Clinical, electrophysiological spectrum and predictors of dysautonomia and successful extubation in Guillian Barre syndrome: a prospective cohort study.

Guillain Barre Syndrome (GBS) is an acute flaccid quadriparesis with or without cranial nerve palsy, autonomic dysfunction and sensory loss. There are different types of GBS based on clinical and neurophysiological findings which include acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor sensory axonal neuropathy (AMSAN), Miller Fisher syndrome (MFS), Pure sensory and pan-dysautonomia variants. About one third patients develop dysautonomia which sometimes are difficult to manage. there are no proven/effective treatment for dysautonomia. like patients with scorpon bite, patients with GBS too have sympathetic over-activity which may be managed with prazosin. prazosin is an alpha blocker. this study intends to assess the spectrum of dysautonomia in patients with GBS and role of prazosin in management of dysautonomia. this is a pre-liminary study assessing the role of prazosin in dysautonomia. 

Respiratory paralysis is common in GBS and majority needs assisted ventilation. The outcome of different subtypes of GBS is different and patients on ventilators usually have poorer outcome. The triggering factors of different subtypes may be different as well as pattern of GBS may be different in different geographical locations. There is paucity of data on the severity and pattern of autonomic dysfunction and its correlation with outcome in patients with GBS. Also, there is lack of predictors of successful extubation and weaning/extubation protocol. The use of 30 min - 2 hours T-Piece trial is a well proven method (Estaban et al, 2001) of weaning in patients with ARDS. However, this has not been tested in patients with neurological diseases especially those with peripheral nerve involvement like GBS.