ABSTRACT

INTRODUCTION. According to international data, among the most common neurological complications of COVID-19, there are lesions of the PNS with a frequency of occurrence of more than 33.7%. Guillain-Barre syndrome (GBS) is of the greatest interest among the complications of PNS, as a rapidly progressive, potentially fatal disease. Differential diagnosis of GBS and acute-onset CIDP is of great clinical importance, since the algorithms of pathogenetic treatment and further patient management tactics differ.

AIM. To identify possible differential diagnostic markers of Guillain-Barre syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy with acute - onset (A-CIDP) in patients with COVID-19.

MATERIAL AND METHODS. From 2020 to 2023, we examined 57 patients (women – 26, men – 31, average age 55.6±9.2 years). The main group included 34 patients (women – 16, men - 18, average age was 54.5±9.3 years), in whom GBS was associated with COVID-19. Of these, 7 patients subsequently had a recurrence of the clinical picture with a chronic course of the disease. In these patients, the initial diagnosis of GBS was changed to CIDP. The comparison group consisted of 23 patients (women – 10, men - 13, average age 57.2±8.6 years) with GBS of a different etiology. Neurological status was assessed using standardized scales to assess sensory and motor disorders in the study groups. To assess the nature of damage to the peripheral nervous system, the method of stimulation electroneuromyography was used. Among the laboratory biomarkers, the S100b protein was selected, which has proven itself well as a marker of damage not only to the central but also to the peripheral nervous systems.

RESULTS AND DISCUSSION. GBS (a form of AIDP) and A-CIDP cannot be clinically differentiated in the acute period. The analysis of the ENMG (amplitude of the M-response and ICV) in dynamics makes it possible to differentiate GBS (the form of AIDP) and CIDP in the early stages. The diagnostic threshold level of S100b protein in blood serum (>7.48 pg/ml) was reliably established at week 8 of the disease in patients with GBS (form of AIDP) and CIDP.

CONCLUSION. Based on the results obtained, a method for the differential diagnosis of GBS and A-CIDP has been developed, which makes it possible to reasonably prescribe the necessary pathogenetic therapy.

KEYWORDS: Guillain-Barre syndrome, acute onset CIDP, COVID-19, differential diagnosis, electroneuromyography, S100b protein

For citation: Vist E.V., Selitsky M.M., Ponomarev V.V. Aspects of Differential Diagnosis of Guillain-Barre Syndrome and Chronic Inflammatory Demyelinating Polyneuropathy with Acute Onset Associated with COVID-19. Comorbidity Neurology. 2024; 1 (4): 44-51. https://doi.org/10.62505/3034-185x-2024-1-4-44-51 (In Russ.).]

*For correspondence: Edgar V. Vist, Assistant of the Department of Neurology and Neurosurgery, Institute of Advanced Training and Retraining of Healthcare Personnel of the Educational Institution, Belarusian State Medical University, Minsk, Belarus, e-mail: edgar.vist@mail.ru

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ADDITIONAL INFORMATION

Edgar V. Vist, Assistant of the Department of Neurology and Neurosurgery, Institute of Advanced Training and Retraining of Healthcare Personnel, Belarusian State Medical University, Minsk, Belarus. E-mail: edgar.vist@mail.ru.

Mikhail M. Selitsky, Cand. Sci. (Med), Associate Professor of the Department of Neurology and Neurosurgery, Institute of Advanced Training and Retraining of Healthcare Personnel, Belarusian State Medical University, Minsk, Belarus. E-mail: m_sialitski@tut.by.

Vladimir V. Ponomarev, Dr. Sci. (Med.), Professor of the Department of Neurology and Neurosurgery, Institute of Advanced Training and Retraining of Healthcare Personnel Belarusian State Medical University, Minsk, Belarus. E-mail: professor.ponomarev@gmail.com.

Author contributions. All authors confirm that their authorship complies with the international ICMJE criteria (all authors made a significant contribution to the preparation of the article, read and approved the final version before publication). Ponomarev V.V. – development of the concept of the article, editing of the final text. Vist E.V., Selitsky M.M. – collection of material, writing of the text, methodology, statistical processing, preparation of the article for publication.

Funding. The authors declare the lack of external funding for the research and publication of the article.

Disclosure. The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article.

Ethics Approval. The protocol of the study was approved by the Local Ethics Committee of the healthcare institution "City Clinical Hospital No5"(Minsk, Belarus).

Informed consent for publication. All patients, and if it was impossible to familiarize and sign the persons responsible for the patients (relatives, social workers, etc.) on behalf of the patients who underwent the examination and participated in this study, signed an information consent.

The content is available under the Creative Commons Attribution 4.0 License.

©2024. Edgar V. Vist, Mikhail M. Selitsky, Vladimir V. Ponomarev