Abstract Details

Title Dysautonomia in Guillain-Barré Syndrome: Prevalence, Clinical Spectrum, and Outcomes

Topic Neuro Trauma and Critical Care

Presentation(s) P9 - Poster Session 9 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-004

Background GBS, when severe, involves the autonomic nervous system. Dysautonomia in GBS has been described in up to two-thirds of patients in older series, but it is unclear what its frequency is in current practice.

Objective To assess the contemporary prevalence of dysautonomia in patients with Guillain-Barré syndrome (GBS), the spectrum and relative frequency of different manifestations of autonomic dysfunction, and how it may impact functional outcomes.

Design/Methods A retrospective review of patients admitted to the Mayo Clinic in Rochester, MN between January 1, 2000, and December 31, 2017, with GBS and dysautonomia was performed. Demographics, comorbidities, parameters of dysautonomia, clinical course, GBS disability score, and Erasmus GBS Outcome Score (EGOS) at discharge were recorded.

Results One hundred eighty seven patients were included with 71 (38%) noted to have at least one manifestation of dysautonomia. Sex and age were not associated with dysautonomia. There were 134 (72%) patients with a demyelinating form of GBS and 48 (36%) patients with demyelination had dysautonomia. Ileus (42%), hypertension (39%), hypotension (37%), fever (29%), tachycardia or bradycardia (27%), and urinary retention (24%) were the most common features. Quadriparesis (P<0.001, OR 2.99, CI 1.57-5.69), bulbar weakness (P<0.001, OR 2.86, CI 1.54-5.30), neck flexor weakness (P<0.001, OR 4.51, CI 2.25-9.05), and mechanical ventilation (P<0.001, OR 6.93, CI 3.39-14.15) were associated with autonomic dysfunction. Patients with dysautonomia more commonly had cardiogenic complications (P=0.01, OR 10.62, CI 1.25-90.11), SIADH (P=0.004, OR 3.34, CI 1.43-7.78), PRES (P=0.03, OR 8.71, CI 0.99-76.17), higher GBS disability score (P<0.001), and EGOS (P<0.001). Mortality was 6% in patients with dysautonomia versus 2% in the entire cohort (P=0.02).

Conclusions Dysautonomia in GBS is a manifestation of more severe involvement of the peripheral nervous system. Accordingly, mortality and functional outcomes are worse. There is a need to investigate if more aggressive treatment is warranted in this category of GBS.

Authors/Disclosures
Tia Chakraborty, MD (Corewell Health) PRESENTER	Dr. Chakraborty has nothing to disclose.
Christopher L. Kramer, MD (Mayo Clinic)	Dr. Kramer has nothing to disclose.
Eelco F. Wijdicks, MD, FAAN (Mayo Clinic W8)	Dr. Wijdicks has received publishing royalties from a publication relating to health care.
Alejandro A. Rabinstein, MD, FAAN (Mayo Clinic)	Dr. Rabinstein has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shionogi . Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Brainomix. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical care/NCS-Springer. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters/UptoDate. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO/DynaMed. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Rabinstein has received research support from Chiesi. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care.