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ISSN: 2641-1911 DOI: 10.33552/ANN.2023.14.

000849

Archives in
Neurology & Neuroscience

Research Article Copyright © All rights are reserved by Delgado-Ochoa Martha Azucena

Clinical and Epidemiological Characteristics of


Guillain-Barré Syndrome and its Variants in Tijuana
General Hospital

Delgado-Ochoa Martha Azucena*, Bataller-Méndez Mauricio, Delgado-Hernández Carlos, García-


Noriega María Victoria and Taboada-Pérez Grecia Carolina
Department of Pediatric Neurology, Tijuana General Hospital, Mexico

*Corresponding author: Delgado-Ochoa Martha Azucena, Department of Pediat- Received Date: March 24, 2023
ric Neurology, Tijuana General Hospital, Mexico. Published Date: April 04, 2023

Abstract
Introduction: Guillain Barré Syndrome is an acute inflammatory polyradiculoneuropathy characterized by progressive, ascending, symmetric
muscle weakness. It is a heterogeneous disease that presents different clinical-epidemiological variants. The following study aims to determine the
frequency of these variants and their clinical and epidemiological characteristics with respect to that published in the national and international
literature.
Material and Methods: An observational, cross-sectional, descriptive and retrospective study was carried out in 25 patients from 1 year to 16
years of age who were diagnosed with Guillain-Barré Syndrome. The variables studied were different epidemiological and clinical characteristics
and the clinical-electrophysiological variants identified.
Results: 14 men (56%) and 11 women (44%), ratio 1.2:1. The most affected age group was schoolchildren (48%). Only 52% of the cases
presented in a classical manner (Acute Demyelinating Inflammatory Polyneuropathy ADIP 32%, Acute Motor Axonal Neuropathy AMAN 20%),
Miller-Fisher Syndrome MFS was identified in 20%, followed by Pharyngeal-Cervial-Brachial FCB in 16% of cases. 3 patients presented overlapping
variants.
Discussion: The clinical and epidemiological characteristics of pediatric Guillain-Barré Syndrome at the Tijuana General Hospital are similar
to the rest of the Mexican population; however, the distribution of clinical-electrophysiological variants is markedly different from the rest of the
world population.

Introduction
autoimmune response has been identified which involves cellular
Guillain-Barré Syndrome (GBS) is an acute inflammatory
and humoral mechanisms against an apparent molecular mimicry
polyradiculoneuropathy that is characterized for a progressive,
between some antigens and the components of myelinating and
symmetric, commonly ascending weakness of the limbs, which
glial cells, primarily gangliosides, which in turn evolves into
usually presents with tendinous hyporeflexia and may include
neurotoxicity and demyelination with the corresponding alteration
cranial nerve compromise [1,2]. Pathophysiologically, an
of neuromuscular transmission that presents with the characteristic

This work is licensed under Creative Commons Attribution 4.0 License ANN.MS.ID.000849. Page 1 of 8
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Archives in Neurology and Neuroscience Volume 14-Issue 5

signs and symptoms [1]. There is a recent history of infectious • Acute Demyelinating Inflammatory Polyneuropathy
diseases in up to a third of patients, being the gastrointestinal and (ADIP): It is considered the classical variant, and it is the most
upper respiratory tract the most frequent [3,4,5]. Different clinical- prevalent in western world [1,6,8]. It is mainly mediated by
electrophysiological variants of the disease are known. These share molecular mimicry after an infection. The microorganism´s
physiological mechanisms but have explicit differences that permit epitopes are presented to T cells by activated neurotropic
their differentiation and might condition its response to treatment macrophages in the peripheric nervous system. There exists
[1,6,7]. These variants have a different distribution across the globe. a cross-reaction that results in cytokine production and
This suggests that geopolitical a sociocultural difference might play free radicals release, affecting the blood neuro barrier and
an important role in the presentation of this disease. destroying the myelin sheat, whit its corresponding effect in
neural conduction speed, presenting as conduction blockade,
Guillain-Barré Syndrome Generalities diminished distal muscular compound action potential and
GBS was first described in 1916 by neurologists George Guillain augmented distal motor latency. It presents in 69 to 90% of
and Jean Alexander Barré in a couple of soldiers while in a French patients [1,2,3,10,12].
hospital. Later, their clinical description would be complemented
• Acute Motor Axonal Neuropathy (AMAN): Its main
with Andre Strohl´s description of the neurophysiological
feature is axonal degeneration with lymphocytic infiltration
characteristics and the cerebrospinal fluid (CSF) composition
and less degree of inflammation. There is also a molecular
of this patients. During the 50´s, a clinical classification was
mimicry component to this presentation, evidenced by the
proposed for the different presentations of the disease. This would
morphological similitude between Campylobacter jejuni
encompass the whole clinical spectrum and facilitate investigation
antigens and host´s gangliosides, primordially expressed in the
in the physiological components of the disease. These would in
motor axolemma surface. B-cell antibodies cross react with the
turn be complemented during the 70´s decade with the description
axonal gangliosides and perpetuate axonal degeneration by
of the Miller-Fisher Syndrome (MFS) and taking us to the current
macrophage and complement activation. Electrophysiological
description of the disease [2,3]. It is defined as an immune-
findings include distal muscular compound potential reduction
mediated acute inflammatory polyradiculopathy that manifests as
in absence of other demyelination markers. Clinically, it is
progressive muscular weakness, hyporeflexia, that tends to include
known for having a purely motor presentation, which tends
sensory symptoms and albuminocytologic dissociation in CSF, as
to have a faster progression with less frequent cranial nerve
well as multiple electrophysiological alterations.
involvement or autonomic disfunction. However, sensory-
Clinical Manifestations motor presentations aren’t uncommon. It has been reported in
up to 70% of cases [1,2,3,10,12].
The disease spectrum shares some characteristics, as are
symmetrical weakness of the limbs and/or cranial nerves, a Less frequent variants [2,10,12] include:
monophasic course of disease and a later plateau. It is usually > Acute Motor and Sensory Axonal Neuropathy (AMSAN): A
associated with recent infectious history, paresthesia before the similar variant to AMAN, however, this is accompanied by sensory
start of the weakness and albuminocytologic dissociation in CSF. symptoms and usually has a more severe and prolonged course.
Nevertheless, other characteristics exist that may differentiate the Axonal injury affects both motor and sensitive fibers. Studies report
variants for the disease [2]. Other symptoms that may appear in a prevalence of less than 22% of cases [5,12]
initial phases of the disease include behavioral changes, irritability,
paresthesia, limb or back pain and gait disturbance. Physical exam > Miller-Fisher Syndrome (MFS): It is defined by the
may reveal symmetric weakness with diminished or abolished triad of ophthalmoplegia, ataxia and hypo/areflexia. It usually
reflexes. Nadir tends to occur between 2 to 4 weeks, followed by presents with hypersomnolence and an absence of limb weakness.
a slow recovery process. Children usually have a shorter course Antiganglioside antibodies have been identified in most of the
than adults, with a faster recovery time and good prognosis. cases. Prevalence of this variant can reach up to 25% of cases
[2,8-12]. An important complication is autonomic disfunction. [1,2,9,10,12]
This may include arrythmias, orthostatic hypotension, systemic > Pharyngeal-Cervial-Brachial (PCB): Symptoms include
arterial hypertension, non-mechanic intestinal obstruction, vesical oropharyngeal, neck and symmetric or asymmetric arm weakness,
disfunction and diaphoresis [5,8]. with arm areflexia and no leg involvement. It may present with
bulbar disfunction, or as a superposition with other variants, as is
Electrophysiological Clinical Variants of Guillain-
MFS or Bickerstaff Encephalitis. Antiganglioside antibodies can be
Barré Syndrome
detected in this variant. Its frequency is reported below 5% of cases
GBS is a heterogenic disease. Differences in symptom [2,10,12].
appearance may present a diagnostic challenge for the clinician.
> Paraparetic: Paresis occurs only in inferior limbs. There
Two main subtypes have been identified, as well as other less usually is sensory involvement and anti-GM1 and anti-GD1b
frequent variants, according to its clinical manifestations and antibodies may be identified [10,12]
electrophysiological and laboratory findings:
> Bilateral Facial Palsy with Paresthesia (BFPP): It presents

Citation: Delgado-Ochoa Martha Azucena*, Bataller-Méndez Mauricio, Delgado-Hernández Carlos, García-Noriega María Victoria and Page 2 of 8
Taboada-Pérez Grecia Carolina. Clinical and Epidemiological Characteristics of Guillain-Barré Syndrome and its Variants in Tijuana General
Hospital. Arch Neurol & Neurosci. 14(5): 2023. ANN.MS.ID.000849. DOI: 10.33552/ANN.2023.13.000849
Archives in Neurology and Neuroscience Volume 14-Issue 5

as bilateral facial weakness accompanied by paresthesia and cascade or acceleration of endogenous immunoglobin breakdown.
diminished reflexes without limb weakness. It does not fulfill Adverse effects include erythema, headache, myalgia, hypotension,
classic GBS criteria, nonetheless, electrophysiological findings are fever, hepatic or kidney injury [3]. The disease has a good prognosis,
similar to those in ADIP [10,12] reaching complete recovery in most patients. However, it presents
with important disability during the acute and subacute phases of
> Pure Sensory: There is no motor involvement, and only
the disease, which in turn can give place to other complications and,
sensory symptoms can be identified. It has been associated with
in some cases, develop into chronic disfunction and neurological
anti-GD1b. Less than 1% of cases have reported this variant [10,12]
sequels. Early diagnosis and treatment enhance prognosis and
> Bickerstaff Brainstem Encephalitis (BBE): It has a similar decreases complications risks during hospital stay [1,3,6,7]. In
presentation to MFS, even sharing the same antiganglioside pediatric studies, mortality has been described between 3 and 5%
antibodies, however, BBE develops into a brainstem encephalopathy [3,5]. Although GBS during infancy tends to be of a better prognosis
with hypersomnolence, reduced conscience, hyperreflexia and, in than in adults, some rare cases may be resistant to standard
some cases, it may simulate brain death [2,10,12]. treatment. This may be due to secondary axonal damage after a
severe and prolonged autoimmune attack. It has been postulated
During The Covid-19 Pandemic that elevated blood levels of IGIV at 2 weeks of administration could
Some triggers that have been identified include, besides be associated with adequate recovery [6,7,9].
infection, vaccination, surgery, cancer and pregnancy [6]. Similarly,
Background in Mexico and the Rest of the World
there have been cases associated to COVID-19 infection, including
children. The most frequent variant in these cases has been ADIP Globally, incidence has been estimated between 0.16 – 3 per
with 75%, followed by AMAN with 11% and AMSAN in 9% [13]. This 100,000 people in every age group, being a little less common in
takes relevance in the fact that there has been a rise in incidence children, with an incidence of 0.34 and 1.34 per 100,000 people
after viral epidemics and recent vaccination campaigns, in which [2,5,10,16]. In the western world, ADIP has been recognized as the
GBS has been found as the most common severe complication in most common variant with up to 90% of cases [2,9], while in eastern
the recent SARS-CoV-2 vaccination in Baja California, or in the countries AMAN tends to be the most common variant [3,5,6,17].
rise in incidence after the Zika epidemic in 2014 [4,14]. During This may be due to a different exposure to certain infectious
the time period between April 2020 and March 2021, Tijuana pathogens, such as Campylobacter jejuni. In Mexico, according to
General Hospital suffered conversion into a Covid-19-only hospital, the Center for Epidemiological Vigilance, in a period of 24 years
including the Pediatric department. Because of this, no patients there were 400 to 600 annual cases reported in children, with an
with GBS were admitted during this time. This, in itself, presented average incidence of 1.5/100,000 habitants, of which 18.7% were
as an opportunity to compare the disease features before and after in the age group of 5 – 14 years old [8].
the exposition of the virus to the population. Besides, geopolitical
It has been published that, in Mexico, the most common
characteristics of a border city, and especially the most transited
history of infectious disease included diarrhea, while the most
international border in the world, causes a cultural shock in regards
common variant has been found to be AMAN, associated with a
to the rest of the country due to the adherent qualities of each
campylobacter jejuni infection in 25% of patients, also presenting
population group, as well as migrant floating population [14,15].
a seasonal distribution with a peak during summer. This may
Evolution and Treatment be due to the geographic characteristics of the region, as well as
the circulating pathogenic flora. Studies completed in pediatric
Treatment includes immunomodulation and support,
hospitals in the center of the country have found an average age of 6
sometimes with the need of invasive mechanical ventilation due
years, with a discreet prevalence in boys, and finding high disability
to respiratory muscle or protective airway reflexes compromise
scores at admission [8]. AMAN was identified in up to 57% of
[3,9]. In children, the main line of treatment is human intravenous
patients, followed by ADIP in about 40% and MSF in 3%. Other
immunoglobulin (IVIG), at a dose of 2g/kg divided in 5 days.
variants are considered rare in children, and weren’t described in
An IGIV dose of 0.4 g/kg over 5 days is preferred because of a
said studies. (4, 8, 16). Nonetheless, it is of notice a study conducted
diminished risk of Treatment Associated Fluctuations (TAF), which
in northwestern Mexico that reported a prevalence of MFS in 17%
means a worsening after the initial stabilization within 8 weeks
[8]. Up to 15% of pediatric patients will need invasive respiratory
of treatment, which is reported in 6 to 16% of patients [10,12].
support due to respiratory mechanical failure during the course of
Plasma exchange has also shown good effectivity; however, this
the disease [16].
is an invasive and riskier process not available in many hospitals.
Steroid treatment has not proved beneficial [3,5]. Some of the Materials and Methods
mechanisms of action that have been proposed for IGIV include: Fc
An observational, transversal, retrospective and descriptive
receptor block in macrophage, inhibiting myelin attack mediated
study was conducted in 25 patients age 1 year to 16 years who
by antibodies; autoantibody and cytokine regulation through
were diagnosed with GBS in the Pediatric department from Tijuana
anti-idiotypic and anti-cytokine ways; up-regulation of Fc-gamma
General Hospital (HGT) between August 2018 and December 2022,
IIB inhibitory receptor in B-cells or Down-regulation of B-cell
excluding those diagnosed between April 1 2020 and March 1 2021,
activation factor; interference with activation of the complement
corresponding to the Covid-19 pandemic hospital transformation

Citation: Delgado-Ochoa Martha Azucena*, Bataller-Méndez Mauricio, Delgado-Hernández Carlos, García-Noriega María Victoria and Page 3 of 8
Taboada-Pérez Grecia Carolina. Clinical and Epidemiological Characteristics of Guillain-Barré Syndrome and its Variants in Tijuana General
Hospital. Arch Neurol & Neurosci. 14(5): 2023. ANN.MS.ID.000849. DOI: 10.33552/ANN.2023.13.000849
Archives in Neurology and Neuroscience Volume 14-Issue 5

in which only SARS-CoV2-positive patients were accepted for (6 – 12 years) with 48%, followed by early childhood (2 – 5 years)
treatment. Studied variables included different epidemiological and adolescents (13 – 16 years) in 20% of cases. Less affected were
and clinical features, as well as identified variants. Relevant data toddlers, with only 12%.
was recovered from the clinical files of each patient using a tool
56% of patients received care in the time after hospital
previously designed for this investigation by the authors. Results
conversion. We failed to find a statistically significant difference for
were processed through Microsoft Excel software, analyzing
disease frequency before and after this event (p=0.4891).
variables with descriptive statistics and comparing results for
both temporal groups. Variable association was assessed with Chi Up to 52% of the patients had no identifiable history in the
Squared Test or Student´s T Test, as appropriate. weeks prior to diagnosis; while 36% presented upper respiratory
tract infections, only 8% presented gastrointestinal infections
Results and only two cases were reported with an infection in another
30 GBS patients were reported, of whom 25 met inclusion site, in both cases urinary, one of which was accompanied by a
criteria for this study. gastrointestinal infection.

> Epidemiological Findings The breakdown of the data can be seen in (Table 1)

Out of all patients, 14 were male (56%) and 11 female (44%) for > Clinical Findings
a 1.2:1 ratio. Most affected age group was that of middle childhood
Table 1: Epidemiological Findings.

Variable Pre-conversion period Post-conversion period Total


Age Group
Toddlers (n, %) 0 3 (21%) 3 (12%)
Early Childhood (n, %) 4 (36%) 1 (7%) 5 (20%)
Middle Childhood (n, %) 6 (54%) 6 (44%) 12 (48%)
Adolescents (n, %) 1 (10%) 4 (28%) 5 (20%)
Sex
Male (n, %) 6 (54%) 8 (57%) 14 (56%)
Female (n, %) 5 (46%) 6 (43%) 11 (44%)
Procedence
Baja California (n, %) 11 (100%) 13 (93%) 24 (96%)
Other parts of Mexico (n, %) 0 1 (7%) 1 (4%)
USA (n, %) 0 0 0
Other (n, %) 0 0 0
Relevant History
Upper Respiratory Tract Infection (n, %) 4 (36%) 5 (36%) 9 (36%)
Gastrointestinal Infection (n, %) 1 (10%) 2 (14%) 2 (8%)
Other Infection (n, %) 2 (18%) 0 1 (4%)
Vaccination (n, %) 0 0 0
Surgery (n, %) 0 0 0
Cancer (n, %) 0 0 0
None (n, %) 5 (46%) 7 (50%) 13 (52%)

In this regard, it was evidenced that 100% of the patients had Hughes scale of disability, at admission a median of 4 was recorded
progressive, symmetrical muscle weakness. 68% of the patients with 64% of the patients confined to a bed upon arrival. 24% of the
reported pain, while only 24% presented paresthesias. Pain reports patients required invasive mechanical ventilation to protect their
were increased by 25% after the hospital reconversion. The vast breathing. At discharge, a median of 3 was evidenced, with only
majority of patients (86%) presented decreased tendon reflexes, 20% of patients confined to a bed. Hospital stay was mostly two
with areflexia of the affected limbs standing out in 56% of cases. weeks or less, with a median of eight to fourteen days. 20% of the
Cranial nerve involvement was noted in 1 out of 3 patients. We patients had a stay of more than twenty-eight days, associated with
highlight the 100% increase in frequency after hospital conversion. mechanical ventilation and higher levels on the disability scale on
In the same way, an increase in the frequency of dysautonomia admission. No deaths were recorded during the study period. The
was evidenced, going from 19 to 50%, highlighting the presence rest of the data obtained is broken down in (Table 2).
of hypertension and ileus in 20% of the patients. Regarding the
> Clinical-electrophysiological variants

Citation: Delgado-Ochoa Martha Azucena*, Bataller-Méndez Mauricio, Delgado-Hernández Carlos, García-Noriega María Victoria and Page 4 of 8
Taboada-Pérez Grecia Carolina. Clinical and Epidemiological Characteristics of Guillain-Barré Syndrome and its Variants in Tijuana General
Hospital. Arch Neurol & Neurosci. 14(5): 2023. ANN.MS.ID.000849. DOI: 10.33552/ANN.2023.13.000849
Archives in Neurology and Neuroscience Volume 14-Issue 5

Table 2: Clinical Findings.

Variable Pre-conversion period Post.conversion period Total


Weakness Distribution
Symmetric 11 (100%) 14 (100%) 25 (100%)
Asymmetric 0 0 0
Pain
Yes 6 (54%) 11 (79%) 17 (68%)
No 5 (45%) 3 (21%) 8 (32%)
Paresthesia
Yes 2 (18%) 4 (29%) 6 (24%)
No 9 (81%) 10 (71%) 19 (76%)
Tendon Reflexes
Normal 2 (18%) 0 2 (8%)
Hyporeflexia 3 (27%) 4 (29%) 7 (28%)
Areflexia 5 (45%) 9 (64%) 14 (56%)
Hypereflexia 1 (9%) 1 (7%) 2 (8%)
Cranial Nerve Involvement
Yes 3 (27%) 6 (43%) 9 (36%)
No 8 (73%) 8 (57%) 16 (64%)
Disautonomia
Hipertension 0 5 (36%) 5 (20%)
Diaphoresis 0 0 1 (4%)
Arhytmias 0 1 (7%) 1 (4%)
Ileus (27%) 2 (14%) 5 (20%)
Orthostatic Hypotension 0 0 0
None 9 (81%) 7 (50%) 15 (60%)
Albummino-Citologyc Dissociation
Yes 4 (36%) 2 (14%) 6 (24%)
No 1 (9%) 6 (43%) 7 (28%
Not performed 6 (54%) 6 (43%) 12 (48%)
Hughes Disability Scale at Admission
1 0 0 0
2 2 (18%) 1 (7%) 3 (12%)
3 4 (36%) 2 (14%) 6 (24%
4 2 (18%) 8 (57%) 10 (40%)
5 3 (27%) 3 (21%) 6 (24%)
Hughes Disability Scale at Discharge
1 2 (18%) 0 2 (8%)
2 3 (27%) 5 (36%) 8 (32%)
3 6 (54%) 4 (29%) 10 (40%)
4 0 5 (36%) 5 (20%)
5 0 0 0
Treatment
IVIG 10 (91%) 12 (86%) 22 (88%)
2nd dose IVIG 0 2 (14%) 2 (8%)
Support 1(9%) 0 1(4%)
Days of Hospital Stay

Citation: Delgado-Ochoa Martha Azucena*, Bataller-Méndez Mauricio, Delgado-Hernández Carlos, García-Noriega María Victoria and Page 5 of 8
Taboada-Pérez Grecia Carolina. Clinical and Epidemiological Characteristics of Guillain-Barré Syndrome and its Variants in Tijuana General
Hospital. Arch Neurol & Neurosci. 14(5): 2023. ANN.MS.ID.000849. DOI: 10.33552/ANN.2023.13.000849
Archives in Neurology and Neuroscience Volume 14-Issue 5

0 to 7 1 (9%) 5 (36%) 6 (24%)


8 to 14 6 (54%) 3 (21%) 9 (36%)
15 to 21 2(18%) 2(14%) 4(16%)
22 to 28 1(9%) 0 1(4%)
More than 29 1 (9%) 4 (29%) 5 (20%)
Deaths 0 0 0

The high frequency of variants classically classified as atypical The difference in the distribution of variants before and after
stands out. Only 52% of the cases presented in a classical manner hospital conversion is striking. Prior to it, typical presentations
(ADIP 32%, AMAN 20%), while among the rest the MFS stood out were reported in 64%, subsequently decreasing to 43%. Among the
with 20% of the cases, followed by the PCB in 16% of the cases. 3 less classic variants, PCB presented a significant increase, reaching
patients presented overlapping variants for 12%, same number as 21% of cases after reconversion.
AMSAN. No cases of pure sensory, paraparetic, BFPP or Bickerstaff
The complete data is summarized in Table 3:
encephalitis were reported.

Table 3: Clinical-Electrophysiological Variants.

Variable Pre-conversion period Post-conversion period Total


Electromyography
Yes 7(64%) 12(86%) 19 (76%)
No 4(36%) 2(14%) 6 (24%)
Identified Variant
ADIP 6 (54%) 4(29%) 10 (40%)
AMAN 3(27%) 3(21%) 6 (24%)
AMSAN 0 3(21%) 3 (12%)
MFS 2(18%) 4(29%) 6 (24%)
PCB 1(9%) 3(21%) 4 (16%)
Mixed* 1(9%) 2(14%) 3 (12%)
Note: The percentages represent the variant with respect to the number of patients. considering the breakdown of mixed presentations.

The presentation in patients is illustrated in Figure 1. When study, a higher prevalence of PDIA is found with 40% of the cases.
performing a breakdown of all the variants detected during the The breakdown of variants can be seen in Figure 1 and Figure 2.

Figure 1: Variants Presentation.

Citation: Delgado-Ochoa Martha Azucena*, Bataller-Méndez Mauricio, Delgado-Hernández Carlos, García-Noriega María Victoria and Page 6 of 8
Taboada-Pérez Grecia Carolina. Clinical and Epidemiological Characteristics of Guillain-Barré Syndrome and its Variants in Tijuana General
Hospital. Arch Neurol & Neurosci. 14(5): 2023. ANN.MS.ID.000849. DOI: 10.33552/ANN.2023.13.000849
Archives in Neurology and Neuroscience Volume 14-Issue 5

Figure 2: Variant Prevalence.

Discussion for institutional approach, complementary diagnostic tests such


as electrophysiological tests were not requested or collected in
The difference in the distribution of clinical-electrophysiological
some cases, which would allow for a better characterization of all
variants in our setting is immediately striking. Although most
registered cases.
studies do not have specific reports of all the variants studied in
this research, the presentations classically considered atypical do Despite this, the difference registered in the distribution of
present a much higher frequency than that described in the global clinical-electrophysiological variants is very evident with the rest
literature. This could be explained by the sociodemographic and of the world population, so new, larger inter-institutional studies
environmental characteristics of our population and geographic are necessary to determine if there really is a difference and the
region, since the city is located on the busiest international border causes that could be associated to it.
in the world and has a large multiethnic floating population.
Conclusions
Similarly, there is an increase in atypical presentations after
hospital conversion (p=0.07) although there is no significant The clinical and epidemiological characteristics of pediatric
increase in cases of the disease. It should be noted that these results Guillain-Barré Syndrome at the General Hospital of Tijuana
only reflect the difference before and after the hospital conversion are similar to the rest of the Mexican population; however, the
period, and not its possible relationship with the COVID-19 distribution of clinical-electrophysiological variants is markedly
pandemic, social isolation and quarantine, or the new hygiene different from the rest of the world population (p=0.003). The
measures derived from it. The results of the study suggest a certain demyelinating variant (ADIP) was the most common in our study in
similarity between the epidemiological characteristics of our 40% of the patients. The prevalence of PCB stands out in 16% of the
population with those reported in the rest of the Mexican Republic patients studied when the world literature suggests a prevalence
[8,14]. An infectious history was only detected in 50% of the of less than 5% [10,12], while in 12% of the patients there was
patients, so we cannot rule out that asymptomatic infections could an overlap of variants. As for MFS, it was presented with the
trigger the disease. Regarding the clinical characteristics, similarity same frequency as AMAN. There does not seem to be a significant
was observed in most of the variables. However, it is noteworthy difference in the relationship of variants or frequency of the disease
that 1 out of 3 patients presented cranial nerve involvement. Most before and after hospital conversion.
of the patients presented in advanced stages of disability, which
Acknowledgement
may suggest both a rapid progression of the disease and little
information from caregivers and health personnel about the nature None.
of it, given that they may perform a medical assessment or make a
hospital referral until the symptoms are very evident. No deaths
Conflict of Interest
were recorded during the study period. The weaknesses of this No Conflict of interest.
research include, first of all, the small sample size. Secondly, the lack
of inclusion of patients from other health institutions, since their References
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Citation: Delgado-Ochoa Martha Azucena*, Bataller-Méndez Mauricio, Delgado-Hernández Carlos, García-Noriega María Victoria and Page 7 of 8
Taboada-Pérez Grecia Carolina. Clinical and Epidemiological Characteristics of Guillain-Barré Syndrome and its Variants in Tijuana General
Hospital. Arch Neurol & Neurosci. 14(5): 2023. ANN.MS.ID.000849. DOI: 10.33552/ANN.2023.13.000849
Archives in Neurology and Neuroscience Volume 14-Issue 5

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Citation: Delgado-Ochoa Martha Azucena*, Bataller-Méndez Mauricio, Delgado-Hernández Carlos, García-Noriega María Victoria and Page 8 of 8
Taboada-Pérez Grecia Carolina. Clinical and Epidemiological Characteristics of Guillain-Barré Syndrome and its Variants in Tijuana General
Hospital. Arch Neurol & Neurosci. 14(5): 2023. ANN.MS.ID.000849. DOI: 10.33552/ANN.2023.13.000849

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