Alam Ibrahim Siddiqui, Ghulam Rasool Bouk, Lal Chand, Sarfraz Ahmed Mahesar, Ghulam Mustafa Tunio.
Variants and variations among Gullian Barre syndrome presenting as acute flaccid paralysis.
Pak J Neurological Sci Jan ;9(2):12-5.

Objectives: Acute flaccid paralysis (AFP) is a clinical syndrome characterized by rapid onset of weakness that frequently includes respiratory and bulbar weakness. An accurate and early diagnosis of the cause has important bearing on the management and prognosis. Guillian Barre Syndrome (GBS) is a post infectious polyradiculoneuropathy involving mainly motor but sometimes sensory and autonomic nerves. Methods: Retrospective and hospital based study was carried out at Department of Neurology CMC Hospital Larkana to find out the clinical features of GBS including existing treatment modalities and its outcome, prognosis of the disease in relation to its severity. Files of the patients aged (8-60) years from Jan-2013 to Dec 2013 fulfilling AFP criteria were included. Diagnostic features included weakness or paresis of limb or flaccid paralysis with or without sensory symptoms or autonomic symptom, cranio-bulbar symptoms, together with laboratory features like albumino-cytological dissociation ,nerve conduction velocity (NCV) , ECG ,Serum electrolytes and MRI. Results: 55 patients were included in the study during 12 months of study period. Among them 29(53%) were diagnosed as GBS, 21(38%) patients were associated with hypokalemic periodic paralysis and 5(9%) patients as idiopathic neuropathy. All of them had undergone NCV test and classified further as AIDP (Acute inflammatory demyelinating polyneuropathy)-18 patients ,AMAN (Acute motor axonal neuropathy) – 8 patients and AMASAN (Acute motor and sensory axonal neuropathy) -3 patients. Majority patients presented with symmetrically ascending paralysis with gradual onset involving all limbs. Males were more affected in our study with male female ratio as 1.62:1 and 23 patients were seen during winter and spring season. There was slightly higher age range during 2nd and 3rd decade and second peak in 5th decade. 10% patients had relapse within 5 year. Associated diseases were URTI, pneumonia, sore throat, diarrhea in majority. Facial Nerve palsy was commonest cranial nerve involvement. Majority improved with supportive treatment alone, 11% patient required ventilator support and 22% referred for plasmapheresis or IVIG. At 3 months follow-up almost half patients fully recovered and improved upon further follow up. Conclusion: Timely diagnosis and prompt treatment is key to manage and support these treatable diseases .Proper education, physiotherapy and psychological support is required.

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