Clinical Spectrum and Electrophysiological Subtypes of Guillain–Barré Syndrome: A Prospective Study from Eastern India

Abstract

Background: Guillain–Barré syndrome (GBS) shows geographic variability in clinical features and electrophysiological subtypes. Contemporary prospective data from Eastern India remain limited.

Objective: To describe the clinical spectrum, seasonal/epidemiologic patterns, and electrophysiological subtype distribution of GBS in a tertiary center in Odisha, and to explore early determinants of disability.

Methods: A prospective observational study was conducted at KIMS, Bhubaneswar (April 2023 to March 2025) including adults fulfilling Brighton criteria levels 1–3. Clinical, epidemiological, and electrophysiological data were analyzed. Subtypes were classified per revised electrodiagnostic criteria. Statistical tests included ANOVA, Tukey HSD, and χ² (p < 0.05 significant).

Results: Fifty-four patients were enrolled (mean age 40.48 ± 14.79 years; M:F = 2:1), with most patients aged 21–40 years (48.1%). Electrophysiological classification demonstrated a predominant axonal pattern (77.8%), comprising AMSAN 50.0% and AMAN 27.8%, while AIDP accounted for 14.8% and MFS for 7.4% (χ² = 21.36, p < 0.001). Age differed significantly across subtypes (ANOVA F = 2.9, p = 0.044), with AMAN patients being significantly older than AMSAN (Tukey p = 0.017). A bimodal seasonal clustering was observed during monsoon (27.8%) and winter (25.9%) (p = 0.698). Antecedent infection was reported in 75.9% of cases, predominantly upper respiratory tract infection (63%), which showed a strong association with axonal subtypes (p < 0.001). Cranial nerve involvement was present in 51.9% and varied markedly across subtypes (p = 0.000048), with higher involvement in MFS and AMSAN. Autonomic dysfunction was noted in 57.4% (p = 0.147). Respiratory failure occurred in 38.9% of patients, most frequently in MFS (75%) and AMAN (40%), all of whom required ventilatory support.

Conclusion: This study demonstrates a clear predominance of axonal GBS variants in Eastern India, with strong association to antecedent upper respiratory infections and higher cranial and respiratory involvement in AMAN and MFS subtypes. These patterns underscore the need for early monitoring and timely supportive care in high-risk patients. While limited by single-center data, the findings highlight important regional characteristics and the need for larger multicentre studies to refine prognosis and management strategies.