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STUDY TO KNOW THE ACUTE FLACCID PARALYSIS CLINICAL PRESENTATION ELECTROPHYSIOLOGIC SUB TYPES OF GBS AND ITS SEASONAL VARIATIONS

Dr. Fatima Dilshad, Dr Khadija Sarwar, Dr Sundas Zafar

Acute flaccid paralysis (AFP) is a clinical syndrome determined by a prompt onset of weakness, often involving bulbar and respiratory weakness. Early and accurate diagnosis of the cause has a significant impact on the prognosis and management. Guillian Barre syndrome (GBS) is post-infectious polyradiculoneuropathy, which mostly affects the motor, but sometimes affects autonomic and sensory nervous system. Objective: To determine the acute flaccid paralysis clinical presentations, electrophysiologic subtypes of GBS, their outcome and seasonal variations in our setup. Study Design: A Retrospective Study. Place And Duration: In the Department of Neurology, Combined Military Hospital (CMH), Lahore for one year duration from September 2017 to September 2018. Methods: Retrospective and hospital studies were performed in the department of Neurology to determine the clinical characteristics of GBS including current treatment methods and outcomes, and prognosis of disease severity. Diagnostic features include paresis, flaccid paralysis or weakness of limb with or without autonomic symptoms or sensory symptoms, albino-cytological dissociation, nerve conduction rate (NCV), laboratory properties such as ECG, serum electrolytes and MRI. Results: In this study; 55 patients were included for 1 year duration. Of these, 29 (53%) had GBS, hypokalemic periodic paralysis in 21 (38%) and idiopathic neuropathy in 5 (9%). NCV test was applied to all and categorized as 18 patients ha AIDP (acute inflammatory demyelinating polyneuropathy, 8 patients had AMAN (acute motor axonal neuropathy) and 3 patients had AMASAN (acute motor and sensory axonal neuropathy. Most of the patients presented symmetrically elevated paralysis, gradually progressing in all extremities. In our study, the rate of males was affected by more females: 1.63: 1 and in spring and winter season; 23 patients presented. During the 2nd and 3rd decade there was mild increase age range and in the 5th decade, the second peak was seen. Ten percent of the patients has recurrence in five years. URTI, pneumonia, sore throat, diarrhea in most of the related diseases. The most common cranial nerve involvement was the paralysis of the facial nerve. The majority improved only with supportive therapy, ventilator support was needed in 11% of patients and 22% indicated IVIG or plasmapheresis. Almost half of the patients completely recovered at 3 months of follow-up and improved at follow-up. Conclusion: Timely treatment and diagnosis is necessary to support and manage these treatable diseases. Adequate training, psychological support and physiotherapy are mandatory. Key words: Hypokalemic periodic paralysis, acute flaccid paralysis, GBS, AIDP, AMASAN, AMAN.

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