From the Guidelines
Guillain-Barré Syndrome (GBS) can present with normal reflexes, especially early in the disease course. According to the study published in Nature Reviews Neurology in 2019 1, GBS can present atypically or as a clinical variant, and patients with GBS can have normal results in electrophysiological studies and cerebrospinal fluid analysis, especially early in the disease course. This suggests that normal reflexes do not rule out the diagnosis of GBS.
The key points to consider in the diagnosis of GBS include:
- The disease can present with atypical features, including normal reflexes
- Electrophysiological studies and cerebrospinal fluid analysis may be normal, especially early in the disease course
- Respiratory function should be monitored in all patients as respiratory failure can occur without symptoms of dyspnoea
- Intravenous immunoglobulin and plasma exchange are equally effective in treating GBS
It is essential to note that the diagnosis of GBS can be challenging due to heterogeneity in clinical presentation, an extensive differential diagnosis, and the lack of highly sensitive and specific diagnostic tools or biomarkers. Therefore, a high index of suspicion and careful evaluation of the patient's symptoms and laboratory results are necessary to make an accurate diagnosis. As stated in the study 1, the incidence of GBS can increase during outbreaks of infectious illnesses that trigger the disease, and the availability of globally applicable clinical guidelines for GBS is crucial for proper diagnosis and management.
In clinical practice, if a patient presents with symptoms suggestive of GBS but has normal reflexes, clinicians should consider other diagnoses or the possibility of a GBS variant, and closely monitor the patient's condition for any changes in reflexes or other symptoms. The study 1 emphasizes the importance of monitoring respiratory function and considering treatment options, such as intravenous immunoglobulin and plasma exchange, which are equally effective in treating GBS.
From the Research
Presentation of Guillain-Barré Syndrome
- Guillain-Barré Syndrome (GBS) is an acute/subacute immune-mediated polyneuropathy characterized by varying degrees of limb or cranial nerve involvement, manifested as limb weakness, absent tendon reflexes, and sensory and autonomic dysfunction caused by demyelination and/or axonal damage of peripheral nerves and nerve roots 2.
- The typical presentation of GBS includes motor paralysis that affects distal muscles more than proximal muscles and is more pronounced and symmetrical, starting in the legs and progressing to the arms, face, and eyes 3.
- Reflexes may be missing, and bifacial weakness may be present, with severe cases resulting in respiratory paralysis and autonomic abnormalities 3.
Reflexes in Guillain-Barré Syndrome
- Deep tendon reflexes are often diminished or absent in patients with GBS 4, 5.
- However, there is no direct evidence in the provided studies to suggest that GBS can present with normal reflexes.
- The studies primarily describe cases where reflexes are either diminished or absent, which is consistent with the typical presentation of GBS 4, 3, 5, 2.
Variants of Guillain-Barré Syndrome
- There are different variants of GBS, including acute sensory axonal neuropathy, acute motor axonal neuropathy, and Miller-Fisher syndrome 3.
- A finger drop variant of GBS has also been reported, characterized by distal weakness of the upper extremities, particularly in the bilateral extensor digitorum 5.
- These variants may present with different clinical features, but the absence of normal reflexes in GBS patients is a common finding across the variants 4, 3, 5, 2.