By Michael Rubin, MD
Professor of Clinical Neurology, Weill Cornell Medical College
SYNOPSIS: Among very old (older than 80 years of age) patients, the prognosis for Guillain-Barré is typically more severe, often with poorer recovery outlook.
SOURCE: Peric S, Berisavac I, Tamas OS, et al. Guillain-Barré syndrome in the elderly. J Peripher Nerv Syst 2016;21;105-110.
Guillain-Barré syndrome (GBS) affects all ages, and tends to affect men more than women. The lifetime risk of an incident of GBS is .1%. Overall incidence of GBS actually increases each decade after age 10, by as much as 20% per decade. Certain studies, however, have shown a drop in incidence rates after 80 years of age, prompting the question: is GBS more severe in elderly patients?
The current study analyzes data retrospectively gleaned from 2009-2013 hospital records, and prospectively considered data from 2014. Peric, et al, studied all cases of GBS that were accepted to seven healthcare centers in three European countries, Serbia, Montenegro, and the Republic of Srpska. According to WHO guidelines, the age 60 was deemed the divider between the young and the old. Those aged 61-80 were considered young-old, while those 80 years and older were deemed the old-old. The GBS disability scale was utilized in the assessment of patient disability, and standard criteria was used for GBS diagnosis. Statistical analysis allowed comparison of Kolmogorov-Smirnov, chi-square, Student’s and Mann-Whitney U tests. Statistical significance was set at 0.05.
Over the course of the study’s six years, Peric, et al. examined 403 patients with cases of GBS. 2Two hundred and fifty of the patients were younger than 60 years of age, while the remaining 153 were older than 60. One-third of GBS cases were preceded by respiratory infection, and one-fifth were preceded by severe diarrheal symptoms. The overall mean time prior to onset of GBS following these incidences was 12 days, and there was no significant difference in rates of illness leading up to GBS incidence. The medical histories of prior illness among both the older and younger patients were similar, with the notable exception being each group’s rate of malignancy, in which older patients were three times as likely to have experienced a malignant tumor. The most prevalent form of GBS in both groups was acute inflammatory demyelinating polyneuropathy; however, acute motor and sensory axonal neuropathy (AMSAN) was twice as likely to occur in older patients (12% vs. 6%). Although elevated cerebrospinal fluid protein was not as common in the older group as in the younger, hyponatremia and severe disability were much more common among the elderly patients.
Neither group saw significantly different rates of intolerance to intravenous immunoglobulin or plasma exchange. Each group had similar side effect frequencies and rates of non-responders (5%). Comparisons between the old-old and the young-old revealed more common bulbar symptoms and comorbidities among old-old patients. Upon time of discharge, 37% of the young old patients had severe disability, whereas the rate of severe disability among the old-old was 67%. The two groups did not demonstrate significantly different rates of AMSAN, although elderly patients — particularly those 80 years and older — tended to develop more severe, less easily treatable cases of GBS with longer recovery times, when compared with non-elderly patients.