A rating scale for the severity of Guillain‐Barré syndrome

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Excerpt

Guillain‐Barré syndrome (GBS) is characterized by acute rapidly progressive symmetric weakness of distal limbs with or without sensory deficits, involvement of respiratory muscles, cranial nerve‐innervated muscles, or autonomic function.1 In the acute stage of GBS, symptoms usually peak within 4 weeks.2 Although many patients are successfully treated with plasma exchange or intravenous immunoglobulin, rates of death or severe disability are between 9% and 17%.3
It is well‐established that respiratory insufficiency, which occurs in 20%‐30% of patients with GBS, is a mortality risk factor.4 In the acute stage of the disease, mortality rates in patients requiring mechanical ventilation (MV) are as high as 20%.6 Many factors that are predictive of MV in GBS have been reported in previous studies; these include disabilities at the nadir, facial nerve palsy, bulbar weakness, neck weakness, and autonomic dysfunction.7 Autonomic dysfunction is detected in two‐third of GBS patients.18 In a prospective survey, the risk of mortality was reported to be 3.14 times greater when autonomic dysfunction was present in mechanically ventilated patients with GBS.19 Therefore, it is essential to assess the respiratory state and autonomic function of patients with GBS.
The GBS disability score and MRC sum score, which precisely define the levels of motor function, are widely used scoring system to evaluate the severity and functional status of patients with GBS.20 However, in the acute phase of GBS, clinicians should pay close attention to the full spectrum of symptoms that indicate urgent threats to a patient's life, and avoid an overly narrow reliance on motor function assessments. Given these considerations, the study reported here aimed to develop a scale that can more comprehensively evaluate the severity of GBS.
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