Guillain-Barre syndrome in Mexico: clinical features and validation of Brighton Collaboration Group criteria. / Síndrome de Guillain-Barré en México: características clínicas y validación de los criterios de Brighton.

INTRODUCTION: As SARS-CoV-2 vaccination is ongoing in Mexico and Guillain-Barre syndrome (GBS) cases have been reported, validation of Brighton criteria in Mexico is necessary. Moreover, epidemiology of GBS in Mexico differs from European and North American countries. OBJECTIVE: To describe the clinical, cerebrospinal and electrodiagnostic features in Mexican patients diagnosed with GBS and classify them according to the Brighton Collaboration Group diagnostic criteria. Patrients and methods. An ambispective cohort study was conducted. We included patients that fulfilled the National Institute of Neurological Disorders and Stroke (NINDS) diagnostic criteria for Guillain-Barre syndrome. Patients in this study were classified according to Brighton collaboration group levels of certainty for Guillain-Barre syndrome. RESULTS: Sixty eight percent of patients were male. Of the 248 patients included, 58.4% had history of a precedent infection, mean time from symptom onset to admission was 5 (1-30) days. Mean Medical Research Council sum score 30.3 ± 15.5. Almost 98% of patients had a monophasic course. Level 1 of certainty according to Brighton collaboration group criteria was fulfilled by 54.6% of patients, level 2 by 45% and level 4 by 0.6%. Patients meeting level 2 of certainty were mostly because normal cerebrospinal fluid findings or findings in nerve conduction studies not consistent with any GBS variants. CONCLUSION: GBS is a frequent autoimmune neuropathy that has been associated with preceding infections and with vaccination campaigns. For SARS-CoV-2 vaccination campaign in Mexico, validation of Brighton Criteria is necessary. Although Mexico's GBS epidemiology has been changing throughout recent years, this study provides similar data compared to other countries.

TITLE: Síndrome de Guillain-Barré en México: características clínicas y validación de los criterios de Brighton.Introducción. Dado que la vacunación contra el SARS-CoV-2 está en curso en México y se han notificado casos de Guillain-Barré, es necesaria la validación de los criterios de Brighton en México. La epidemiología de Guillain-Barré en México difiere de la de los países europeos y norteamericanos. Objetivo. Describir las características clínicas, cerebroespinales y electrodiagnósticas en pacientes mexicanos con diagnóstico de Guillain-Barré y clasificarlos según los criterios diagnósticos del Brighton Collaboration Group. Pacientes y métodos. Se realizó un estudio de cohorte ambispectivo. Se incluyó a pacientes que cumplen con los criterios del National Institute of Neurological Disorders and Stroke para el síndrome de Guillain-Barré (SGB). Se clasificó a los pacientes según los niveles de certeza del Brighton Collaboration Group para el SGB. Resultados. El 68% de los pacientes eran hombres. De los 248 pacientes incluidos, el 58,4% tenía antecedentes de infección previa. La media desde el inicio de los síntomas hasta el ingreso fue de 5 (1-30) días, y la puntuación media de la suma del Medical Research Council, de 30,3 ± 15,5. El nivel 1 de certeza según los criterios del Brighton Collaboration Group se cumplió en el 54,6% de los pacientes; el nivel 2, en el 45%; y el nivel 4, en el 0,6%. Los pacientes que alcanzaron el nivel 2 de certeza se debieron principalmente a hallazgos normales en el líquido cefalorraquídeo o a hallazgos en estudios de neuroconducción que no cumplen los criterios de ninguna variante de SGB. Conclusión. El SGB es una neuropatía autoinmune frecuente que se ha asociado con infecciones previas y con campañas de vacunación. Para la campaña de vacunación contra el SARS-CoV-2 en México es necesaria la validación de los criterios de Brighton. Aunque la epidemiología del SGB en México ha ido cambiando a lo largo de los últimos años, este estudio proporciona datos similares en comparación con otros países.

Frequency of neurological manifestations in patients with COVID 19 in acute stage and convalescence

Objective: To study the neurologic manifestations in the acute phase and convalescence of COVID-19. Background: There were the firsts reports of unexplained pneumonia from Wuhan, China, caused by SARS-CoV-2 and The World Health Organization named the disease COVID-19. Neurological manifestation increased reports, including the central nervous system and peripheral nervous system manifestations. Design/Methods: We performed a descriptive, prospective, longitudinal study at Nationale Institute of Nutrition and Medical Sciences, a COVID center in Mexico. We followed-up COVID 19 (positive PCR and hospitalization, from 23rd March until 30th June 2020). We recollected data and interviewed them in the first month after egress. Results: We included 1072, median age was 53.2 years, 65% males, risk factors were obesity/overweight 83.8%, hypertension 30.3%, diabetes 27.9%. 163 developed neurological events, 12.6% delirium, miopaty 4.1%, awakening disturbances 3.4%, seizures 0.8%, stroke 0.8% and encephalities 0.2%. 23.3% ingresed UCI, 71.8% with neurological events (p<0.001), delirium was 82.8%. In the follow up, we reach out 432 (53.4%), the most common symptoms were depressive symptoms 51.2%, limb weakness 46.8%, inadequate sleep quality 63.5%, sensory involvement (parestesias 39.6%), lack of concentration 36.2%, gait abnormality 31.1%, dizziness 31.1%, taste impairment 30.8%, cephalea 27.2%, smell impairment 26.5%, tremmor 32.8%, visual impairment 17.5% and seizure 0.7%. Weakness in daily activity 84.7%, in the UCI group (97.8%) (p <0.005). The patients in UCI had more prevalence of inadequate sleep quality, gait abnormality, dysphagia, dizziness, limb weakness, sensory involvement (paresthesias), taste impairment, with p<0.005. The disability by discharge was 24%;in the subgroup with neurological events, disability was more frequent (p<0.05). Conclusions: Neurological manifestations in SARS-CoV-2 as initial symptom, at hospitalization and after one month, represent one of this disease's essential part. Were prevalent more in the UCI patients and with severe COVID 19. This association between COVID severity and neurological manifestations is also present in the follow up.