A total of 50 patients were studied. All patients were hospitalized and the average duration of hospital stay was 17.57 days. Age and Sex distribution: 35 patients (70%) were males and 15(30%) were females. The age of patients ranged from 18 to 70 years (Mean age 35.72 years) with the maximum number (48%) of patients in between 40 to 50 yrs. age group & in between 30 to 40 (40%) yrs.Figure 1 . Most number of cases were seen in the months of April to June. Antecedent illness: Twenty four (48%) patients had some antecedent event prior to the development of GBS Figure 2 . The most common antecedent illness was upper respiratory tract infection and diarrhea. At onset, sensory symptoms (pain and paresthesia) were noted in 8 cases (16%), and limb weakness was seen in 39 cases (76.98%). On the day of admission, 17 cases were in stage IV of illness, 32 patients in stage III, and 1 patients in stage V. Clinical features at the peak deficit were analyzed. All the 39 cases had limb weakness, Other features like bulbar palsy were present in 3 cases (6%). Autonomic disturbance was noted in 14 cases (28%). We also observed constipation and sinus bradycardia. Apart from these, bladder symptoms were noted in 3 cases (6%), transient hypotension in 5 (10%).Table 2]. In the electrophysiological studies, 20(40%) cases showed the presence of acute inflammatory demyelinating polyneuropathy (AIDP), Axonal involvement in 8 (16%) cases and mixed in 22 (44%) patients Figure 3,Figure 4 . In the cerebrospinal fluid (CSF) study, 41 cases (38.85%) showed albumin-cytological dissociation. one case showed low CSF protein and polyneuropathy; the case was later confirmed by nerve conduction study. Researchers noted varied results on the benefit of IVIg in shortening the course of GBS, though IVIg is easily administered and well tolerated and are currently the first-line immunotherapy in GBS^. 32 (64%) cases received IVIG and improvement is seen in symptom. Out of 50 patients, 32 (64%) received Intravenous Immunoglobulin (IVIG). 10 (2.7%) received I/V Predinisolone and 8(16%) did not receive any treatment either due to minimal weakness or in recovery phase.. Outcome was assessed at discharge, and at 1, 3, 6, and 12 months. 32 64%)cases were able to walk with or without support at 3 months, and complete recovery at 6 months 34(80%), 1 case (2%) was bed bound.

Figure 1

Fifty patients were included in this prospective study. The maximum number of patients was in between 40 to 50 years age group (28%). Kaplan et al13 reviewed 2575 cases and found the peak incidence to be between 50 and 74 years of age with lesser peak between 15 and 35 years. Similarly Peter C. Dowling14 also reported two peaks. There is a male preponderance in our study which is in conformity with the report by Robert M. et al.15 However, Peter C. Dowling’s14 study of 176 patients Showed an equal incidence in males and females. No seasonal variation in incidence of GBS could be inferred from this study in conformity with the majority of studies in literature15 . However a few studies have noted a seasonal clustering of cases. Kaur et al16 reported an increased incidence in summer and autumn. Peter C. Dowling14 also noted an increase in summer. Twenty four (48%) of our patients had a definite antecedent event prior to onset of illness. Winer et al13 reported that over half of GBS patients experience symptoms of viral respiratory or gastrointestinal infections. Ropper et al also reported a high incidence of 73%. In contrast a study by Kaur et al16 showed a lower incidence of 32%. Zhahirul Islam et al showed 69% had antecedent illness of which 37% of cases were preceded by diarrhoea17 The interval between prodromal illness and onset of GBS is most frequently from 1-3 weeks. Occasionally it is as long as 6 weeks. Kaur et a16 reported a mean interval of 9.2 days. In our study there is a mean interval of 8.06 (± 4.21) days between the prodromal and the onset of GBS. The most common antecedent illness was upper respiratory tract infection (18%) while diarrheal illness and lower respiratory tract infection was seen in five patients (10%). Ascending paralysis was noted in 70% (35 patients) and descending paralysis in 4% (2 patients), while 26 %( 13 patients) had simultaneous involvement of all four limbs. According to description by Winer et al13 that muscle weakness usually starts in legs and ascends to arms in most cases. A meta-analysis of large series by Allan H. Ropper18 showed ascending paralysis in 60%, descending paralysis in 20% and involvement of all four limbs simultaneously in 20% cases.

All patients had involvement of the legs and involvement of limbs was symmetric in all cases. None of the patients had involvement of hands alone, which is in conformity to the observation of Winer et al13 who said that the arms are not affected in isolation. One patient also had ataxia and involvement of 3rd, 4th and 6th cranial nerves. They were diagnosed to have Miller Fisher Variant of GBS. Overall, about 50% of patients with GBS reach maximal weakness by 1 week, 70% by 2 weeks, and 80% by 3 weeks in the course of illness. 56% of our patients had cranial nerve dysfunction.20% of patients had involvement of multiple cranial nerves. This is in conformity with the 50% incidence reported by Winer et al13 and 60% in Allan H. Ropper’s meta-analysis. Kaur et al16 reported an incidence of 41% in her study from North India. Facial Nerve was the most commonly involved 22 patients in our series in concordance with most series. IX and X cranial nerves were involved in only 9 patients in contrast to the reported incidence of 50% in Allan H. Ropper’s meta-analysis.3,4,6 cranial nerves involved in 2 patients. In this study autonomic dysfunction occurred in 28% of patients. Cardiac arrhythmia occurred in 6% of cases, postural hypotension in 10% of cases, Fluctuating Blood pressure was noted in 8% of patients. Transient sphincteric dysfunction in the form of urinary retention and hesitancy was seen in three (6%) patients. Allan H.Ropper’s meta analysis reported 15% incidence of transient bladder disturbances in GBS patients NK Singh et al12 observed sphincter disturbance in 20% of patients.

CSF protein was raised above 50mg% in 41 (82%) patients. Winer et al 13,19 reported raised CSF protein in 80% patients while 90% was reported in Allan H.Ropper’s18 meta-analysis. The lower number of patients with raised CSF protein in this study was probably because all CSF studies were done between 1 and 2 weeks from onset and not repeated thereafter. It is possible that there may have been a rise in CSF protein later in the course of illness, which was not recorded. Furthermore, it has been noted in some studies that CSF protein may not rise throughout the course of illness in some patients with GBS. upta RC1719 reports such patients did not show rise in CSF protein even at 6 weeks. CSF pleocytosis was seen in three patients. Electrophysiological studies were conducted in all patients and 20 of them showed demyelinating pattern, 8 of them showed axonal pattern, 22 patients mixed pattern. Patients having mixed and axonal pattern showed poor prognosis compared to patients having demyelinate pattern.

Males were predominantly affected. Motor weakness was the most common presenting illness. Female preponderance was observed in demyelinating form and male preponderance in axonal form of GBS. AIDP patients were older, while axonal form were younger. Seasonal occurrence predominantly in rainy season was noted. Axonal (AMAN+ AMSAN) form dominated than demyelinating form (AIDP). GBS occurs in all age groups with a greater incidence in the older age group above 40 years. However age did not have any correlation with prognosis. GBS affects both sexes; however males were affected more than females in the ratio of 3.6:1.4 in this study. 48% of patients reported a definite antecedent event prior to onset of GBS. Onset of GBS is heralded by both motor and sensory symptoms Ascending type of paralysis was most commonly seen in our study. Peak flow test, peripheral saturation, single breath count, and bulbar weakness may be a predictor of respiratory failure. There was a significant association of Low MRC sum score with respiratory failure. Early diagnosis of respiratory failure and prompt intervention improves patient outcome. Further large sample studies are required to assess respiratory failure and subdivision of Hughes grade 5.