Clinical and Electrophysiological Spectrum of Guillain-Barré Syndrome in Syria: A Prospective Cohort Study...

Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyneuropathy that presents significant diagnostic and therapeutic challenges, particularly in low-resource settings. While GBS has been extensively studied in high-income countries, data from conflict-affected and resource-limited regions such as Syria remain scarce. Understanding regional disease patterns and atypical clinical variants is essential for timely diagnosis and management.

This prospective study was conducted at the National and Al-Mowasat University Hospitals in Damascus between September 2023 and February 2025. Patients who met the Brighton and National Institute of Neurological Disorders and Stroke criteria for GBS were enrolled in the study. Demographic, clinical, and electrophysiological data were collected and analysed, with subgroup comparisons between typical and atypical presentations.

Forty-seven patients were included, of whom 54.4% were male. Classical ascending paralysis occurred in 83% of patients, with 55.3% classified as typical GBS and 44.7% as atypical GBS. Notable atypical features included acute anuria, isolated upper or lower limb weakness, Miller Fisher syndrome, and bilateral facial palsy or weakness with paraesthesia. Acute inflammatory demyelinating polyneuropathy was the most common subtype (59.6%), followed by acute motor-sensory axonal neuropathy (17.0%) and acute motor axonal neuropathy (6.4%). Albuminocytologic dissociation was observed in 70.2% of cases. Atypical cases more frequently lacked a preceding infection, exhibited asymmetric or cranial nerve involvement, and showed a varied time to nadir.

This is the first prospective cohort study of GBS in Syria and highlights the diverse clinical spectrum of the disease in a resource-limited context. Atypical forms constitute nearly half of all cases and present distinct diagnostic challenges. These findings emphasise the need for heightened clinical awareness and tailored diagnostic approaches in such settings.