Electrodiagnostic subtyping in Guillain–Barré syndrome patients in the International Guillain–Barré Outcome Study

Samuel Arends; Judith Drenthen; Laura de Koning; Peter van den Bergh; Robert D. M. Hadden; Satoshi Kuwabara; Ricardo C. Reisin; Nortina Shahrizaila; Senda Ajroud‐Driss; Giovanni Antonini; Shahram Attarian; Claudia Balducci; Tulio Bertorini; Thomas H. Brannagan; Guido Cavaletti; Chi‐Chao Chao; Govind Chavada; Klaus‐Ulrich Dillmann; Mazen M. Dimachkie; Giuliana Galassi; Gerardo Gutiérrez‐Gutiérrez; Thomas Harbo; Badrul Islam; Zhahirul Islam; Hans Katzberg; Susumu Kusunoki; Fiore Manganelli; James A. L. Miller; Julio Pardo; Yann Pereon; Yusuf A. Rajabally; Soren Sindrup; Mark Stettner; Antonino Uncini; Camiel Verhamme; Michal Vytopil; Waqar Waheed; Bart C. Jacobs; David R. Cornblath

doi:10.1111/ene.16335

Electrodiagnostic subtyping in Guillain–Barré syndrome patients in the International Guillain–Barré Outcome Study

Samuel Arends, Judith Drenthen, Laura de Koning, Peter van den Bergh, Robert D. M. Hadden, Satoshi Kuwabara, Ricardo C. Reisin, Nortina Shahrizaila, Senda Ajroud‐Driss, Giovanni Antonini, Shahram Attarian, Claudia Balducci, Tulio Bertorini, Thomas H. Brannagan, Guido Cavaletti, Chi‐Chao Chao, Govind Chavada, Klaus‐Ulrich Dillmann, Mazen M. Dimachkie, Giuliana GalassiGerardo Gutiérrez‐Gutiérrez, Thomas Harbo, Badrul Islam, Zhahirul Islam, Hans Katzberg, Susumu Kusunoki, Fiore Manganelli, James A. L. Miller, Julio Pardo, Yann Pereon, Yusuf A. Rajabally, Soren Sindrup, Mark Stettner, Antonino Uncini, Camiel Verhamme, Michal Vytopil, Waqar Waheed, Bart C. Jacobs, David R. Cornblath

College of Health and Life Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Background and purpose: Various electrodiagnostic criteria have been developed in Guillain–Barré syndrome (GBS). Their performance in a broad representation of GBS patients has not been evaluated. Motor conduction data from the International GBS Outcome Study (IGOS) cohort were used to compare two widely used criterion sets and relate these to diagnostic amyotrophic lateral sclerosis criteria.

Methods: From the first 1500 patients in IGOS, nerve conduction studies from 1137 (75.8%) were available for the current study. These patients were classified according to nerve conduction studies criteria proposed by Hadden and Rajabally.

Results: Of the 1137 studies, 68.3% (N = 777) were classified identically according to criteria by Hadden and Rajabally: 111 (9.8%) axonal, 366 (32.2%) demyelinating, 195 (17.2%) equivocal, 35 (3.1%) inexcitable and 70 (6.2%) normal. Thus, 360 studies (31.7%) were classified differently. The areas of differences were as follows: 155 studies (13.6%) classified as demyelinating by Hadden and axonal by Rajabally; 122 studies (10.7%) classified as demyelinating by Hadden and equivocal by Rajabally; and 75 studies (6.6%) classified as equivocal by Hadden and axonal by Rajabally. Due to more strictly defined cutoffs fewer patients fulfilled demyelinating criteria by Rajabally than by Hadden, making more patients eligible for axonal or equivocal classification by Rajabally. In 234 (68.6%) axonal studies by Rajabally the revised El Escorial (amyotrophic lateral sclerosis) criteria were fulfilled; in axonal cases by Hadden this was 1.8%.

Conclusions and discussion: This study shows that electrodiagnosis in GBS is dependent on the criterion set utilized, both of which are based on expert opinion. Reappraisal of electrodiagnostic subtyping in GBS is warranted.

Original language	English
Article number	e16335
Number of pages	11
Journal	European Journal of Neurology
Volume	31
Issue number	9
Early online date	4 Jul 2024
DOIs	https://doi.org/10.1111/ene.16335
Publication status	Published - Sept 2024

Bibliographical note

Copyright © 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Data Access Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Keywords

Guillain–Barré syndrome
amyotrophic lateral sclerosis
electrodiagnosis
nerve conduction studies
polyneuropathy

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10.1111/ene.16335Licence: CC BY-NC-ND 4.0

Euro J of Neurology - 2024 - Arends - Electrodiagnostic subtyping in Guillain Barr syndrome patients in the International
Copyright © 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Final published version, 1.02 MBLicence: CC BY-NC-ND 4.0

Cite this

Arends, S., Drenthen, J., de Koning, L., van den Bergh, P., Hadden, R. D. M., Kuwabara, S., Reisin, R. C., Shahrizaila, N., Ajroud‐Driss, S., Antonini, G., Attarian, S., Balducci, C., Bertorini, T., Brannagan, T. H., Cavaletti, G., Chao, CC., Chavada, G., Dillmann, KU., Dimachkie, M. M., ... Cornblath, D. R. (2024). Electrodiagnostic subtyping in Guillain–Barré syndrome patients in the International Guillain–Barré Outcome Study. European Journal of Neurology, 31(9), Article e16335. https://doi.org/10.1111/ene.16335

@article{d35fb5d51446434a94b8decc44a7065a,

title = "Electrodiagnostic subtyping in Guillain–Barr{\'e} syndrome patients in the International Guillain–Barr{\'e} Outcome Study",

abstract = "Background and purpose: Various electrodiagnostic criteria have been developed in Guillain–Barr{\'e} syndrome (GBS). Their performance in a broad representation of GBS patients has not been evaluated. Motor conduction data from the International GBS Outcome Study (IGOS) cohort were used to compare two widely used criterion sets and relate these to diagnostic amyotrophic lateral sclerosis criteria.Methods: From the first 1500 patients in IGOS, nerve conduction studies from 1137 (75.8%) were available for the current study. These patients were classified according to nerve conduction studies criteria proposed by Hadden and Rajabally.Results: Of the 1137 studies, 68.3% (N = 777) were classified identically according to criteria by Hadden and Rajabally: 111 (9.8%) axonal, 366 (32.2%) demyelinating, 195 (17.2%) equivocal, 35 (3.1%) inexcitable and 70 (6.2%) normal. Thus, 360 studies (31.7%) were classified differently. The areas of differences were as follows: 155 studies (13.6%) classified as demyelinating by Hadden and axonal by Rajabally; 122 studies (10.7%) classified as demyelinating by Hadden and equivocal by Rajabally; and 75 studies (6.6%) classified as equivocal by Hadden and axonal by Rajabally. Due to more strictly defined cutoffs fewer patients fulfilled demyelinating criteria by Rajabally than by Hadden, making more patients eligible for axonal or equivocal classification by Rajabally. In 234 (68.6%) axonal studies by Rajabally the revised El Escorial (amyotrophic lateral sclerosis) criteria were fulfilled; in axonal cases by Hadden this was 1.8%.Conclusions and discussion: This study shows that electrodiagnosis in GBS is dependent on the criterion set utilized, both of which are based on expert opinion. Reappraisal of electrodiagnostic subtyping in GBS is warranted.",

keywords = "Guillain–Barr{\'e} syndrome, amyotrophic lateral sclerosis, electrodiagnosis, nerve conduction studies, polyneuropathy",

author = "Samuel Arends and Judith Drenthen and {de Koning}, Laura and {van den Bergh}, Peter and Hadden, {Robert D. M.} and Satoshi Kuwabara and Reisin, {Ricardo C.} and Nortina Shahrizaila and Senda Ajroud‐Driss and Giovanni Antonini and Shahram Attarian and Claudia Balducci and Tulio Bertorini and Brannagan, {Thomas H.} and Guido Cavaletti and Chi‐Chao Chao and Govind Chavada and Klaus‐Ulrich Dillmann and Dimachkie, {Mazen M.} and Giuliana Galassi and Gerardo Guti{\'e}rrez‐Guti{\'e}rrez and Thomas Harbo and Badrul Islam and Zhahirul Islam and Hans Katzberg and Susumu Kusunoki and Fiore Manganelli and Miller, {James A. L.} and Julio Pardo and Yann Pereon and Rajabally, {Yusuf A.} and Soren Sindrup and Mark Stettner and Antonino Uncini and Camiel Verhamme and Michal Vytopil and Waqar Waheed and Jacobs, {Bart C.} and Cornblath, {David R.}",

note = "Copyright {\textcopyright} 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. ",

year = "2024",

month = sep,

doi = "10.1111/ene.16335",

language = "English",

volume = "31",

journal = "European Journal of Neurology",

issn = "1351-5101",

publisher = "Wiley-Blackwell",

number = "9",

}

Arends, S, Drenthen, J, de Koning, L, van den Bergh, P, Hadden, RDM, Kuwabara, S, Reisin, RC, Shahrizaila, N, Ajroud‐Driss, S, Antonini, G, Attarian, S, Balducci, C, Bertorini, T, Brannagan, TH, Cavaletti, G, Chao, CC, Chavada, G, Dillmann, KU, Dimachkie, MM, Galassi, G, Gutiérrez‐Gutiérrez, G, Harbo, T, Islam, B, Islam, Z, Katzberg, H, Kusunoki, S, Manganelli, F, Miller, JAL, Pardo, J, Pereon, Y, Rajabally, YA, Sindrup, S, Stettner, M, Uncini, A, Verhamme, C, Vytopil, M, Waheed, W, Jacobs, BC & Cornblath, DR 2024, 'Electrodiagnostic subtyping in Guillain–Barré syndrome patients in the International Guillain–Barré Outcome Study', European Journal of Neurology, vol. 31, no. 9, e16335. https://doi.org/10.1111/ene.16335

TY - JOUR

T1 - Electrodiagnostic subtyping in Guillain–Barré syndrome patients in the International Guillain–Barré Outcome Study

AU - Arends, Samuel

AU - Drenthen, Judith

AU - de Koning, Laura

AU - van den Bergh, Peter

AU - Hadden, Robert D. M.

AU - Kuwabara, Satoshi

AU - Reisin, Ricardo C.

AU - Shahrizaila, Nortina

AU - Ajroud‐Driss, Senda

AU - Antonini, Giovanni

AU - Attarian, Shahram

AU - Balducci, Claudia

AU - Bertorini, Tulio

AU - Brannagan, Thomas H.

AU - Cavaletti, Guido

AU - Chao, Chi‐Chao

AU - Chavada, Govind

AU - Dillmann, Klaus‐Ulrich

AU - Dimachkie, Mazen M.

AU - Galassi, Giuliana

AU - Gutiérrez‐Gutiérrez, Gerardo

AU - Harbo, Thomas

AU - Islam, Badrul

AU - Islam, Zhahirul

AU - Katzberg, Hans

AU - Kusunoki, Susumu

AU - Manganelli, Fiore

AU - Miller, James A. L.

AU - Pardo, Julio

AU - Pereon, Yann

AU - Rajabally, Yusuf A.

AU - Sindrup, Soren

AU - Stettner, Mark

AU - Uncini, Antonino

AU - Verhamme, Camiel

AU - Vytopil, Michal

AU - Waheed, Waqar

AU - Jacobs, Bart C.

AU - Cornblath, David R.

N1 - Copyright © 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

PY - 2024/9

Y1 - 2024/9

N2 - Background and purpose: Various electrodiagnostic criteria have been developed in Guillain–Barré syndrome (GBS). Their performance in a broad representation of GBS patients has not been evaluated. Motor conduction data from the International GBS Outcome Study (IGOS) cohort were used to compare two widely used criterion sets and relate these to diagnostic amyotrophic lateral sclerosis criteria.Methods: From the first 1500 patients in IGOS, nerve conduction studies from 1137 (75.8%) were available for the current study. These patients were classified according to nerve conduction studies criteria proposed by Hadden and Rajabally.Results: Of the 1137 studies, 68.3% (N = 777) were classified identically according to criteria by Hadden and Rajabally: 111 (9.8%) axonal, 366 (32.2%) demyelinating, 195 (17.2%) equivocal, 35 (3.1%) inexcitable and 70 (6.2%) normal. Thus, 360 studies (31.7%) were classified differently. The areas of differences were as follows: 155 studies (13.6%) classified as demyelinating by Hadden and axonal by Rajabally; 122 studies (10.7%) classified as demyelinating by Hadden and equivocal by Rajabally; and 75 studies (6.6%) classified as equivocal by Hadden and axonal by Rajabally. Due to more strictly defined cutoffs fewer patients fulfilled demyelinating criteria by Rajabally than by Hadden, making more patients eligible for axonal or equivocal classification by Rajabally. In 234 (68.6%) axonal studies by Rajabally the revised El Escorial (amyotrophic lateral sclerosis) criteria were fulfilled; in axonal cases by Hadden this was 1.8%.Conclusions and discussion: This study shows that electrodiagnosis in GBS is dependent on the criterion set utilized, both of which are based on expert opinion. Reappraisal of electrodiagnostic subtyping in GBS is warranted.

AB - Background and purpose: Various electrodiagnostic criteria have been developed in Guillain–Barré syndrome (GBS). Their performance in a broad representation of GBS patients has not been evaluated. Motor conduction data from the International GBS Outcome Study (IGOS) cohort were used to compare two widely used criterion sets and relate these to diagnostic amyotrophic lateral sclerosis criteria.Methods: From the first 1500 patients in IGOS, nerve conduction studies from 1137 (75.8%) were available for the current study. These patients were classified according to nerve conduction studies criteria proposed by Hadden and Rajabally.Results: Of the 1137 studies, 68.3% (N = 777) were classified identically according to criteria by Hadden and Rajabally: 111 (9.8%) axonal, 366 (32.2%) demyelinating, 195 (17.2%) equivocal, 35 (3.1%) inexcitable and 70 (6.2%) normal. Thus, 360 studies (31.7%) were classified differently. The areas of differences were as follows: 155 studies (13.6%) classified as demyelinating by Hadden and axonal by Rajabally; 122 studies (10.7%) classified as demyelinating by Hadden and equivocal by Rajabally; and 75 studies (6.6%) classified as equivocal by Hadden and axonal by Rajabally. Due to more strictly defined cutoffs fewer patients fulfilled demyelinating criteria by Rajabally than by Hadden, making more patients eligible for axonal or equivocal classification by Rajabally. In 234 (68.6%) axonal studies by Rajabally the revised El Escorial (amyotrophic lateral sclerosis) criteria were fulfilled; in axonal cases by Hadden this was 1.8%.Conclusions and discussion: This study shows that electrodiagnosis in GBS is dependent on the criterion set utilized, both of which are based on expert opinion. Reappraisal of electrodiagnostic subtyping in GBS is warranted.

KW - Guillain–Barré syndrome

KW - amyotrophic lateral sclerosis

KW - electrodiagnosis

KW - nerve conduction studies

KW - polyneuropathy

UR - https://onlinelibrary.wiley.com/doi/10.1111/ene.16335

UR - http://www.scopus.com/inward/record.url?scp=85197482284&partnerID=8YFLogxK

U2 - 10.1111/ene.16335

DO - 10.1111/ene.16335

M3 - Article

C2 - 38965709

SN - 1351-5101

VL - 31

JO - European Journal of Neurology

JF - European Journal of Neurology

IS - 9

M1 - e16335

ER -

Electrodiagnostic subtyping in Guillain–Barré syndrome patients in the International Guillain–Barré Outcome Study

Abstract

Bibliographical note

Data Access Statement

Keywords

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