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Electrodiagnosis of Guillain-Barre syndrome in the International GBS Outcome Study: Differences in methods and reference values

Arends S 1 , Drenthen J 2 , van den Bergh P 3 , Franssen H 4 , Hadden RDM 5 , Islam B 6 Show all authors , Kuwabara S 7 , Reisin RC 8 , Shahrizaila N 9 , Amino H 10 , Antonini G 11 , Attarian S 12 , Balducci C 13 , Barroso F 14 , Bertorini T 15 , Binda D 16 , Brannagan TH 17 , Buermann J 18 , Casasnovas C 19 , Cavaletti G 20 , Chao CC 21 , Dimachkie MM 22 , Fulgenzi EA 23 , Galassi G 24 , Gutiérrez Gutiérrez G 25 , Harbo T 26 , Hartung HP 27 , Hsieh ST 28 , Kiers L 29 , Lehmann HC 30 , Manganelli F 31 , Marfia GA 32 , Mataluni G 33 , Pardo J 34 , Péréon Y 35 , Rajabally YA 36 , Santoro L 37 , Sekiguchi Y 38 , Stein B 39 , Stettner M 40 , Uncini A 41 , Verboon C 42 , Verhamme C 43 , Vytopil M 44 , Waheed W 45 , Wang M 46 , Zivkovic S 47 , Jacobs BC 48 , Cornblath DR 49 , IGOS consortium

Affiliations 

  • 1 Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Haga Teaching Hospital The Hague, The Hague, the Netherlands. Electronic address: s.arends@erasmusmc.nl
  • 2 Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: j.drenthen@erasmusmc.nl
  • 3 Department of Neurology, University Hospital St-Luc, Brussels, Belgium. Electronic address: peter.vandenbergh@uclouvain.be
  • 4 Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
  • 5 Department of Neurology, King's College Hospital, London, United Kingdom. Electronic address: robert.hadden@nhs.net
  • 6 Laboratory Sciences and Services Division (LSSD), International Centre for Diarrhoeal Disease Research (icddr,b) Dhaka, Bangladesh. Electronic address: badrul.islam@icddrb.org
  • 7 Department of Neurology, Chiba University Hospital, Chiba, Japan. Electronic address: kuwabara-s@faculty.chiba-u.jp
  • 8 Department of Neurology, Hospital Británico, Buenos Aires, Argentina. Electronic address: rcreisin@intramed.net
  • 9 Department of Neurology, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: nortina@um.edu.my
  • 10 Department of Neurology, Chiba University Hospital, Chiba, Japan
  • 11 Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Sant'Andrea Hospital, Rome, Italy
  • 12 Department Neuromuscular Disorders, Hôpital de La Timone, Marseille, France. Electronic address: shahram.attarian@ap-hm.fr
  • 13 Department of Neurology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
  • 14 Department of Neurology, Fleni Hospital, Buenos Aires, Argentina. Electronic address: fbarroso@fleni.org.ar
  • 15 Department of Neurology, The University of Tennessee Health Science Center, Memphis, USA. Electronic address: tbertori@uthsc.edu
  • 16 Department of Neurology, Valduce Hospital, Como, Italy
  • 17 Department of Neurology, Columbia University, New York City, USA. Electronic address: tb2325@cumc.columbia.edu
  • 18 Department of Neurology, University Hospital of Saarland, Homburg, Germany; Department of Neurology, MVZ Pfalzklinikum, Kusel, Germany. Electronic address: jan.buermann@mvz.pfalzklinikum.de
  • 19 Department of Neurology, Hospital Universitari de Bellvitge-IDIBELL and CIBERER, Barcelona, Spain. Electronic address: carloscasasnovas@bellvitgehospital.cat
  • 20 Department of Neurology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. Electronic address: guido.cavaletti@unimib.it
  • 21 Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: b1401019@ms17.hinet.net
  • 22 Department of Neurology, The University of Kansas Medical Center, Kansas City, USA. Electronic address: mdimachkie@kumc.edu
  • 23 Department of Neurology, Hospital Cesar Milstein, Buenos Aires, Argentina. Electronic address: efulgenzi@intramed.net
  • 24 Department of Neurology, University Hospital of Modena, Modena, Italy. Electronic address: giulianagalassi@alice.it
  • 25 Department of Neurology, Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Spain
  • 26 Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: tharbo@dadlnet.dk
  • 27 Department of Neurology, University of Dusseldorf, Dusseldorf, Germany. Electronic address: hans-peter.hartung@uni-duesseldorf.de
  • 28 Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: shsieh@ntu.edu.tw
  • 29 Clinical Neurophysiology, Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia. Electronic address: lynette.kiers@mh.org.au
  • 30 Department of Neurology, University Hospital of Cologne, Cologne, Germany. Electronic address: helmar.lehmann@uk-koeln.de
  • 31 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy
  • 32 Department of System Medicine, Dysimmune Neuropathies Unit, Policlinico Tor Vergata, Roma, Italy. Electronic address: marfia@uniroma2.it
  • 33 Department of System Medicine, Dysimmune Neuropathies Unit, Policlinico Tor Vergata, Roma, Italy
  • 34 Department of Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain. Electronic address: julio.pardo.fernandez@sergas.es
  • 35 Department of Clinical Neurophysiology, Reference Centre for Neuromuscular Disorders AOC, Filnemus, Euro-NMD, University of Nantes, Nantes, France. Electronic address: yann.pereon@univ-nantes.fr
  • 36 Department of Neurology, Queen Elizabeth Hospital, Birmingham, United Kingdom. Electronic address: y.rajabally@aston.ac.uk
  • 37 Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy. Electronic address: lusantor@unina.it
  • 38 Department of Neurology, Chiba University Hospital, Chiba, Japan. Electronic address: syukari536@chiba-u.jp
  • 39 Department of Neurology, St. Joseph's Regional Medical Center, Paterson, USA. Electronic address: steinb@sjhmc.org
  • 40 Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Essen, Germany. Electronic address: mark.stettner@uk-essen.de
  • 41 Department of Neuroscience, Imaging and Clinical Sciences, University "G. D'Annunzio", Chieti, Italy. Electronic address: uncini@unich.it
  • 42 Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: j.verboon@erasmusmc.nl
  • 43 Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: c.verhamme@amsterdamumc.nl
  • 44 Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA. Electronic address: michal.vytopil@lahey.org
  • 45 Department of Neurology, University of Vermont Medical Centre, Burlington, USA. Electronic address: waqar.waheed@uvmhealth.org
  • 46 Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China. Electronic address: emgwangmin@126.com
  • 47 Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, USA. Electronic address: zivksx@upmc.edu
  • 48 Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: j.drenthen@erasmusmc.nl
  • 49 Department of Neurology, Johns Hopkins University, Baltimore, MD, USA. Electronic address: dcornbl@jhmi.edu
Clin Neurophysiol, 2022 Jun;138:231-240.
PMID: 35078730 DOI: 10.1016/j.clinph.2021.12.014

Abstract

OBJECTIVE: To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barré syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS).

METHODS: Prospectively collected clinical and EDx data were available in 957 IGOS patients from 115 centers. Only the first EDx study was included in the current analysis.

RESULTS: Median timing of the EDx study was 7 days (interquartile range 4-11) from symptom onset. Methodology varied between centers, countries and regions. Reference values from the responding 103 centers were derived locally in 49%, from publications in 37% and from a combination of these in the remaining 15%. Amplitude measurement in the EDx studies (baseline-to-peak or peak-to-peak) differed from the way this was done in the reference values, in 22% of motor and 39% of sensory conduction. There was marked variability in both motor and sensory reference values, although only a few outliers accounted for this.

CONCLUSIONS: Our study showed extensive variation in the clinical practice of EDx in GBS patients among IGOS centers across the regions.

SIGNIFICANCE: Besides EDx variation in GBS patients participating in IGOS, this diversity is likely to be present in other neuromuscular disorders and centers. This underlines the need for standardization of EDx in future multinational GBS studies.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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