Association of Plasma and Cerebrospinal Fluid Glucose Level with Clinical Severity in Patients with Guillain-Barre Syndrome.

Guillain-Barre' syndrome (GBS) is an acute onset disease of the peripheral nerves with a variable presentation and severity. It is the most common cause of acute flaccid paralysis worldwide after the eradication of poliomyelitis. Regarding the diagnosis of GBS, cerebrospinal fluid analysis and electrophysiological study plays a pivotal role. The objective of the study was to find out an association between cerebrospinal fluid (CSF) glucose, fasting plasma glucose (FPG) and hemoglobin A1C (HbA1C) with clinical severity in patients with GBS. This cross-sectional observational study conducted in the department of Neurology, Mymensingh medical college included 61 patients of GBS who were not known to have diabetes mellitus. Besides analyzing CSF and electrophysiological study various epidemiological and clinical parameters were also studied. FPG and HbA1C were measured for each patient. Clinical severities were assessed by Hughes functional grading scale and were classified into ambulatory group (Grade 1-3) and non-ambulatory group (Grade 4-6). Most of the patients were male (67.2%). Axonal variety was found the most common subtype 35(57.4%) followed by AIDP 23(37.7%) elicited by electrophysiological criteria. Ambulatory group (disability score ≤3) represents 63.9% patients and 36.1% were in non-ambulatory group (disability score ≥4). Mean CSF glucose found to be significantly higher in non-ambulatory group (3.40±0.39) mmol/L compared to ambulatory group (2.85±0.41) mmol/L, (p<0.001). Higher frequency of elevated FPG (>5.5mmol/L) was found in non-ambulatory group (63.6%) compared to ambulatory group (28.2%), (p=0.007). No significant difference of elevated HbA1C was found between ambulatory and non-ambulatory group (p=0.206). This study demonstrates that higher grades of clinical severity were associated with elevated CSF glucose and FPG but not with HbA1C.