TY - JOUR
T1 - Guillain-Barré Syndrome in India
T2 - Population-based validation of the Brighton criteria
AU - Mateen, Farrah J.
AU - Cornblath, David R.
AU - Jafari, Hamid
AU - Shinohara, Russell T.
AU - Khandit, Devendra
AU - Ahuja, Bina
AU - Bahl, Sunil
AU - Sutter, Roland W.
N1 - Funding Information:
Conflict of interest statement: All authors declare no conflicts of interest. Funding: Dr. Mateen is supported by the 2010 Practice Research Fellowship Grant from the American Academy of Neurology . Dr. Cornblath has served as Consultant for Merck, Pfizer, Mitshubishi Pharma, Sanofi-Aventis, Baxter, Bristol-Myers Squibb, Eisai, Octapharma, Sun Pharma, Acorda, DP Clinical, Exelixis, Geron, Johnson & Johnson, Genyzme, Cebix, Abbott, CSL Behring, Ardea Biosciences and Bionevia; as DSMB member for Pfizer, Schwarz Biosciences, Avigen, Johnson & Johnson, Biogen and GlaxoSmithKline; and has Technology Licensing to and Royalties from Abbott, Johnson & Johnson, Sanofi-Aventis. Mr. Russell Shinohara is supported by the Epidemiology and Biostatistics of Aging Training Grant T32 AG000247 . Drs. Jafari, Khandit, Ahuja, Bahl, and Sutter have no financial disclosures.
PY - 2011/12/6
Y1 - 2011/12/6
N2 - Objective: Case definitions of GBS were recently developed in response to the 2009 H1N1 vaccination programme but have undergone limited field testing. We validate the sensitivity of the Brighton Working Group case definitions for Guillain-Barré Syndrome (GBS) using a population-based cohort in India. Methods: The National Polio Surveillance Unit of India actively collects all cases of acute flaccid paralysis (AFP) in children <15 years old, including cases of GBS. Cases of GBS with available cerebrospinal fluid (CSF) and nerve conduction studies (NCS) results, neurological examination, clinical history, and exclusion of related diagnoses were selected (2002-2003). Relevant data were abstracted and entered into a central database. Sensitivity of the Brighton GBS criteria for level 3 of diagnostic certainty which requires no clinical laboratory testing, level 2 which employs CSF or NCS, and level 1 which employs both, were calculated. Results: 79 cases of GBS (mean age 6.5 years, range 4.0-14.5; 39% female) met the case definition. GBS cases were ascending (79%), symmetrical (85%), and bilateral (100%); involving lower extremity hypotonia (86%) and weakness (100%), upper extremity hypotonia (62%) and weakness (80%), areflexia/hyporeflexia (88%), respiratory muscles (22%), bulbar muscles (22%), and cranial nerves (13%). Four limbs were involved in 80% of cases. Mean time to maximal weakness was 5.2 days (range 0.5-30 days) with nadir GBS disability scores of 3 (7%), 4 (67%), 5 (15%), 6 (10%), or unclear (1%). CSF (mean time to lumbar puncture 29 days) was normal in 29% with cytoalbuminologic dissociation in 65% (mean protein 105. mg/dL, range 10-1000; mean cell count 11/μL, range 0-220, n= 4 with >50. cells/μL). Significant improvement occurred in 73% whereas death (9%) occurred 6-29 days after sensorimotor symptom onset. The majority of cases (86%) fulfilled Brighton level 3, level 2 (84%), and level 1 (62%) of diagnostic certainty. Conclusion: The diagnosis of GBS can be made using Brighton Working Group criteria in India with moderate to high sensitivity. Brighton Working Group case definitions are a plausible standard for capturing a majority of cases of GBS in field operations in low income settings during AFP surveillance.
AB - Objective: Case definitions of GBS were recently developed in response to the 2009 H1N1 vaccination programme but have undergone limited field testing. We validate the sensitivity of the Brighton Working Group case definitions for Guillain-Barré Syndrome (GBS) using a population-based cohort in India. Methods: The National Polio Surveillance Unit of India actively collects all cases of acute flaccid paralysis (AFP) in children <15 years old, including cases of GBS. Cases of GBS with available cerebrospinal fluid (CSF) and nerve conduction studies (NCS) results, neurological examination, clinical history, and exclusion of related diagnoses were selected (2002-2003). Relevant data were abstracted and entered into a central database. Sensitivity of the Brighton GBS criteria for level 3 of diagnostic certainty which requires no clinical laboratory testing, level 2 which employs CSF or NCS, and level 1 which employs both, were calculated. Results: 79 cases of GBS (mean age 6.5 years, range 4.0-14.5; 39% female) met the case definition. GBS cases were ascending (79%), symmetrical (85%), and bilateral (100%); involving lower extremity hypotonia (86%) and weakness (100%), upper extremity hypotonia (62%) and weakness (80%), areflexia/hyporeflexia (88%), respiratory muscles (22%), bulbar muscles (22%), and cranial nerves (13%). Four limbs were involved in 80% of cases. Mean time to maximal weakness was 5.2 days (range 0.5-30 days) with nadir GBS disability scores of 3 (7%), 4 (67%), 5 (15%), 6 (10%), or unclear (1%). CSF (mean time to lumbar puncture 29 days) was normal in 29% with cytoalbuminologic dissociation in 65% (mean protein 105. mg/dL, range 10-1000; mean cell count 11/μL, range 0-220, n= 4 with >50. cells/μL). Significant improvement occurred in 73% whereas death (9%) occurred 6-29 days after sensorimotor symptom onset. The majority of cases (86%) fulfilled Brighton level 3, level 2 (84%), and level 1 (62%) of diagnostic certainty. Conclusion: The diagnosis of GBS can be made using Brighton Working Group criteria in India with moderate to high sensitivity. Brighton Working Group case definitions are a plausible standard for capturing a majority of cases of GBS in field operations in low income settings during AFP surveillance.
KW - Epidemiology
KW - Guillain-Barré Syndrome
KW - India
KW - Paralysis
KW - Surveillance
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U2 - 10.1016/j.vaccine.2011.09.123
DO - 10.1016/j.vaccine.2011.09.123
M3 - Article
C2 - 22001121
AN - SCOPUS:82555170272
VL - 29
SP - 9697
EP - 9701
JO - Vaccine
JF - Vaccine
SN - 0264-410X
IS - 52
ER -