Autonomic Dysfunction in Patients with Guillain-Barré Syndrome in Sub-Acute Phase LC16-LC20
Dr. Nidhi Rawat,
Assistant Professor, Department of Physical Medicine and Rehabilitation, St. John’s Medical College Hospital, Bengaluru-560034, Karnataka, India.
Introduction: Autonomic involvement is seen in two-thirds of Guillain-Barré Syndrome (GBS) patients.
Aim: To evaluate the pattern and extent of autonomic dysfunction in GBS patients in sub-acute phase and find its correlation with severity in GBS patients.
Materials and Methods: A prospective, cross-sectional study was conducted in 29 GBS patients in Department of Neurological Rehabilitation at a tertiary care institute. All consecutive patients diagnosed with GBS fulfilling the inclusion criteria were subjected to laboratory cardiac autonomic tests. To assess the fatigue Fatigue Severity Scale (FSS) was used, disability status was assessed by Hughes Disability Scale (HDS), and muscle weakness was assessed by Medical Research Council (MRC) sum scores. Statistical analysis was done by Stata 11. The significance of p-value was considered at 0.05.
Results: Twenty-nine patients were included with 17 (59%) men and mean age of 31 years. On Heart Rate Variability (HRV) test 26 (90%) patients had reduced power, 15 (52%) patients had sympathovagal balance and 14 (48%) had sympathovagal imbalance with sympathetic dominance. On conventional cardiac testing 16 (55%) patients had cardiac involvement. On tilt table 5 (17%) patients had Postural Orthostatic Tachycardia Syndrome (POTS) and 3 (10%) patients had orthostatic hypotension. Significant association was found on HRV and conventional cardiac autonomic tests with duration between disease onset and testing (p=0.04) and (p=0.01) respectively. Significant correlation of reduced power was found with presence of antecedent events (p=0.01) and duration between disease onset and testing (p=0.01). Sympatho vagal imbalance showed significant association with presence of respiratory distress and need for ventilator (p=0.04).
Conclusion: Laboratory cardiac autonomic tests are non-invasive and easily applicable to quantitatively evaluate autonomic dysfunction even in severely disabled GBS patients. Autonomic dysfunction is common in patients with pulmonary involvement. However, it has no relation with the severity of motor disability. This study suggests that autonomic dysfunction in GBS should be studied even during the sub-acute phase.