente, o ecocardiograma tridimensional (3D) contribui com detalhamento anatômico na avaliação das estruturas cardíacas acometidas pela doença. Mostramos um caso em que é ilustrado o papel da ecocardiografia no diagnóstico e avaliação de complicações da endocardite, comparando as imagens do ecocardiograma 3D pré-operatórias, com os achados durante o ato cirúrgico. (AU)

Native valve bacterial endocarditis is an uncommon, complex, and highly morbid disease that requires prolonged clinical treatment and challenging surgical interventions. Transthoracic and transesophageal echocardiography are paramount assessment tools whose findings are included in the diagnostic criteria. Three-dimensional echocardiography shows further realistic imaging details. Here we present a case demonstrating the role of echocardiography in the diagnosis of endocarditis and the identification of its complications to show how advanced imaging techniques may have a remarkable resemblance with in vivo surgical findings. (AU)

Casos clínicos de los síndromes de Guillain-Barré y Miller-Fisher relacionados con la COVID-19 / Clinical cases of Guillain-Barré and Miller-Fisher syndromes linked to COVID-19

Introducción: la enfermedad por coronavirus del 2019 (COVID-19), causada por el nuevo coronavirus SARSCoV-2, se ha asociado con el desarrollo de enfermedades neurológicas como el síndrome de Guillain-Barré (SGB) y sus variantes. En el presente trabajo se reportan dos casos de síndromes desmielizantes asociados con la COVID-19. Casos clínicos: hombre de 53 años con SGB y mujer de 29 años con la variante del síndrome de Miller-Fisher (SMF), respectivamente. Ambos presentaron los signos y síntomas neurológicos clásicos de polineuropatía desmielinizante que caracterizan a estos síndromes. De las pruebas bioquímicas paraclínicas, el aumento de proteínas en líquido cefalorraquídeo fue distintiva. La positividad de la RT-qPCR para el SARS-CoV-2 indicó la asociación de los SGB y SMF con la COVID-19. Ambos pacientes se trataron con inmunoglobulina intravenosa y mostraron mejoría. La electromiografía realizada en semanas posteriores aún mostrabaafectación desmielinizante crónica. Conclusión: los casos de los SGB y SMF, junto con otros casos similares reportados en todo el mundo, proporcionan más evidencia para el SARS-CoV-2 como nueva posible etiología de estas raras enfermedades neurológicas.

Background: coronavirus disease 2019 (COVID-19), caused by the new coronavirus SARS CoV-2, has been associated with the development of neurological diseases such as Guillain-Barré syndrome (GBS) and its variants. In the present work, two cases of demyelinating syndromes associated with COVID-19 are reported. Clinical cases: 53-year-old male with GBS and and 29-yearold female with Miller-Fisher syndrome (MFS) variant, respectively. Both patients presented the classic neurological signs and symptoms of demyelinating polyneuropathy that characterizes the syndromes. From the paraclinical biochemical tests, the increase of proteins in cerebrospinal fluid was distinctive. The positivity of the RT-qPCR for SARSCoV-2 suggested the association of GBS and MFS with COVID-19. Both patients were treated with intravenous immunoglobulin showing improvement. Electromyography performed weeks ahead still showed chronic demyelinating involvement. Conclusion: The cases of GBS and MFS, along with other similar cases reported around the world, provide further evidence for SARS-CoV-2 as a new possible etiology of these rare neurological diseases.

Estudio de la epidemiología neurológica en Colombia a partir de información administrativa (ESENCIA). Resultados preliminares 2015-2017 / Neuroepidemiologic study in Colombia based on administrative data (ESENCIA). Preliminary results 2015-2017

Resumen Introducción: Con la transición demográfica y epidemiológica, se espera que la prevalência de las patologías neurológicas aumente. En particular, Colombia no dispone de indicadores actualizados sobre la frecuencia de dichas enfermedades. Objetivo: Determinar la prevalencia de 10 patologías neurológicas de relevancia (migraña, epilepsia, enfermedad de Alzheimer, ataque cerebrovascular isquémico y hemorrágico, enfermedad de Parkinson, esclerosis múltiple, miastenia gravis, meningitis, síndrome de Guillain-Barré y enfermedad de motoneurona) en pacientes con edad ≥15 años entre 2015-2017. Materiales y métodos: Estudio de corte transversal a partir de fuentes administrativas, con base en los Registro Individuales de Prestación de Servicios (RIPS), consolidados por el Ministerio de Salud. Se analizaron las características sociodemográficas disponibles (sexo, grupo etario, régimen de salud, procedencia, etc.) y se ajustaron las prevalencias obtenidas según las distribuciones de la población mundial y nacional. Resultados: Para el 2017, las prevalencias ajustadas a la distribución etaria mundial, por 100 000 habitantes, fueron: migraña 2170 (IC95 °% 2164-2176); epilepsia 586 (IC95 °% 583-589); enfermedad de Alzheimer 387 (IC95 °% 384-389); ataque cerebrovascular 263 (IC95 % 260-265), específicamente, isquémico 136 (IC95 % 134-137) y hemorrágico 96 (IC95 % 95-98); enfermedad de Parkinson 91 (IC95 % 90-93), esclerosis múltiple 19 (IC95 % 18-19); miastenia gravis 11 (IC95% 11-11); meningitis 10 (IC95 % 9-10); síndrome de Guillain-Barré 9 (IC95 % 8-9); y enfermedad de motoneurona 6 (IC95 °% 5-6). La mediana de variación 2015-2017 fue del 19,38 °%. Conclusión: Las patologías más prevalentes a nivel nacional, en orden de frecuencia, fueron migraña, epilepsia y enfermedad de Alzheimer.

Abstract Introduction: With the demographic and epidemiological transition, the prevalence of neurological pathologies is expected to increase. In particular, Colombia does not have updated indicators regarding the frequency of these diseases. Objective: To determine the prevalence of ten relevant neurological pathologies (migraine, epilepsy, Alzheimer>s disease, ischemic and hemorrhagic stroke, Parkinson>s disease, multiple sclerosis, myasthenia gravis, meningitis, Guillain-Barre syndrome and motor neuron disease) in patients aged ≥15 years between 2015-2017. Materials and methods: Cross-sectional study of administrative sources, based on the Individual Service Provision Registries (RIPS) consolidated by the Ministry of Health. The available socio- demographic characteristics (sex, age group, health regime, origin, etc.) were analyzed, and the obtained prevalences were adjusted according to the distributions of the world and national population. Results: For 2017, the prevalences adjusted to the world age distribution, per 100,000 inhabitants, were: migraine 2170 (95%CI 2164-2176); epilepsy 586 (95%CI 583-589); Alzheimer>s disease 387 (95%CI 384-389); stroke 263 (95%CI 260-265), specifically, ischemic 136 (95%CI 134137) and hemorrhagic (95%CI 95-98); Parkinson's disease 91 (95%CI 90-93), multiple sclerosis 19 (95%CI 1819); myasthenia gravis 11 (95%CI 11-11); meningitis 10 (95%CI 9-10); Guillain-Barre syndrome 9 (95%CI 8-9); and motor neuron disease 6 (95%CI 5-6). The 2015-2017 median variation was 19.38%. Conclusion: The most prevalent pathologies nationwide, in order of frequency, were migraine, epilepsy, and Alzheimer>s disease.

Guillain-Barre syndrome related to COVID-19: muscle and nerve biopsy findings

BACKGROUND: the involvement of the peripheral nervous system (PNS) in COVID-19 is rare and, to date, morphological aspects from muscle and nerve biopsies have not been reported. Here, we describe a case of Guillain-Barré Syndrome (GBS) related to COVID-19 and demonstrate findings from peripheral nerve and skeletal muscle biopsies. A 79-year-old man presented with progressive weakness in both legs over one-week, evolving to both arms and urinary retention within 6 days. Four days earlier, he had a cough, febrile sensation and mild respiratory discomfort. On admission, his was afebrile, and without respiratory distress. A neurological examination disclosed asymmetric proximal weakness, diminished reflexes and no sensitive abnormalities. Three days later, the patient presented with bilateral facial weakness and proximal muscle strength worsened. Deep tendon reflexes and plantar responses were absent. Both superficial and profound sensitivity were decreased. From this point, oxygen saturation worsened, and the patient was placed on mechanical ventilation. CSF testing revealed one cell and protein 185 mg/dl. A chest CT showed the presence of ground-glass opacities and RT-PCR for SARS-CoV-2 was positive. The muscle biopsy revealed moderate neuromyopathic findings with positive expression for MHC-class I, C5b9, CD8 and CD68. The nerve biopsy showed inflammatory infiltrates predominantly with endoneurial compound formed by CD45 and CD68. The patient was treated with Oseltamivir for 9 days followed by IVIG for 5 days and died three days later of septic shock. DISCUSSION: this is the first documented case of GBS associated with COVID-19 with a muscle and nerve anatomopathological study. A systematic review about neurological complications caused by COVID-19 described 11 patients with GBS. The morphological features reported in our patient showed signs of involvement of the immune system, suggesting that direct viral invasion could have played a role in the pathogenesis of peripheral nerve injury. Hereafter, further research will be necessary to understand the triggers for these cells migrating into the peripheral nerve.

INTRODUÇÃO: O envolvimento do sistema nervoso periférico (SNP) na COVID-19 é raro e, até o momento, os aspectos morfológicos de biópsias de músculo e nervo não foram relatados. Descrevemos um caso de Síndrome de Guillain-Barré (SGB) na vigência de COVID-19 destacando os achados na biopsia de músculo e nervo. Um homem de 79 anos apresentou fraqueza progressiva em ambas as pernas ao longo de uma semana, evoluindo para ambos os braços e retenção urinária em 6 dias. Quatro dias antes, apresentou tosse, sensação febril e leve desconforto respiratório. Na admissão, apresentava-se afebril e sem alteração respiratória. O exame neurológico mostrou fraqueza proximal assimétrica, reflexos diminuídos e sensibilidade preservada. Três dias após, o paciente evoluiu com fraqueza facial bilateral e piora da força muscular proximal. Reflexos tendinosos profundos e cutâneo plantar ausentes bilateralmente. A sensibilidade superficial e profunda estavam diminuídas. Evoluiu com piora na saturação de oxigênio sendo colocado sob ventilação mecânica. O exame de liquor revelou uma célula e aumento de proteína (185 mg / dl). A TC de tórax revelou a presença de opacidades em vidro fosco e o RT-PCR para SARS-CoV-2 foi positivo. A biópsia muscular mostrou achados neuromiopáticos moderados com imunoexpressão positiva para MHC classe I, C5b9, CD8 e CD68. A biópsia de nervo revelou infiltrado inflamatório inflamatórios predominantemente endoneural composto por CD45 e CD68. O paciente foi tratado com Oseltamivir por 9 dias seguido de IVIG por 5 dias indo a óbito após três dias por choque séptico. DISCUSSÃO: Este é o primeiro caso documentado de SGB associada a COVID-19 com estudo anatomopatológico de músculo e nervo. Uma revisão sistemática de complicações neurológicas associadas à COVID-19 descreveu 11 pacientes com SGB. As características morfológicas em nosso paciente mostrando sinais de envolvimento do sistema imunológico sugere que a invasão viral direta pode ter colaborado no processo patogênico da lesão neuromuscular. A partir daí, mais pesquisas serão necessárias para entender os gatilhos para essas células migrarem para o nervo periférico.

Guía basada en la evidencia. Diagnóstico y manejo del síndrome de Guillain-Barré en diez pasos / Evidence based guidelines. Diagnosis and management of Guillain-Barré syndrome in ten steps

Resumen El síndrome de Guillain-Barré (SGB) es una enfermedad inmunológica del nervio periférico y las raíces nerviosas, poco frecuente, potencialmente mortal y que suele desencadenarse por infecciones. La incidencia del SGB puede aumentar durante el brote de enfermedades infecciosas, tal como se observó en las epidemias del virus Zika en la Polinesia Francesa en 2013 y en América Latina en 2015. El diagnóstico y el manejo clínico del SGB pueden ser complicados ya que su presentación y el curso de la enfermedad son heterogéneos, y actualmente no se cuenta con guías clínicas internacionales. Para respaldar a los médicos, especialmente en el contexto de un brote de una enfermedad infecciosa, hemos desarrollado una guía clínica aplicable en todo el mundo para el diagnóstico y el tratamiento del SGB. La guía se basa en literatura actualizada y el consenso de expertos, y tiene una estructura de diez pasos para facilitar su uso en la práctica clínica. Inicialmente, brindamos una introducción a los criterios de diagnóstico, variantes clínicas y diagnósticos diferenciales del SGB. Los diez pasos luego abordan el reconocimiento y el diagnóstico temprano del SGB, la admisión a la unidad de cuidados intensivos, indicación y selección de tratamiento, seguimiento y tratamiento de la progresión de la enfermedad, predicción del curso clínico, resultados y tratamiento de complicaciones y secuelas.

Abstract Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and in 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diag nostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.

Peripheral neuropathy in COVID-19 is due to immune-mechanisms, pre-existing risk factors, anti-viral drugs, or bedding in the Intensive Care Unit / Neuropatia periférica na COVID-19 com mecanismos immunológicos, fatores de risco preexistentes, medicamentos antivirais e compressão dos nervos periféricos nos leitos da Unidade de Terapia Intensiva

ABSTRACT Background: This mini-review aims to summarize and discuss previous and recent advances in the clinical presentation, pathophysiology, diagnosis, treatment, and outcome of SARS-CoV-2-associated peripheral neuropathies. Methods: Literature review. Results: Altogether, 105 articles about SARS-CoV-2-associated neuropathy describing 261 patients were retrieved. Peripheral neuropathy in patients with COVID-19 is frequent and predominantly due to immune mechanisms or neurotoxic side effects of drugs used to treat the symptoms of COVID-19 and, to a lesser extent, due to the compression of peripheral nerves resulting from prolonged bedding in the Intensive Care Unit (ICU) and pre-existing risk factors such as diabetes. SARS-CoV-2 does not cause viral neuropathy. Neurotoxic drugs such as daptomycin, linezolid, lopinavir, ritonavir, hydro-chloroquine, cisatracurium, clindamycin, and glucocorticoids should be administered with caution and patients should be appropriately bedded in the ICU to prevent SARS-CoV-2-associated neuropathy. Patients with Guillain-Barré syndrome (GBS) benefit from immunoglobulins, plasma exchange, and steroids. Conclusions: Neuropathies of peripheral nerves in patients with COVID-19 are frequent and mostly result from immune mechanisms or neurotoxic side effects of drugs used to treat the symptoms of COVID-19 and, to a lesser extent, from the compression of peripheral nerves due to prolonged bedding on the ICU. SARS-CoV-2 does not cause infectious neuropathy.

RESUMO Introdução: A presente minirrevisão tem como objetivo resumir e discutir os avanços dos aspectos clínicos, fisiopatológicos, de diagnóstico, tratamento e evolução das neuropatias dos nervos periféricos associadas à COVID-19. Métodos: Revisão da literatura. Resultados: Foram avaliados 105 artigos sobre neuropatia associada à COVID-19. Nesses estudos, 261 pacientes apresentaram boa evolução. As neuropatias dos nervos periféricos em pacientes com COVID-19 são frequentes e se devem, principalmente, aos mecanismos immunológicos ou efeitos colaterais neurotóxicos dos medicamentos utilizados para o tratamento da COVID-19, a fatores de risco pré-existentes, como diabetes e, em menor parte, à compressão dos nervos periféricos nos leitos da UTI. A COVID-19 não causa neuropatia viral. Os medicamentos neurotóxicos, como daptomicina, linezolida, lopinavir, ritonavir, hidro-cloroquina, cisatracúrio, clindamicina e glicocorticoides devem ser administrados com cautela, e os pacientes deve ser adequadamente admitidos nos leitos da UTI para prevenir o desenvolvimento de neuropatia associada à COVID-19. Pacientes com síndrome de Guillain-Barré (GBS) se beneficiam de imunoglobulinas, plasmaférese e esteroides. Conclusões: As neuropatias dos nervos periféricos em pacientes com COVID-19 são raras e predominantemente devidas aos efeitos colaterais neurotóxicos das mecanismos immunológicos ou drogas utilizadas para o tratamento de COVID-19 e, em menor parte, devido à compressão dos nervos periféricos nos leitos da UTI. A COVID-19 não causa neuropatia infeciosa.

Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru / Características clínico-epidemiológicas asociadas con los resultados al alta y la estacionalidad entre los pacientes sobrevivientes con síndrome de Guillain-Barré en un hospital nacional de tercer nivel, Lima, Peru

ABSTRACT Background: Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system. Severe motor deficit (SMD), respiratory impairment, cranial nerve involvement and autonomic dysfunction are associated with a poor prognosis. Objective: To investigate the association between the clinical-epidemiological characteristics and the discharge results among Peruvian patients with GBS. Methods: We carried out a retrospective observational study on patients with GBS who survived until discharge. We used the Brighton Collaboration's criteria and considered Hughes Severity Scale (HSS) scores greater than two to be SMD. We defined the discharge results as an improvement if the HSS score decreased by at least one point from admission to hospital discharge and defined hospital stay as prolonged if > 14 days. Results: We analyzed 92 patients, among whom 70.7% were male. Quadriparesis (81.1%) and hyporeflexia (86.8%) were the most characteristic manifestations. We observed that more than half of the cases were in summer and winter. Gastrointestinal infections were associated with a higher proportion of prolonged stays. The proportion of improvement was lower among patients who had an SMD at hospital admission. We confirmed these results through fitting in multivariate models. Conclusions: The prolonged stay was related to previous gastrointestinal infection, while a less improvement in SMD individuals at admission. Prospective multicenter surveillance systems are needed for monitoring GBS cases in low-income settings like Peru.

RESUMEN Antecedentes: El síndrome de Guillain-Barré (SGB) es una enfermedad autoinmune que afecta al sistema nervioso periférico. Déficit motor severo (DMS), compromiso respiratorio, afectación de pares craneales y disfunción autonómica se asocian con un mal pronóstico. Objetivo: Investigar la asociación entre las características clínico-epidemiológicas y los resultados del alta en pacientes peruanos con SGB. Métodos: Realizamos un estudio observacional retrospectivo de pacientes con SGB supervivientes hasta el alta. Consideramos los criterios de colaboración de Brighton y una escala de severidad de Hughes (ESH) superior a dos como un DMS. Definimos los resultados del alta como una mejoría si el ESH disminuyó en al menos un punto desde el ingreso hasta el alta hospitalaria y una estadía prolongada si el tiempo de hospitalización fue > 14 días. Resultados: Analizamos 92 pacientes, de los cuales el 70,7% eran varones. La cuadriparesia (81,1%) y la hiporreflexia (86,8%) fueron las manifestaciones más características. Observamos más de la mitad de los casos en verano e invierno. Las infecciones gastrointestinales se asociaron con una mayor proporción de estadías prolongadas. La proporción de mejoría fue menor en los pacientes que tenían un DMS al ingreso hospitalario. Confirmamos estos resultados con modelos multivariados ajustados. Conclusiones: La estadía prolongada se relacionó con infección gastrointestinal previa, mientras que una mejoría menor en individuos con DMS al ingreso. Necesitamos sistemas de vigilancia multicéntricos prospectivos para monitorear los casos de SGB en un entorno de bajos ingresos como Perú.

Síndrome de Miller Fisher tratado con plasmaféresis durante el embarazo: reporte de un caso y revisión de la literatura / Miller Fisher syndrome treated with plasmapheresis during pregnancy: Case report and review of the literature

Resumen Objetivo: Reportar el caso de una paciente gestante con síndrome de Guillain-Barré (SGB) presentado en la variante denominada síndrome de Miller Fisher (SMF), y realizar una revisión en torno al diagnóstico, tratamiento y pronóstico de esta variedad de SGB durante la gestación. Materiales y métodos: Se presenta el caso de una gestante de 27 semanas con síndrome de Miller Fisher, quien fue tratada con plasmaféresis en un hospital militar de referencia, con evolución satisfactoria a los 15 días y continuación normal del embarazo, parto a las 38 semanas con recién nacido sano. Se realizó una búsqueda bibliográfica en bases de datos electrónicas: Medline vía PubMed, Lilacs, SciELO, ScienceDirect, Ovid, con los términos "Embarazo", "Síndrome de Miller Fisher", "Síndrome de Guillain-Barré". Se incluyeron cohortes, series y reportes de casos de mujeres gestantes con síndrome de Miller Fisher; se extrajo información sobre los métodos diagnósticos, el tratamiento utilizado y el pronóstico materno y perinatal. La búsqueda se hizo en junio de 2020, sin restricción por fecha, pero sí por tipo de idioma (español e inglés). Resultados: Se identificaron 423 títulos, tres estudios cumplieron los criterios de inclusión, los tres correspondieron a reportes de caso. Todos los casos mostraron seropositividad para antigangliósidos GQ1b positivos; en ningún caso hubo alteración imagenológica. Dos pacientes recibieron inmunoglobulina intravenosa y la tercera paciente se dejó en observación. Hasta el momento no se documentan complicaciones obstétricas. Conclusión: Existen pocos casos reportados de SMF durante la gestación, el diagnóstico se basa en el examen clínico; el tratamiento con inmunoglobulina IV representa la alternativa utilizada con mayor frecuencia. En el caso presentado se utilizó la plasmaféresis. Se desconoce el impacto de la variedad del síndrome de Miller Fisher sobre el curso normal de la gestación y sobre los resultados perinatales a largo plazo. Se requieren más estudios que aborden el diagnóstico, el tratamiento y el pronóstico de esta entidad.

Abstract Objective: To report the case of pregnant woman with Guillain-Barré syndrome (GBS) presenting as the Miller Fisher variant, and to review the literature on the diagnosis, treatment and prognosis of this GBS variant during gestation. Materials and Methods: Pregnant woman presenting at 27 weeks of gestation with Miller Fisher syndrome (MFS), treated in a military referral hospital with a satisfactory course after 15 days, continuation of normal pregnancy and delivery of a healthy neonate at 38 weeks. A search of the literature was conducted in the Medline via PubMed, Lilacs, SciELO, ScienceDirect and Ovid databases using the terms "Pregnancy," "Miller Fisher syndrome," "Guillain-Barré syndrome". Cohorts, case series and case reports of pregnant women with MFS were included. Data on diagnostic methods, treatment and maternal and perinatal prognosis were extracted. The search was made on June 2020, with no restriction by date, but restriction by language (Spanish and English). Results: Overall, 423 titles were identified, three studies met the inclusion criteria, the three of them corresponding to case reports. All cases were found to be seropositive for anti-GQ1b ganglioside antibodies. No imaging abnormalities were found in any of the cases. Two patients received IV immunoglobulin and the third patient was kept under observation. No obstetric complications have be documented so far. Conclusion: There are few cases of MFS reported during pregnancy. Intravenous immunoglobulin is the most frequently used treatment option. Plasmapheresis was used in the case presented here. The impact of the Miller Fisher variant on the normal course of gestation and on long-term perinatal outcomes is unknown. Further studies that look into the diagnosis, treatment and prognosis of this condition are required.

Epidemiological and clinical aspects of Guillain-Barré syndrome and its variants / Aspectos epidemiológicos e clínicos da síndrome de Guillain-Barré e suas variantes

Abstract Background: Guillain-Barré syndrome (GBS), an acute polyradiculoneuropathy that occurs because of an abnormal inflammatory response in the peripheral nervous system, is clinically characterized by acute flaccid paresis and areflexia with or without sensory symptoms. This syndrome can lead to disabling or even life-threatening sequelae. Objective: This study aimed to present the clinical and epidemiological aspects of GBS in patients admitted to a tertiary-level hospital in the Federal District between January 2013 and June 2019. Methods: In this observational, cross-sectional and retrospective study, medical records of patients diagnosed with acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy or acute axonal motor-sensitive neuropathy based on electromyographic findings were included, and clinical data were collected retrospectively. Results: A total of 100 patients (63 males and 37 females; ratio, 1.7:1) aged 2-86 years (mean, 36.4 years) were included. The mean annual incidence rate of GBS was 0.54 cases/100,000 inhabitants, with 52 and 49% of the cases occurring between October and March (rainy season) and between April and September (dry season), respectively. The proportions of patients showing each GBS variant were as follows: demyelinating forms, 57%; axonal forms, 39%; and undetermined, 4%. The mean duration of hospitalization was 8-15 days for most patients (38%). During hospitalization, 14% of the patients required mechanical ventilation and 20% experienced infectious complications. Conclusion: The findings indicate that there was an increase in the incidence of GBS during the rainy season. Moreover, we did not observe the typical bimodal distribution regarding age at onset.

RESUMO Introdução: Síndrome de Guillain-Barré (SGB), uma polirradiculoneuropatia aguda que ocorre devido a uma resposta inflamatória anormal no sistema nervoso periférico, é caracterizada clinicamente por paralisia flácida aguda e arreflexia, com ou sem sintomas sensitivos. Essa síndrome pode deixar sequelas incapacitantes ou até ameaçar a vida. Objetivo: Apresentar os aspectos clínicos e epidemiológicos da SGB em pacientes internados em um hospital terciário do Distrito Federal, no período de janeiro/2013 a junho/2019. Métodos: Estudo observacional, transversal e retrospectivo, no qual pacientes com diagnóstico de polirradiculoneuropatia desmielinizante inflamatória aguda, neuropatia axonal motora aguda ou neuropatia axonal sensitivo motora aguda a partir dos achados eletroneuromiográficos foram selecionados e seus dados clínicos coletados retrospectivamente em seus prontuários. Resultados: Um total de 100 pacientes (63 homens e 37 mulheres; proporção de 1,7:1), com idades entre 2-86 anos (média, 36,4 anos), foram incluídos. A taxa média anual de incidência de SGB foi de 0,54 casos/100.000 habitantes, com 52 e 49% dos casos ocorrendo entre outubro e março (período chuvoso) e entre abril e setembro (período seco), respectivamente. A proporção de pacientes que apresentaram cada variante de SGB foi a seguinte: formas desmielinizantes, 57%; formas axonais, 39%; e indeterminado, 4%. A duração média da hospitalização foi de 8‒15 dias para a maioria dos pacientes (38%). Durante a hospitalização, 14% dos pacientes necessitaram de ventilação mecânica e 20% apresentaram complicações infecciosas. Conclusão: Os resultados indicam aumento na incidência de GBS durante a estação chuvosa. Além disso, não observamos a distribuição bimodal típica em relação à idade de início.

Síndrome de Guillain Barré asociado a infección SARS-COV-2, reporte de caso clínico / Guillain-Barre syndrome associated with SARS-COV2: a case report

En diciembre de 2019, en Wuhan ­ China, se reportaron varios casos de neumonía de etiología desconocida. A inicios del 2020 se identificó el virus coronavirus 2 del Síndrome Respiratorio Agudo Severo (SARS ­ COV2) como agente causal de la enfermedad. La Organización Mundial de la Salud (OMS) definió la afección por este virus como COVID 19 confirmando su presencia en Sudamérica y en el Ecuador en febrero, por lo cual el 11 de marzo se declaró como una pandemia. Esta patología afecta principalmente al sistema respiratorio, sin embargo, existe el reporte de manifestaciones neurológicas en pacientes con COVID 19. Por lo cual, se informa el primer caso en Ecuador de Síndrome de GuillaIn Barré asociado a la misma.

In December 2019, in Wuhan ­ China, several cases of pneumonia of unknown etiology were reported. At the beginning of 2020, the Severe Acute Respiratory Syndrome coronavirus 2 (SARS ­ COV2) was identified as the disease's causal agent. The World Health Organization (WHO) defined this virus as COVID 19, confirming its presence in South America and Ecuador in February. Later on March 11, it was declared a pandemic. This pathology mainly affects the respiratory system; however, there is a report of neurological manifestations in patients with COVID 19. Therefore, we report the first case of Guillain Barré syndrome associated with COVID 19 in Ecuador.

Craniofacial and neurological manifestations in patients with Guillain-Barré syndrome / Manifestaciones neurológicas craneofaciales en pacientes con síndrome de Guillain-Barré

Introducción: Among the broad range of symptoms of the Guillain-Barré Syndrome (GBS), patients can present craniofacial manifestations. Consequently, the participation of the dental surgeon in the evaluation of the stomatognathic system using a multidisciplinary approach model is very important. Objective: To identify the craniofacial and neurological manifestations of the Guillain-Barré Syndrome in patients from three hospitals in the district of Lambayeque, Peru, in 2019. Material and Methods: A descriptive, prospective, and cross-sectional study was carried out in 59 patients diagnosed with GBS by means of a clinical evaluation carried out by previously calibrated neurologists (k=0.911). Additionally, an oral evaluation of the oral hygiene index, the periodontal status, and the oral pH was carried out. Data were processed using frequency distribution tables. Results: 4 4.07% of the patients presented at least one functional alteration, such as unilateral limitation for facial expressions (25.42%), dysphagia (18.64%), alteration in phonation (11.86%), and loss of the sense of taste (6.78%), showing involvement of the corresponding cranial nerves. In addition, unfavorable conditions of oral hygiene and acid pH were observed in some cases, which proved adverse for the periodontal structures of the patients. Conclusion: The study found craniofacial manifestations of GBS, such as cases of unilateral facial palsy, dysphagia, difficulty in phonation, and loss of the sense of taste, due to the alteration of the cranial nerves that command these functions. In addition, poor oral hygiene, and the presence of acidic pH in some patients created an adverse environment for the integrity of the periodontal structures

Introducción: El Síndrome de Guillain-Barré (SGB) dentro de su amplia sintomatología puede presentar manifestaciones craneofaciales, por lo que resulta importante la participación del cirujano dentista en la evaluación del sistema estomatognático desde un modelo de abordaje multidisciplinario. Objetivo: Identificar las manifestaciones neurológicas craneofaciales del Síndrome de Guillain-Barré en pacientes de tres establecimientos de salud de Lambayeque, Perú en el año 2019. Materiales y Metodos: Se realizó un estudio descriptivo, prospectivo y transversal, con 59 pacientes diagnosticados con SGB, mediante una evaluación clínica realizada por médicos neurólogos previamente calibrados (k=0,911). Adicionalmente se realizó una evaluación bucodental del índice de higiene oral, del estado periodontal y del pH bucal, siendo procesados los datos mediante tablas de distribución de frecuencias. Resultados: El 44,07% de pacientes presentaron por lo menos una alteración funcional, identificando limitación unilateral para expresiones faciales (25.42%), disfagia (18.64%), alteración en la fonación (11.86%) y pérdida del sentido del gusto (6.78%), evidenciando compromiso de los pares craneales correspondientes. Además se observaron condiciones desfavorables de higiene oral y de pH ácido en algunos casos, que resultaron adversas para las estructuras periodontales de los pacientes. Conclusión: Fueron encontradas manifestaciones craneofaciales del SGB, identificando casos con parálisis facial unilateral, disfagia, dificultad para la fonación y pérdida del sentido del gusto, debido a la alteración de los pares craneales que comandan esas funciones. Además las condiciones desfavorables de higiene oral y la presencia de pH ácido en algunos casos, propiciaron un ambiente adverso para la integridad de las estructuras periodontales.

Síndrome de Guillain-Barré asociado a accidente apídico: reporte de caso / Guillain-Barré syndrome associated with a bee sting accident: a case report / Síndrome de Guillain-Barré associada a acidente elapídico: relato de caso

El accidente apídico implica un bajo riesgo de morir por reacciones agudas como anafilaxia. Es frecuente que se desconozcan otros riesgos como el hepático y el neurológico. Dentro de las complicaciones menos conocidas está la polineuropatía aguda conocida como Guillain- Barré. La causa más ampliamente descrita es la reacción cruzada entre IgE y la proteína básica de mielina. A continuación, se reporta el primer caso en América Latina sobre la asociación entre Guillain-Barré y accidente por picadura de abejas. En este caso, hay criterios de causalidad como el nexo temporal, la plausibilidad biológica y la coherencia con otros artículos reportados en la literatura médica.

Bee sting accident usually implies a low risk of dying from acute reactions such as anaphylaxis. Other risks such as liver and neurological risks are often unknown. Among the lesser-known complications caused by this type of accident is the acute polyneuropathy known as Guillain-Barré. The most widely described cause is the cross reaction between IgE and myelin basic protein. The article reports the first case in Latin America on the association between Guillain-Barré and a bee sting accident. In this case, there are causality criteria such as temporal link, biological plausibility, and consistency with other articles reported in the medical literature

O acidente elapídico implica um baixo risco de morte por reações agudas, como anafilaxia. Outros riscos, como hepáticos e neurológicos, são frequentemente desconhecidos. Entre as complicações menos conhecidas está a polineuropatia aguda conhecida como Guillain-Barré. A causa mais amplamente descrita é a reação cruzada entre a IgE e a proteína básica da mielina. A seguir, é relatado o primeiro caso na América Latina sobre a associação entre Guillain-Barré e um acidente com picada de abelha. Nesse caso, há critérios de causalidade como vínculo temporal, plausibilidade biológica e consistência com outros artigos relatados na literatura médica

Guillain-Barré syndrome associated with SARS-CoV-2 infection: a scoping review

SUMMARY BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can affect the nervous system, triggering problems such as the Guillain-Barre Syndrome (GBS), an association that can bring complications to the patient. OBJECTIVE: This scoping review aimed to clarify the clinical features and analyze patients with GBS associated with SARS-CoV-2 infection, looking at morbidity, mortality, and neurological outcomes. SEARCH STRATEGY: The search was conducted through Medline, Web of Science, Embase, CINAHAL, Latin-American and Caribbean Literature in Health Sciences (LILACS), clinicaltrials.gov, SCOPUS, and the Cochrane Central Register of Controlled Trials. SELECTION CRITERIA: Observational studies, published after 2019, describe patients with GBS associated with SARS-CoV-2 infection. There were no language restrictions while selecting the studies. DATA COLLECTION AND ANALYSIS: Three authors, Kleyton Santos de Medeiros, Luíza Thomé de Araújo Macêdo, and Wederson Farias de Souza, independently screened the search results using titles and abstracts. Duplicate studies were excluded. The same authors then went through the entire text to determine whether the studies met the inclusion criteria. Discrepancies were resolved by other reviewers, Ana Paula Ferreira Costa, Ayane Cristine Sarmento, and Ana Katherine Gonçalves. Finally, the selection of the studies was summarized in a PRISMA flow diagram. MAIN RESULTS: Main manifestations were fever, coughing, dyspnea, sore throat, ageusia, anosmia, and respiratory failure, in addition to paresthesia of the upper and lower limbs, tetraparesis, facial diplegia, areflexia, asthenia, mastoid pain, acute ataxia, fatigue, numbness, swallowing disorder, and moderate low back pain. CONCLUSION: Coronavirus disease 2019 (COVID-19) can trigger the GBS, despite the few studies on this topic. Patients had clinical manifestations of COVID-19 infection and neurological manifestations characterizing GBS.

Velocidad de progresión de la enfermedad como predictor de severidad en el síndrome de Guillain-Barré / Disease progression velocity as predictor of severity in Guillain-Barre syndrome

RESUMEN Objetivo: Identificar a la velocidad de progresión de la enfermedad como un predictor de severidad en pacientes con síndrome de Guillain-Barré (SGB). Materiales y métodos: Estudio observacional prospectivo que incluyó pacientes con diagnóstico confirmado de SGB entre mayo y agosto de 2019 en cuatro hospitales del Perú. La velocidad de progresión de la enfermedad (VPE) fue definido como el tiempo transcurrido entre el inicio de los síntomas neurológicos y el pico máximo de la severidad neurológica. Resultados: De 94 casos con SGB, la edad promedio fue 42 años; 73 (77,8%) pacientes presentaron SGB severo, la estancia hospitalaria promedio fue 18,4 días; 45 (47,8%) pacientes presentaron cuadro diarreico previo; 63 (67,1%) pacientes presentaron un inicio de debilidad motora en miembros superiores y 31 (32,9%) en miembros inferiores; 9 (10,0%) pacientes presentaron algún tipo de disautonomía; 8 (8,5%) pacientes debieron usar ventilación mecánica, y 2 (2,0%) pacientes fallecieron. La VPE ≤ 1 día tiene el 79% de probabilidad de desarrollar enfermedad severa, la VPE de dos y tres días tienen el 61% y el 38% de probabilidad, respectivamente, de progresar a las formas severas. Conclusión: La VPE es un predictor de mal pronóstico cuando es menor de 2 días. La VPE neurológica es un método de evaluación clínica práctica y accesible que debe evaluarse en pacientes con SGB.

ABSTRACT Objective: To identify the velocity of disease progression as a predictor of severity in patients with Guillain-Barre syndrome (GBS). Materials and methods: Prospective observational study of patients with confirmed diagnosis of GBS between May and August 2019 in four hospitals in Peru. The disease progression velocity (DPV) was defined as the time since the onset of neurological symptoms and the maximum peak of neurological severity. Results: Of 94 cases with GBS, the average age was 42 years; 73 (77.8%) patients presented severe GBS, the average hospital stay was 19 days; 45 (47.8%) patients had diarrheal symptoms previously, in 63 (67.1%) patients the onset of motor weakness was located in the upper limbs and in 31 (32.9%) it was located in the lower limbs, 9 (10.0%) patients presented some type of dysautonomy; admission to mechanical ventilation was needed in 8 (8.5%) patients, and the deceased were 2 (2.0%). The DPV≤ 1 day has a 79% probability of developing severe disease, the two and three day DPV have the probability of 61% and 38% respectively of progressing to severe forms. Conclusion: DPV is a predictor of poor prognosis when it is less than 2 days and with a possible requirement for mechanical ventilation. The speed of progression of neurological disease is a practical and accessible clinical evaluation method that should be evaluated in patients with GBS.

Características clínicas y respuesta al recambio plasmático terapéutico en los pacientes con síndrome de Guillain Barré / Clinical characteristics and plasma exchange response in Guillain-Barré patients

RESUMEN El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.

ABSTRACT The objective of the study was to describe the clinical characteristics, treatment response and possible associated factors of patients with Guillain-Barré syndrome at the National Institute of Neurological Sciences. A descriptive study on hospital discharges was conducted during the period 2017-2019. Treatment response was evaluated based on Hughes' disability scale. From 31 patients 61.3% were males and the mean age was 50 years. At admission, 87.1% of patients were on grade 3 or 4 of Hughes scale, most of them with axonal compromise which was associated to disability. Only 22 patients received plasma exchange; 6 months thereafter, 90.9% of patients decreased by at least one degree in Hughes scale and 42.8% were left without disability. In conclusion, a male and axonal subtype predominance was found, been the latter associated to disability.

Características clínicas y respuesta al recambio plasmático terapéutico en los pacientes con síndrome de Guillain Barré / Clinical characteristics and plasma exchange response in Guillain-Barré patients

RESUMEN El objetivo del estudio fue describir las características clínicas, la respuesta al tratamiento y posibles factores asociados de los pacientes con síndrome de Guillain Barré en el Instituto Nacional de Ciencias Neurológicas. Se realizó un estudio descriptivo sobre egresos hospitalarios durante el periodo 2017-2019. La respuesta al tratamiento se evaluó mediante la escala de discapacidad de Hughes. De los 31 pacientes el 61,3% eran varones, y la edad promedio fue de 50 años. Al ingreso, el 87,1% de pacientes se encontraban en el grado 3 o 4 de la escala de Hughes, la mayoría con compromiso axonal, el cual estuvo asociado a discapacidad. Solo 22 pacientes recibieron recambio plasmático; luego de seis meses el 90,9% disminuyó al menos en un grado en la escala de Hughes y el 42,8% quedaron sin discapacidad. En conclusión, se encontró un predominio del sexo masculino y del compromiso axonal, este último asociado a discapacidad.

ABSTRACT The objective of the study was to describe the clinical characteristics, treatment response and possible associated factors of patients with Guillain-Barré syndrome at the National Institute of Neurological Sciences. A descriptive study on hospital discharges was conducted during the period 2017-2019. Treatment response was evaluated based on Hughes' disability scale. From 31 patients 61.3% were males and the mean age was 50 years. At admission, 87.1% of patients were on grade 3 or 4 of Hughes scale, most of them with axonal compromise which was associated to disability. Only 22 patients received plasma exchange; 6 months thereafter, 90.9% of patients decreased by at least one degree in Hughes scale and 42.8% were left without disability. In conclusion, a male and axonal subtype predominance was found, been the latter associated to disability.