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VALIDITY OF BRIGHTON CRITERIA IN THE DIAGNOSIS OF GUILLAIN-BARRÉ SYNDROME (GBS) IN PAKISTAN

Objective: Guillain–Barre syndrome (GBS) case definitions have been developed in recent past for its quick diagnosis. However, they have not been adopted worldwide especially in developing countries like Pakistan. In this study, we validated the sensitivity of Brighton working group case definitions for GBS at Services Hospital Lahore. Methods: A total of 30 cases of GBS with available clinical history, neurological examination,cerebrospinal fluid(CSF) and nerve conduction studies (NCS) results, and exclusion of related diagnoses were selected (2014–2015). Sensitivity of the Brighton criteria for GBS for level 3 of diagnostic certainty which requires no clinical laboratory testing, level 2 which employs CSF or NCS, and level 1 which employs both, were calculated. Results: All the 30 cases of GBS (mean age 37±16 years, range 16-62; 31% females) met the GBS case definitions. These cases were characterized as AIDP (30%), AMSAN (56.7%), AMAN (5%) involving lower extremity hypotonia and weakness (100%), upper extremity hypotonia and weakness (100%), areflexia (82.8) and hyporeflexia (17.2%). Four limbs were involved in almost all the cases (100%). CSF (mean time to lumbar puncture 29 days) was not found normal in any case with cytoalbuminologic dissociation in 100% (mean protein 105 mg/dL, range 10–1000; mean cell count 11/µL, range 0–50s, with <50 cells/µL). The majority of cases (88%) fulfilled Brighton level 1 (88%), level 2 (10%), and level 3 (2%) of diagnostic certainty. Conclusion: In conclusion, GBS diagnosis using Brighton Working Group criteria can be made successfully in developing countries like Pakistan with moderate to higher sensitivity.