Clinical and Cerebrospinal Fluid Correlations with Electrophysiological Subtypes in Guillain–Barré Syndrome

Abstract

Background: Guillain-Barré syndrome (GBS) is classified into demyelinating (AIDP) and axonal (AMAN, AMSAN) subtypes by nerve conduction studies, with distinct clinical courses and prognoses. Regional variation in subtype distribution is documented, but Bangladeshi data linking clinical and cerebrospinal fluid (CSF) findings to subtype remain scarce. We aimed to determine the distribution of nerve-conduction-defined subtypes and their associations with demographic, clinical, and CSF characteristics in adults with GBS. Methods: This cross-sectional study was performed at Dhaka Medical College Hospital from November 2013 to November 2014. Fifty people with clinically confirmed Guillain-Barré Syndrome received neurological evaluation, nerve conduction studies, and cerebrospinal fluid analysis at least seven days post-symptom start. Patients were categorised as having acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN), or acute motor and sensory axonal neuropathy (AMSAN). CSF, neurological, clinical, and demographic characteristics were compared between subgroups. Results: AIDP was the most common subtype, observed in 25 patients (50.0%), followed by AMAN in 21 (42.0%) and AMSAN in 4 (8.0%). Age distribution differed significantly among subtypes (p=0.036), with AMAN more frequent in younger adults and AMSAN more frequent in older patients. Symmetrical ascending weakness was common across subtypes: AIDP 88.0%, AMAN 95.2%, and AMSAN 100.0%. Sensory symptoms and impaired sensory examination were present only in AMSAN and were significantly associated with subtype (both p=0.001). Ventilatory support was numerically highest in AMAN (38.1%). Raised CSF protein was frequent across all subtypes with normal CSF cell counts. CSF protein >170 mg/dL was more common in AIDP than AMAN (88.0% vs 28.6%). Conclusion: GBS in this Bangladeshi cohort showed mixed electrophysiological patterns, with AIDP predominance and substantial AMAN burden. Sensory involvement suggested AMSAN, while CSF supported diagnosis but not subtype classification.