Clinical and Neurophysiological Pattern of Guillain-Barré Syndrome in Kuwait

Objective: To study the clinical and neurophysiological pattern of Guillain-Barré syndrome (GBS) in Kuwait. Materials and Methods: The clinical records of consecutive GBS patients admitted to Ibn Sina Hospital, Kuwait, during a 7-year period between 1997 and 2003 were analyzed. Results: Of the 41 cases, 77% were male. The majority of the cases presented during the winter months and a preceding infection was reported in two thirds of them. Proximal lower limb (LL) weakness was the predominant clinical presentation. Nerve conduction studies (NCS) demonstrated a demyelinating pattern in 70%, an axonal pattern in 15%, mixed type in 5% and no abnormality in the remaining 5%. The majority of the patients (73%) improved with one course of intravenous immunoglobulin (IV IG). Mean recovery time (MRT) was 4.4 weeks. Delayed recovery (MRT ≥6 weeks) was noted in patients with predominant distal weakness in the LL (MRT 7.8 weeks; p = 0.001), proximal weakness in the upper limb (UL) (MRT 6 weeks; p = 0.005), autonomic disturbance (MRT 6.5 weeks; p = 0.05), and axonal type GBS (MRT 6 weeks; p = 0.001). Conclusion: The presence of predominant distal weakness in LL, proximal weakness in UL, autonomic disturbance and axonal pattern in NCS predict a poor outcome. Hence we recommend early immunomodulatory therapy in patients presenting with these features.