Comparison of Cerebrospinal Fluid Protein Level with Clinical Severity and Electrophysiological Category in Patients with Guillain-Barre´ Syndrome

Abstract

Background: Guillain-Barre’ syndrome (GBS) is an acute onset polyneuropathy withvariable presentation and severity. It is the most common cause of acute flaccid paralysis worldwide. The cerebrospinal fluid (CSF) analysis and electrophysiological study plays a pivotal role in diagnosis of GBS.

Objective: This study aimed at finding a relation between CSF protein level with clinical severity and electrophysiological category of GBS patients.

Methods: Sixty-three patients of GBS were diagnosed and enrolled as per Brighton collaboration criteria. Besides analyzing CSF and electrophysiological study various epidemiological and clinical parameters were also studied. Patients were subgrouped into AIDP, axonal GBS including in-excitable forms incorporating both Acute Motor Axonal Neuropathy (AMAN) and Acute Motor Sensory Axonal Neuropathy (AMSAN), equivocal and normal categories by modified electrodiagnostic criteria of Rajabally. Clinical severity was assessed by Hughes functional grading scale and were classified into ambulatory group (Grade 1-3) and non-ambulatory group (Grade 4-6).

Results: Axonal variety was found the most common subtype 36 (57.1%) followed by AIDP 24 (38.1%) elicited by electrophysiological criteria. Mean CSF protein was 102.10±43.06 mg/dl. History of preceding illness was present in 65.1% subjects. Cranial nerve involvement was found in 36.5% patients and autonomic dysfunction in 23.8% patients. A disability score of 4 was found in 36.5% patients, followed by 3 in 34.9% and 2 in 27% and 1 in 1.6% patients. Ambulatory group represents 63.5% patients and 36.5% were in non-ambulatory group. Mean CSF protein found to be significantly higher in non-ambulatory group compared to ambulatory group (p<0.001). AIDP showed higher CSF protein than axonal subtype (p =0.014).

Conclusion: This study demonstrates that higher level of CSF protein is associated with higher grade of clinical severity and also with demyelinating subtype.