Top

Clinical Autonomic Research

Published in:

01-06-2019 | Review

Autonomic involvement in Guillain–Barré syndrome: an update

Authors: Zoya Zaeem, Zaeem A. Siddiqi, Douglas W. Zochodne

Published in: Clinical Autonomic Research | Issue 3/2019

Abstract

Background

Guillain–Barré syndrome (GBS), an inflammatory, usually demyelinating polyradiculopathy, is characterized by ascending symmetrical limb weakness, sensory disturbances, and absent or reduced deep tendon reflexes. There is extensive literature suggesting that GBS is associated with autonomic dysfunction in up to two-thirds of patients. However, it is interesting that there is still no consensus amongst medical professionals regarding whether GBS patients should be routinely screened for autonomic nervous system (ANS) neuropathy. This is an important issue, as the mortality rate from presumed ANS abnormalities now exceeds that of respiratory failure. Given the long interval since this literature was last comprehensively reviewed, an update on this topic is warranted.

Methods

A PubMed search yielded 193 results with the terms “GBS or Guillain–Barré syndrome and autonomic symptoms” and 127 results with the terms “GBS or Guillain–Barré syndrome and dysautonomia.”

Results

This review will summarize the current literature involving GBS and autonomic dysfunction in terms of presentation, management, and a brief discussion of prognosis. We also examine prospective approaches that may be helpful and update a proposed management plan.

Guillain G, Barré JA, Strohl A (1916) Sur a syndrome of radiculonévrite avec hyperalbuminose du liquide céphalo-rachidien sans réaction cellulaire. Remarques sur les caractéres cliniques et graphiques des réflexes tendineux. Bull Soc Méd Hôp Paris 40:1462–1470

Hartung HP, Pollard JD, Harvey GK, Toyka KV (1995) Immunopathogenesis and treatment of the Guillain–Barré syndrome—Part I. Muscle Nerve 18:137–153CrossRef

Hauck LJ, White C, Feasby TE, Zochodne DW, Svenson LW, Hill MD (2008) Incidence of Guillain–Barré syndrome in Alberta, Canada: an administrative data study. J Neurol Neurosurg Psychiatry 79:318–320CrossRef

Flachenecker P (2006) Epidemiology of neuroimmunological diseases. J Neurol 253:2–8CrossRef

Ropper AH, Wijdicks EFM, Truax BT (1991) Guillain–Barré syndrome. Contemporary neurology series. FA Davis, Philadelphia

Osler W (1892) The principles and practice of medicine: designed for the use of practitioners and students of medicine. D. Appleton and Company, New York

Zochodne DW (1994) Autonomic involvement in Guillain-Barré syndrome: a review. Muscle Nerve 17:1145–1155CrossRef

Haymaker W, Kernohan JW (1949) The Landry-Guillain–Barré syndrome: a clinicopathologic report of fifty fatal cases and a critique of the literature. Medicine (Baltimore) 28:59CrossRef

Winer JB, Hughes RA (1988) Identification of patients at risk of arrhythmia in the Guillain–Barré syndrome. Q J Med 68(257):735–739PubMed

10.

Clarke E, Bayliss RIS, Cooper R (1954) Landry–Guillain–Barré syndrome: cardiovascular complications; treatment with A.C.T.H. and cortisone. BMJ 2(4903):1504–1507CrossRef

11.

Roseman E, Aring CD (1941) Infectious polyneuritis. Medicine (Baltimore) 20:463CrossRef

12.

Guillain G (1936) Radiculoneuritis with acellular hyperalbuminosis of the cerebrospinal fluid. Arch Neurol Psychiat (Chicago) 36:975CrossRef

13.

MacNeal PS, Bland JH (1950) Am Pract Digest Treat 1:337–346

14.

Johnson DF (1949) Bulbar syndrome following non-diptheritic throat infections; report of two cases, one with albumino-cytologic dissociation. Bull Los Angel Neurol Soc 14(3):182–186

15.

Sabin AB, Aring CD (1941) Visceral lesions in infectious polyneuritis: (infectious neuronitis, acute polyneuritis with facial diplegia, Guillain–Barré syndrome, Landry’s paralysis). Am J Pathol 17(4):469–482.15PubMedPubMedCentral

16.

Teloh HA (1953) Myocarditis in poliomyelitis. AMA Arch Path 55(5):408–411

17.

Greenland P, Griggs RC (1980) Arrhythmic complications in the Guillain–Barré syndrome. Arch Intern Med 140:1053–1055CrossRef

18.

Flachenecker P, Toyka KV, Reiners K (2001) Cardiac arrhythmias in Guillain–Barre syndrome. An overview of the diagnosis of a rare but potentially life-threatening complication. Nervenarzt 72(8):610–617CrossRef

19.

Flachenecker P, Müllges W, Wermuth P, Hartung HP, Reiners K (1996) Eyeball pressure testing in the evaluation of serious bradyarrhythmias in Guillain–Barré syndrome. Neurology 47:102–108CrossRef

20.

Flachenecker P, Lem K, Müllges W, Reiners K (2000) Detection of serious bradyarrhythmias in Guillain–Barré syndrome: sensitivity and specificity of the 24-hour heart rate power spectrum. Clin Auton Res 10:185–191CrossRef

21.

Pfeiffer G, Schiller H, Kruse J, Netzer J (1999) Indicators of dysautonomia in severe Guillain–Barré syndrome. J Neurol 246:1015–1022CrossRef

22.

Flachenecker P (2007) Autonomic dysfunction in Guillain–Barré syndrome and multiple sclerosis. J Neurol 254(suppl 2):1196–11101

23.

Rousseff RT, Al-Khashan S, Khuraibet AJ (2010) Transient cardiomyopathy as the presenting feature of Guillain–Barré syndrome. J Peripher Nerv Syst 15:153–155CrossRef

24.

Vengadakrishnan K, Koushik AK, Lakshmi M (2014) Severe autonomic dysfunction with cardiac arrest as the presenting feature of Guillain–Barre syndrome. Sch J App Med Sci 2(6H):3423–3425

25.

Fugate JE, Wijdicks EF, Kumar G, Rabinstein AA (2009) One thing leads to another: GBS complicated by PRES and Takotsubo cardiomyopathy. Neurocrit Care 11:395–397CrossRef

26.

Gill D, Goyes VR, Dean R, Liu K (2017) Takotsubo cardiomyopathy with Guillain–Barré syndrome. Proc (Bayl Univ Med Cent) 30(3):307–308CrossRef

27.

Iga K, Himura Y, Izumi C, Miyamoto T, Kijima K, Gen H, Konishi T (1995) Reversible left ventricular dysfunction associated with Guillain–Barré syndrome: an expression of catecholamine cardiotoxicity? Jpn Circ J 59:236–240CrossRef

28.

Mukerji S, Aloka F, Farooq MU, Kassab MY, Abela GS (2009) Cardiovascular complications of the Guillain–Barré Syndrome. Am J Cardiol 104:1452–1455CrossRef

29.

Zhang Q, Gu Z, Jiang J, Bai X, Feng Y, Huang Z, Zhou D, Liu L (2010) Orthostatic hypotension as a presenting symptom of the Guillain–Barré syndrome. Clin Auton Res 20(3):209–210CrossRef

30.

Bavikatte G, Gaber T, Eshiett MU (2010) Posterior reversible encephalopathy syndrome as a complication of Guillain–Barre syndrome. J Clin Neurosci 17(7):924–926CrossRef

31.

Nabi S, Rajput HM, Badshah M, Ahmed S (2016) Posterior reversible encephalopathy syndrome (PRES) as a complication of Guillain–Barre’ syndrome (GBS). BMJ Case Rep 3:2016

32.

Sutter R, Mengiardi B, Lyrer P, Czaplinski A (2009) Posterior reversible encephalopathy as the initial manifestation of a Guillain–Barre syndrome. Neuromuscul Disord 19(10):709–710CrossRef

33.

Banakar BF, Pujar GS, Bhargava A, Khichar S (2014) Guillain–Barre syndrome with posterior reversible encephalopathy syndrome. J Neurosci Rural Pract 5:63–65CrossRef

34.

Chen A, Kim J, Henderson G, Berkowitz A (2015) Posterior reversible encephalopathy syndrome in Guillain–Barre syndrome. J Clin Neurosci 22:914–916CrossRef

35.

Rigamonti A, Basso F, Scaccabarozzi C, Lauria G (2012) Posterior reversible encephalopathy syndrome as the initial manifestation of Guillain–Barre syndrome: case report and review of the literature. J Peripher Nerv Syst 17:356–360CrossRef

36.

Aleyadhy AA, Hassan GM (2013) Hypertensive encephalopathy as the initial manifestation of Guillain–Barré syndrome in a 7-year-old girl. Neurosciences 18:163–165PubMed

37.

Doss-Esper CE, Singhal AB, Smith MS, Henderson GV (2005) Reversible posterior leukoencephalopathy, cerebral vasoconstriction, and strokes after intravenous immune globulin therapy in Guillain–barre syndrome. J Neuroimaging 15:188–192PubMed

38.

Nakajima M (2005) Posterior reversible encephalopathy complicating intravenous immunoglobulins in a patient with Miller-Fisher syndrome. Eur Neurol 54:58–60CrossRef

39.

Stetefeld HR, Lehmann HC, Fink GR, Burghaus L (2014) Posterior reversible encephalopathy syndrome and stroke after intravenous immunoglobulin treatment in Miller-Fisher syndrome/Bickerstaff brain stem encephalitis overlap syndrome. J Stroke Cerebrovasc Dis 23:e423–e425CrossRef

40.

Koichihara R, Hamano S, Yamashita S, Tanaka M (2008) Posterior reversible encephalopathy syndrome associated with IVIG in a patient with Guillain–Barre syndrome. Pediatr Neurol 39:123–125CrossRef

41.

Incecik F, Herguner MO, Altunbasak S, Yildizdas D (2011) Reversible posterior encephalopathy syndrome due to intravenous immunoglobulin in a child with Guillain–Barre syndrome. J Pediatr Neurosci 6:138–140PubMedPubMedCentral

42.

Ribeiro BN, Salata TM, Borges RS, Marchiori E (2016) Posterior reversible encephalopathy syndrome following immunoglobulin therapy in a patient with Miller-Fisher syndrome. Radiol Bras 49:58–59CrossRef

43.

Shiraiwa N, Umesawa M, Hoshino S, Enomoto T, Kusunoki S, Tamaoka A, Ohkoshi N (2017) Miller Fisher syndrome with sinus arrest. Neurol Int 9(3):7312CrossRef

44.

Madsen JK, Meibom J, Videbak R, Pedersen F, Grande P (1988) Transcutaneous pacing: experience with the Zoll noninvasive temporary pacemaker. Am Heart J 116:7–10CrossRef

45.

Kordouni M, Jibrini M, Siddiqui MA (2007) Long-term transvenous temporary pacing with active fixation bipolar lead in the management of severe autonomic dysfunction in Miller-Fisher syndrome: a case report. Int J Cardiol 117:e10–e12CrossRef

46.

Nachamkin I, Allos BM, Ho T (1998) Campylobacter species and Guillain–Barre syndrome. Clin Microbiol Rev 11:555–567CrossRef

47.

Burns TM, Lawn ND, Low PA, Camilleri M, Wijdicks EF (2001) Adynamic ileus in severe Guillain–Barré syndrome. Muscle Nerve 24:963–965CrossRef

48.

Sakakibara R, Uchiyama T, Tamura N, Kuwabara S, Asahina M, Hattori T (2007) Urinary retention and sympathetic sphincter obstruction in axonal Guillain–Barre syndrome. Muscle Nerve 35(1):111–115CrossRef

49.

Sakakibara R, Uchiyama T, Kuwabara S, Mori M, Ito T, Yamamoto T, Awa Y, Yamaguchi C, Yuki N, Vernino S, Kishi M, Shirai K (2009) Prevalence and mechanism of bladder dysfunction in Guillain–Barré syndrome. Neurourol Urodyn 5:432–437CrossRef

50.

Ventura HO, Messerli FH, Barron RE (1986) Norepinephrine induced hypertension in Guillain–Barre syndrome. J Hypertens 4:265–267CrossRef

51.

Durocher A, Servais B, Caridroix M, Chopin C, Wattel F (1980) Autonomic dysfunction in the Guillain–Barre syndrome. hemodynamic and neurobiochemical studies. Intens Care Med 6:3–6CrossRef

52.

Otokida K, Yoshida H, Sato N, Kutsuzawa S, Isagozawa S, Yamada M, Kato M (1990) Acute autonomic neuropathy associated with a high serum bradykinin level and positive antinuclear and anti-DNA antibodies titers. Jpn J Med 29:560–565CrossRef

53.

Yao H, Fukiyama K, Takada Y, Fujishima M, Omae T (1985) Neurogenic hypertension in the Guillain–Barre syndrome. Jpn Heart J 26:593–596CrossRef

54.

Ahmad J, Kham AS, Siddiqui MA (1985) Estimation of plasma and urinary catecholamines in Guillain–Barré syndrome. Jpn J Med 24:24–29CrossRef

55.

Saxenhofer H, Weidman P, Shaw S et al (1988) Atrial natriuretic factor in the Landry–Guillain–Barre syndrome. N Engl J Med 319:448CrossRef

56.

Wijdicks EFM, Ropper AH, Nathanson JA (1990) Atrial natriuretic factor and blood pressure fluctuations in Guillain-Barré syndrome. Ann Neurol 27(3):337–338CrossRef

57.

Fagius J, Wallin BG (1983) Microneurographic evidence of excessive sympathetic outflow in the Guillain–Barré syndrome. Brain 106:589–600CrossRef

58.

Yamamoto K, Sobue G, Iwase S, Nagamatsu M, Mano T, Mitsuma Y (1997) Skin sympathetic nerve activity in Guillain–Barre syndrome: a microneurographic study. J Neurol Neurosurg Psychiatry 63:537–541CrossRef

59.

Asahina M, Kuwabara S, Suzuki A, Hattori T (2002) Autonomic function in demyelinating and axonal subtypes of Guillain–Barre syndrome. Acta Neurol Scand 105:44–50CrossRef

60.

Singh NK, Jaiswal AK, Misra S, Srivastava PK (1987) Assessment of autonomic dysfunction in Guillain–Barre syndrome and its prognostic implications. Acta Neurol Scand 35:101–105CrossRef

61.

Tuck RR, McLeod JG (1981) Autonomic dysfunction in Guillain–Barré syndrome. J Neurol Neurosurg 44(11):983–990CrossRef

62.

Lyu RK, Tang LM, Hsu WC, Chen ST (2002) Quantitative cardiovascular autonomic function study in Fisher syndrome. J Neurol Neurosurg Psychiatry 73:333–335CrossRef

63.

Lyu RK, Tang LM, Hsu WC, Chen ST, Chang HS, Wu YR (2002) A longitudinal cardiovascular autonomic function study in mild Guillain–Barre syndrome. Eur Neurol 47(2):79–84CrossRef

64.

Flachenecker P, Wermuth P, Hartung HP, Reiners K (1997) Quantitative assessment of cardiovascular autonomic function in Guillain–Barre syndrome. Ann Neurol 42(2):171–179CrossRef

65.

Flachenecker P, Hartung HP, Reiners K (1997) Power spectrum analysis of heart rate variability in Guillain–Barré syndrome. A longitudinal study. Brain 120(Pt 10):1885–1894CrossRef

66.

Koeppen S, Kraywinkel K, Wessendorf TE, Ehrenfeld CE, Schurks M, Diener HC, Weimar C (2006) Long-term outcome of Guillain–Barre syndrome. Neurocrit Care 5(3):235–242CrossRef

67.

Jamil A, Siddiqi ZA (2009) Role of autonomic dysfunction in post GBS fatigue. New insights in GBS - A 10 year experience at University of Alberta Hospital. University of Alberta Masters thesis, Chapter 4

68.

Merkies IS, Schmitz PI, van der Meché FG, Samijn JP, van Doorn PA, Inflammatory Neuropathy Cause and Treatment (2002) Clinimetric evaluation of a new overall disability scale in immune mediated polyneuropathies. J Neurol Neurosurg Psychiatry 72:596–601CrossRef

69.

Meena AK, Khadilkar SV, Murthy JMK (2011) Treatment guidelines for Guillain–Barre syndrome. Ann Indian Acad Neurol 14(suppl 1):S73–S81CrossRef

70.

Hughes RA, Wijdicks EF, Barohn R, Benson E, Cornblath DR, Hahn AF et al (2003) Practice parameter: immunotherapy for Guillain–Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 61:736–740CrossRef

71.

Guillain G (1953) Considérations sur le syndrome de Guillain et Barré. Ann Med 54:81–149

Title: Autonomic involvement in Guillain–Barré syndrome: an update
Authors: Zoya Zaeem
Zaeem A. Siddiqi
Douglas W. Zochodne
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: Clinical Autonomic Research / Issue 3/2019
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI: https://doi.org/10.1007/s10286-018-0542-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Autonomic involvement in Guillain–Barré syndrome: an update

Abstract

Background

Methods

Results

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Please log in to get access to this content

Other articles of this Issue 3/2019

Do astronauts get postural tachycardia syndrome? And other updates on recent autonomic research

Immune and autonomic nervous system interactions in multiple sclerosis: clinical implications

Autonomic symptom burden is an independent contributor to multiple sclerosis related fatigue

Post-stroke short-lasting unilateral neuralgiform headache attacks with autonomic symptoms (SUNA): response to lamotrigine and sphenopalatine ganglion block

Neurogenic lower urinary tract dysfunction in multiple sclerosis, neuromyelitis optica, and related disorders

Does clip removal help for compensatory hyperhidrosis complicating thoracic sympathetic clipping?