Guillain Barre Syndrome in the Elderly: Does Age Affect the Course?

Research Article

Gerontol Geriatr Res. 2023; 9(2): 1088.

Guillain Barré Syndrome in the Elderly: Does Age Affect the Course?

Kirchner RJ¹*; Alessandro L¹; Castiglione JI¹; Varela F¹; Barroso F¹

¹Department of Neurology, Neurological Research Institute Dr. Raúl Carrea, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Argentina

*Corresponding author: Kirchner RJ Department of Neurology, Neurological Research Institute, Montañeses 2325, Buenos Aires, C1428, Argentina. Email: rjkirchner@fleni.org.ar

Received: March 27, 2023 Accepted: May 06, 2023 Published: May 13, 2023

Abstract

Objectives: Describe the characteristics of Guillain Barré Syndrome in patients older than 60 years (Latin American population).

Methods: Retrospective analysis of 141 patients with diagnosis of Guillain Barré Syndrome. 43 in the elderly group (>60 years) and 98 patients in the young group (18–59 years). Clinical characteristics, electrodiagnosis, cerebrospinal fluid, treatment and prognosis (12 months of follow-up) were compared between groups.

Results: A longer delay from the prodrome to the disease (median in days 14 vs 7; p=0.04). greater involvement in deep sensitivity (72.5% vs 29.6%; p=0.001) and ataxia (30.2% vs 13.2%; p=0.01) in the elderly.

In the follow-up, the prognosis was similar using the Hughes scale (12 months: ederly group 0.22 vs young group 0.29; p=0.6).

Conclusions: A longer delay from the prodromal event to the onset of Guillain Barré Syndrome in the elderly could be interpreted as a more insidious presentation in the context of immunosenescence.

A greater compromise of deep sensitivity and ataxia must be taken into consideration for an adequate approach to rehabilitation.

With our results we cannot conclude that age is an independent risk factor for worse prognosis.

Keywords: Guillain barré syndrome; Elderly; Immunosenescence

Abbreviations: GBS: Guillain Barré Syndrome; MRC: Medical Research Council Sum Score Scale; CSF: Lumbar Cerebrospinal Fluid; EMG: Electromyogram; ICU: Intensive Care Unit

Introduction and objectives

Guillain Barré syndrome (GBS) is an acute-onset immune-mediated polyradiculoneuropathy. Worldwide, it is the most common cause of acute neuromuscular weakness in all age groups (from 4 months to 95 years), with an overall incidence of 0.5-2 per 100,000 people [1]. Although some studies report an increase in incidence with age [2], other authors describe a bimodal distribution with a peak in the fourth and sixth decade of life [3,4] with a decrease after 80 years of age [5-7].

Establishing an individual prognosis is difficult due to the variability of the disease, which depends on multiple factors, for example: electrophysiological variants [8] timing of treatment initiation [9] and others inherent to the patient such as age. In relation to this last point, studies have been carried out to assess specific age groups, mainly in the pediatric population [10], although analyzes aimed at GBS in the elderly are scarce [11-13]. In these studies, some characteristics of this age range were described, such as a higher incidence of axonal variants and a worse prognosis in terms of disability and mortality.

Since the World Health Organization defines the elderly as any person over 60 years of age, the objective of this study is to describe the clinical, electrophysiological and prognostic characteristics of GBS in Latin American population.

Materials and Methods

A retrospective analysis of medical records of patients older than 18 years with diagnosis of GBS, treated at a referral center (Buenos Aires, Argentina), in the period from June-2006 to June-2021.

Patients were evaluated by neurologists from our neuromuscular disorders clinic or hospital neurologist, and the diagnosis of GBS was established according to the criteria developed at the National Institute of Neurological Disorders and Stroke (NINDS) [14].

Demographic characteristics such as age, sex, and diabetes (comorbidity for neuropathy) were evaluated.

Within the clinical characteristics, the presence of prodromes (infectious conditions or vaccinations), the delay from the prodrome to the onset of the symptoms, degree of motor deficit at the nadir using the Medical Research Council (MRC) sum score scale [15], loss of tendon reflexes, cranial nerve involvement, alteration of the sensory system (neuropathic pain, paresthesia and hypoesthesia for protopathic touch, bathyesthesia and palesthesia), ataxia and dysautonomia (alterations in heart rate, blood pressure, bladder and gastrointestinal) were assessed.

Patients were evaluated by analysis of lumbar Cerebrospinal Fluid (CSF) and Electromyogram (EMG) with conduction velocities of at least 3 motor nerves and 3 sensory nerves [16]. To categorize these results and establish the electrophysiological subtype, Hadden et. al diagnostic criteria [17] were used.

The treatment performed in the different groups was analyzed: gamma globulin, plasmapheresis, or wait and see; Also, if the patients spent part of the hospitalization in the Intensive Care Unit (ICU) for the reason they required it: ventilatory failure or dysautonomia with hemodynamic instability.

To assess the prognosis, the condition was classified according to the Hughes disability scale [18] at the time of hospitalization as: mild (score 0 to 2) or severe (score 3 to 5). After hospital discharge, a follow-up of at least 1 year was carried out, evaluating the patients with the same scale at 6 and 12 months. Futhermore, the total days of hospitalization, days of hospitalization in the ICU, use of ventilatory assistance if required, and mortality were detailed.

The data of the variables corresponding to the group of patients older than 60 years (elderly group) were compared with the group of patients aged 18-59 years (young group). Differences of the variables between both groups were compared using student t test, Fisher test, and Pearson chi-squared test, accordingly. Software Rstudio was used to perform statistical analysis.

Results

Demographic and Clinical Variable Results [Table N°1]