Clinical Spectrum, Management Patterns, and Short-Term Outcomes of Guillain–Barré Syndrome at Ayub Teaching Hospital, Abbottabad

Abstract

Background

Guillain–Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy associated with considerable neurological morbidity, respiratory compromise, and variable functional recovery. Regional differences in clinical presentation, electrophysiological subtypes, and treatment practices have been reported, while local data from Pakistan remain limited.

Objective

To evaluate the clinical spectrum, management patterns, and short-term outcomes of patients with Guillain–Barré syndrome admitted to a tertiary care hospital in Pakistan.

Methods

This descriptive cross-sectional study was conducted in the Department of Medicine at Ayub Teaching Hospital over a period of 18 months from July 2024 to December 2025. A total of 90 adult patients diagnosed with Guillain–Barré syndrome based on compatible clinical features with supportive cerebrospinal fluid and/or nerve conduction study findings were included through non-probability consecutive sampling. Demographic characteristics, antecedent illnesses, neurological findings, electrophysiological subtypes, treatment modalities, requirement for intensive care and ventilatory support, and short-term in-hospital outcomes were recorded using a structured proforma. Data were analyzed using SPSS version 26, and results were presented as frequencies, percentages, and mean ± standard deviation where appropriate.

Results

The mean age of patients was 38.6 ± 15.2 years, and 56 (62.2%) were male. Antecedent illness was documented in 71 (78.9%) patients, with acute diarrheal illness being the most common preceding event in 34 (37.8%) cases. Ascending quadriparesis was the predominant clinical presentation, observed in 78 (86.7%) patients, while sensory symptoms were present in 49 (54.4%). Facial nerve involvement and autonomic dysfunction were noted in 27 (30.0%) and 22 (24.4%) patients, respectively. Electrophysiological studies were available in 83 patients, among whom acute inflammatory demyelinating polyneuropathy was the most frequent subtype, identified in 49 (59.0%) cases. Albuminocytologic dissociation was observed in 58 (76.3%) patients who underwent cerebrospinal fluid analysis. Plasma exchange was the most commonly utilized disease-modifying therapy, administered to 44 (48.9%) patients, whereas 19 (21.1%) received intravenous immunoglobulin. Intensive care admission and mechanical ventilation were required in 21 (23.3%) and 13 (14.4%) patients, respectively. At discharge, 63 (70.0%) patients demonstrated clinical improvement, while 24 (26.7%) remained significantly disabled. Overall in-hospital mortality was 3.3%.

Conclusion

Guillain–Barré syndrome in our setting predominantly affected young and middle-aged adults and commonly presented with ascending symmetrical weakness following antecedent infectious illness. Acute inflammatory demyelinating polyneuropathy was the most frequent electrophysiological subtype, although axonal variants constituted a substantial proportion of cases. Plasma exchange remained the principal treatment modality in this resource-limited setting. Although most patients showed short-term clinical improvement, residual disability remained common, particularly among patients with severe disease requiring critical care support. Early recognition, timely supportive management, and improved access to neurocritical care and immunotherapy may help improve outcomes in patients with Guillain–Barré syndrome.