Guillain-Barré syndrome in the elderly: clinical, electrophysiological, therapeutic and outcome features

There are few papers devoted to geriatric Guillain-Barré (GBS) and many related issues remain unanswered. OBJECTIVE: To describe clinical, electrophysiological and therapeutic features in this age. METHOD: Clinico-epidemiological data and therapy of GBS patients older than 60 years were reviewed. Hughes scores were used to quantify neurological deficit and define outcome. RESULTS: Among 18 patients (mean age 64.8 years), 9 had evident prodrome and 80% noticed initially sensory-motor deficit. Demyelinating GBS was found in 8 and axonal in 6 subjects. There was one Miller-Fisher and 3 unclassified cases. Plasmapheresis (PFX) was single therapy in 12 patients and intravenous immunoglobulin (IVIg) in 2. Disability scores just before therapy were similar in both groups, so as short and long term outcome. CONCLUSION: Axonal GBS seems to be more frequent in the elderly and this may have prognostic implications. PFX and IVIg were suitable options, but complications were noticed with PFX. Prospective studies are needed to better understand and manage GBS in the elderly.

Publicações sobre a síndrome de Guillain-Barré (SGB) no idoso são escassas e várias questões sobre o tema estão abertas. OBJETIVO: Descrever aspectos clínico-eletrofisiológicos, terapêuticos e prognóstico no idoso. MÉTODO:Revisamos os prontuários de pacientes acima de 60 anos com SGB. A escala de Hughes foi usada para quantificar os déficits iniciais e finais. RESULTADOS: No total de 18 pacientes (média de idade 64,8 anos), 50% tiveram pródromo e 80% tiveram déficit sensitivo-motor no início. SGB desmielinizante foi encontrada em 8 pacientes, axonal em 6 e uma síndrome de Miller-Fisher. Três casos não puderam ser classificados. Plasmaférese (PFX) foi empregada isoladamente em 12 pacientes e imunoglobulina endovenosa (IVIg) em 2. A disfunção inicial nos dois grupos tratados era semelhante, assim como a evolução a curto e longo prazo. CONCLUSÃO: A forma axonal da SGB parece ser mais freqüente no idoso e isto pode ter implicações prognósticas. PFX e IVIg foram eficazes, mas complicações ocorreram apenas no grupo tratado com PFX. Estudos prospectivos são necessários para um melhor entendimento e manejo da SGB no idoso.

Relação entre mortalidade adulta e indicadores socioeconômicos nas Regioes Metropolitanas do Brasil / Relation of adult mortality and socioeconomical data on metropolitan regions of Brazil

PURPOSE: To evaluate the association between the adult mortality, in the age range between 10 and 64 years old in 2000, and socioeconomic indicators for 16 metropolitan regions of Brazil. METHODS: From the datas of the Mortality System from the Ministry of Heath, were calculated the crude mortality rates (CMR) to all the causes of dead and sex, for the 16 metropolitan regions in Brazil. As a form of guarantee the spacial camparability, the CMR were standardized by age and sex, achieving the total mortality-standardized rates and for sex by the direct method of standardization. The correlation of Pearson was obtained for the 9 indicators and the analysis of cluster was used for the agroupment of the metropolitan regions. RESULTS: The matrix of correlation of Pearson showed significant correlation only between the TMSR, the urbanization degree and residence with rubbish collection. Three groups of metropolitan regions were identified. CONCLUSION: The analysis of agroupment identified three groups: 1--Porto Alegre, São Paulo, Vitória, Curitiba, Maceió, Rio de Janeiro e recife; 2--Florianópolis, Natal, Fortaleza, Brasília e São Luís e 3--Goiânia, Belo Horizonte, Salvador e Belém, that showed be significantly different by analysis of variance (P = 0.000).