Prevalence of Clinical and Electrophysiological Features among Patients Diagnosed with Very Early Guillain-Barré Syndrome (VE-GBS) Presenting in a Tertiary Care Hospital

Background: Guillain-Barré Syndrome (GBS) is a severe inflammatory polyradiculoneuropathy which manifests itself with progressive weakness and sensory impairments. Very Early GBS (VE-GBS) that manifests itself within four days after the onset of the symptoms is a major diagnostic problem because of the changing electrophysiological evidence. The prompt diagnosis and initiation of immunotherapy are essential to enhance patients and improve the outcomes. Objectives: To identify the frequency of clinical features such as areflexia, ascending weakness, sensory symptoms, bulbar involvement, cranial nerve palsy, respiratory involvement, and ophthalmoplegia; and to determine the frequency of the electrophysiological subtypes (AIDP, AMAN, AMSAN, Mixed, Equivocal) in patients with VE-GBS presented to a tertiary care hospital. Method: It is a descriptive cross-sectional study that sampled 62 patients who had Brighton criteria of GBS and whose onset of symptoms was <4 days of symptom onset through non-probability consecutive sampling. Nerve conduction and complete method of clinical examination was done. Data was examined through SPSS version 26.0 having descriptive statistics and chi-square tests of association. Results: Mean age was 35.85±9.00 years with male predominance (43/62, 69.4%; male female ratio 2.26:1). Most common clinical features were areflexia (60/62, 96.8%), ascending weakness (44/62, 71.0%), and sensory symptoms (32/62, 51.6%). Mixed pattern was the most frequent subtype (26/62, 41.9%), followed by AIDP (13/62, 21.0%) and equivocal pattern (11/62, 17.7%). H-reflex absence (50/62, 80.6%) and F-wave anomalies (54/62, 87.1%) were the most sensitive early electrophysiological markers. Conclusion: VE-GBS includes predominantly mixed or equivocal electrophysiological patterns and classical GBS subtypes can be identified in only 40.3% of VE-GBS patients during the first four days. The most sensitive early signs are H-reflex deficiency and F-wave abnormalities, which help to make timely diagnosis when it is impossible to make a diagnosis based on classical subtypes.