Острая моторная аксональная невропатия: особенности диагностики, лечения и реабилитации

Острая аксональная моторная невропатия (ОМАН) — аксональный вариант синдрома Гийена-Барре, характеризующийся острым поражением двигательных волокон периферических нервов. В остром периоде терапия состоит из специфических и неспецифических методов лечения. К специфическим относятся операции высокообъемного программного плазмафереза и курсы высокодозной внутривенной иммунотерапии препаратами иммуноглобулинов G. Неспецифические методы заключаются в симптоматической терапии. В период реконвалесценции целесообразно более раннее назначение восстановительного лечения с привлечением мультидисциплинарной бригады специалистов.

1. van Doorn P.A., Van den Bergh P.Y.K., Hadden R.D.M., Avau B., Vankrunkelsven P., Attarian S., Blomkwist-Markens P.H., Cornblath D.R., Goedee H.S., Harbo T., Jacobs B.C., Kusunoki S., Lehmann H.C., Lewis R.A., Lunn M.P., Nobile-Orazio E., Querol L., Rajabally Y.A., Umapathi T., Topaloglu H.A., Willison H.J. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. Eur J Neurol. 2023;30(12):3646–3674. https://doi.org/10.1111/ene.16073

2. Shastri A., Al Aiyan A., Kishore U., Farrugia M.E. Immune-Mediated Neuropathies: Pathophysiology and Management. Int J Mol Sci. 2023;24(8):7288. https://doi.org/10.3390/ijms24087288

3. Collet R., Caballero-Ávila M., Querol L. Clinical and pathophy-siological implications of autoantibodies in autoimmune neuropathies. Rev Neurol (Paris). 2023;179(8):831–843. https://doi.org/10.1016/j.neurol.2023.02.064

4. Censi S., Bisaccia G., Gallina S., Tomassini V., Uncini A. Guillain-Barré syndrome and SARS-CoV-2 infection: a systematic review and meta-analysis on a debated issue and evidence for the ‘Italian factor’. Eur J Neurol. 2024;31(2):e16094. https://doi.org/10.1111/ene.16094

5. Filosto M., Cotti Piccinelli S., Gazzina S., Foresti C., Frigeni B., Servalli M.C., Sessa M., Cosentino G., Marchioni E., Ravaglia S., Briani C., Castellani F., Zara G., Bianchi F., Del Carro U., Fazio R., Filippi M., Magni E., Natalini G., Palmerini F., Perotti A.M., Bellomo A., Osio M., Nascimbene C., Carpo M., Rasera A., Squintani G., Doneddu P.E., Bertasi V., Cotelli M.S., Bertolasi L., Fabrizi G.M., Ferrari S., Ranieri F., Caprioli F., Grappa E., Manganotti P., Bellavita G., Furlanis G., De Maria G., Leggio U., Poli L., Rasulo F., Latronico N., Nobile-Orazio E., Beghi E., Padovani A., Uncini A. Guillain-Barré syndrome and COVID-19: A 1-year observational multicenter study. Eur J Neurol. 2022;29(11):3358–3367. https://doi.org/10.1111/ene.15497

6. Liu S., Zhang W.W., Jia L., Zhang H.L. Guillain-Barré syndrome: immunopathogenesis and therapeutic targets. Expert Opin Ther Targets. 2024;28(3):131–143. https://doi.org/10.1080/14728222.2024.2330435

7. Rose M.Q., Santos C.D., Rubin D.I., Siegel J.L., Freeman W.D. Guillain-Barré Syndrome After Acute Hepatitis E Infection: A Case Report and Literature Review. Crit Care Nurse. 2021;41(4):47–53. https://doi.org/10.4037/ccn2021129

8. Dalugama C., Shelton J., Ekanayake M., Gawarammana I.B. Dengue fever complicated with Guillain-Barré syndrome: a case report and review of the literature. J Med Case Rep. 2018;12:137. https://doi.org/10.1186/s13256-018-1626-y

9. Lim C.S., Kaisbain N., Lim W.J. A Rare Combination: Dengue Fever Complicated With Guillain-Barre Syndrome. Cureus. 2023;15(6):e40957. https://doi.org/10.7759/cureus.40957

10. Doets A.Y., Verboon C., van den Berg B., Harbo T., Cornblath D.R., Willison H.J., Islam Z., Attarian S., Barroso F.A., Bateman K., Benedetti L., van den Bergh P., Casasnovas C., Cavaletti G., Chavada G., Claeys K.G., Dardiotis E., Davidson A., van Doorn P.A., Feasby T.E., Galassi G., Gorson K.C., Hartung H.P., Hsieh S.T., Hughes R.A.C., Illa I., Islam B., Kusunoki S., Kuwabara S., Lehmann H.C., Miller J.A.L., Mohammad Q.D., Monges S., Nobile Orazio E., Pardo J., Pereon Y., Rinaldi S., Querol L., Reddel S.W., Reisin R.C., Shahrizaila N., Sindrup S.H., Waqar W., Jacobs B.C.; IGOS Consortium. Regional variation of Guillain-Barré syndrome. Brain. 2018;141(10):2866–2877. https://doi.org/10.1093/brain/awy232

11. Скрипченко Н.В., Вильниц А.А., Егорова Е.С., Скрипченко Е.Ю., Климкин А.В., Войтенков В.Б., Конев А.И., Алексеева Л.А. Неотложные состояния при нейроинфекциях у детей. Российский педиатрический журнал. 2022;3(1):287. https://www.rospedj.ru/jour/article/view/447/377 (доступ не ограничен).

12. Carpentier V.T., Le Guennec L., Fall S.A.A., Viala K., Demeret S., Weiss N. Syndrome de Guillain-Barré: physiopathologie et aspects diagnostiques [Pathophysiological and diagnostic aspects of Guillain-Barré syndrome]. Rev Med Interne. 2022;43(7):419–428. https://doi.org/10.1016/j.revmed.2021.12.005

13. Bazán-Rodríguez L., Ruiz-Avalos J.A., de Saráchaga A.J., Martinez-Jimenez E., López-Hernández J.C., Vargas-Cañas S. Dysautonomia and related outcomes in Guillain-Barre syndrome. Auton Neurosci. 2023;245:103070. https://doi.org/10.1016/j.autneu.2022.103070

14. Chakraborty T., Kramer C.L., Wijdicks E.F.M., Rabinstein A.A. Dysautonomia in Guillain-Barré Syndrome: Prevalence, Clinical Spectrum, and Outcomes. Neurocrit Care. 2020;32(1):113–120. https://doi.org/10.1007/s12028-019-00781-w

15. Cheng Y., Liu K., Li C., Zhang W., Wu X., Fang S. Risk Factors for Mechanical Ventilation in Patients with Guillain-Barré Syndrome. Neurocrit Care. 2022;37(1):121–128. https://doi.org/10.1007/s12028-022-01457-8

16. Luijten L.W.G., Doets A.Y., Arends S., Dimachkie M.M., Gorson K.C., Islam B., Kolb N.A., Kusunoki S., Papri N., Waheed W., Walgaard C., Yamagishi Y., Lingsma H., Jacobs B.C. IGOS Consortium. Modified Erasmus GBS Respiratory Insufficiency Score: a simplified clinical tool to predict the risk of mechanical ventilation in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry. 2022;94(4):300–308. https://doi.org/10.1136/jnnp-2022-329937

17. Galassi G., Mazzoli M., Ariatti A., Bedin R., Marzullo D., Bastia E., Agnoletto V., Gozzi M., Valzania F., Meletti S., Marchioni A. Predictors of respiratory failure in Guillain-Barré syndrome: a 22 year cohort study from a single Italian centre. Eur J Neurol. 2024;31(1):e16090. https://doi.org/10.1111/ene.16090

18. Wachira V.K., Farinasso C.M., Silva R.B., Peixoto H.M., de Oliveira M.R.F. Incidence of Guillain-Barré syndrome in the world between 1985 and 2020: A systematic review. Glob Epidemiol. 2023;5:100098. https://doi.org/10.1016/j.gloepi.2023.100098

19. Hagen K.M., Ousman S.S. The Neuroimmunology of Guillain-Barré Syndrome and the Potential Role of an Aging Immune System. Front Aging Neurosci. 2021;12:613628. https://doi.org/10.3389/fnagi.2020.613628

20. Супонева Н.А., Пирадов М.А., Никитин С.С., Тимченко О.Л., Грачева Л.А., Быкова Л.П., Лапин С.В., Федькина Ю.А., Костырева М.В., Шабалина А.В., Гришина Д.А. Патогенетическая и прогностическая роль аутоантител к ганглиозидам периферических нервов при синдроме Гийена-Барре. Анналы клинической и экспериментальной неврологии. 2013;7(1):4–11. https://cyberleninka.ru/article/n/patogeneticheskaya-i-prognosticheskaya-rol-autoantitel-k-gangliozidam-perifericheskih-nervov-pri-sindrome-giyena-barre. (доступ не ограничен).

21. Козырева А.А., Бембеева Р.Т., Дружинина Е.С., Заваденко Н.Н. Синдром Гийена-Барре у детей. Журнал неврологии и психиатрии им. С.С. Корсакова. 2023;123(9):20–32. https://doi.org/10.17116/jnevro202312309220

22. Wu X., Shen D., Li T., Zhang B., Li C., Mao M., Zhao J., Liu K., Zhang H.L. Distinct Clinical Characteristics of Pediatric Guillain-Barré Syndrome: A Comparative Study between Children and Adults in Northeast China. PLoS One. 2016;11(3):e0151611. https://doi.org/10.1371/journal.pone.0151611

23. Shibeshi M.S., Mengesha A.A., Gari K.T. Pediatric Guillain-Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management Challenges, and Hospital Outcome. Pediatric Health Med Ther. 2023;14:107–115. https://doi.org/10.2147/PHMT.S401461

24. Jin M., Liu J., Liu K., Zhao L., Zhao Z., Sun S. Sympathetic skin response (SSR) in pediatric Guillain-Barré syndrome. Front Neurol. 2023;14:1177394. https://doi.org/10.3389/fneur.2023.1177394

25. Al Amrani F., Al-Abdwani R., Al Rashdi F., Al-Ajmi E., Al Futaisi A. Guillain-Barré Syndrome Associated with SARS-CoV-2 in Two Pediatric Patients. Sultan Qaboos Univ Med J. 2023;23(3):400–404. https://doi.org/10.18295/squmj.5.2022.040

26. Akçay N., Menentoğlu M.E., Bektaş G., Şevketoğlu E. Axonal Guillain-Barre syndrome associated with SARS-CoV-2 infection in a child. J Med Virol. 2021;93(9):5599–5602. https://doi.org/10.1002/jmv.27018

27. Pourbakhtyaran E., Heidari M., Akbari M.G., Mohammadi M., Badv R.S., Zamani G., Tavasoli A.R., Rezaei Z., Mamishi S., Haji Esmaeil Memar E., Hosseiny S.M.M., Ghabeli H., Haghighi R., Ashrafi M.R. Childhood Guillain-Barre syndrome in the SARS-CoV-2 era: Is there any causative relation? Clin Case Rep. 2022;10(12):e6772. https://doi.org/10.1002/ccr3.6772

28. Levison L.S., Thomsen R.W., Markvardsen L.K., Christensen D.H., Sindrup S.H., Andersen H. Pediatric Guillain-Barré Syndrome in a 30-Year Nationwide Cohort. Pediatr Neurol. 2020;107:57–63. https://doi.org/10.1016/j.pediatrneurol.2020.01.017

29. Kobayashi Takahashi Y., Hayakawa I., Abe Y. Diagnostic odyssey of Guillain-Barré syndrome in children. Brain Dev. 2024;46(2):108–113. https://doi.org/10.1016/j.braindev.2023.10.004

30. Tiwari I., Alam A., Kanta C., Koonwar S., Garg R.K., Pandey S., Jain A., Kumar R. Clinical Profile and Predictors of Mechanical Ventilation in Guillain-Barre Syndrome in North Indian Children. J Child Neurol. 2021;36(6):453–460. https://doi.org/10.1177/0883073820978020

31. Brisset M., Nicolas G. Peripheral neuropathies and aging. Geriatr Psychol Neuropsychiatr Vieil. 2018;16(4):409–413. https://doi.org/10.1684/pnv.2018.0768

32. Peric S., Berisavac I., Stojiljkovic Tamas O., Rajic S., Babic M., Cvijanovic M., Dominovic-Kovacevic A., Basta I., Beslac-Bumbasirevic L., Lavrnic D. Guillain-Barré syndrome in the elderly. J Peripher Nerv Syst. 2016;21(2):105–110. https://doi.org/10.1111/jns.12163

33. Briseño-Godínez M.E., Arauz A., López-Hernández J.C., de Saráchaga A.J., Pérez-Valdez E.Y., May-Más R.N., López-Hernández G., Bazán-Rodriguez L., Galnares-Olalde J.A., León-Manríquez E., Vargas-Cañas E.S. Prognostic Factors in Elderly Patients With Guillain-Barré Syndrome: Does Age Matter? Neurohospitalist. 2021;11(4):303–309. https://doi.org/10.1177/19418744211002676

34. Minamino M., Miyamoto K., Kuwahara M., Yoshikawa K., Koh J., Kusunoki S., Nagai Y., Ito H. Characteristics of Guillain-Barré syndrome in super-elderly individuals. J Neurol. 2023; 270(4):2191–2196. https://doi.org/10.1007/s00415-023-11567-8

35. Kim S., Han H.J., Shin H.Y., Kim S.W. Old age and multiple comorbidity are associated with delayed diagnosis of Guillain-Barre syndrome. Sci Rep. 2022;12(1):9913. https://doi.org/10.1038/s41598-022-14184-z

36. Bose S., Loo L.K., Rajabally Y.A. Causes and consequences of diagnostic delay in Guillain-Barré syndrome in a UK tertiary center. Muscle Nerve. 2022;65(5):547–552. https://doi.org/10.1002/mus.27506

37. Lee H.S., Suh B.C., Kim J.K., Kim B.J., Nam T.S., Oh J., Bae J.S., Shin K.J., Kim S.W., Kim S.M., Shin H.Y. Serial Nerve Conduction Studies in Guillain-Barré Syndrome: Its Usefulness and Precise Timing. J Clin Neurophysiol. 2024;41(3):278–284. https://doi.org/10.1097/WNP.0000000000000985

38. Rath J., Schober B., Zulehner G., Grisold A., Krenn M., Cetin H., Zimprich F. Nerve conduction studies in Guillain-Barré syndrome: Influence of timing and value of repeated measurements. J Neurol Sci. 2021;420:117267. https://doi.org/10.1016/j.jns.2020.117267

39. He S., Lin Y. Application and Value of Limbs Peripheral Nerve Ultrasound in Guillain-Barre Syndrome. Altern Ther Health Med. 2024;30(10):416–421. https://alternative-therapies.com/oa/index.html?fid=9248. (доступ не ограничен)

40. Umapathi T., Lim C.S.J., Ng B.C.J., Goh E.J.H., Ohnmar O. A Simplified, Graded, Electrodiagnostic Criterion for Guillain-Barré Syndrome That Incorporates Sensory Nerve Conduction Studies. Sci Rep. 2019;9(1):7724. https://doi.org/10.1038/s41598-019-44090-w

41. Uncini A., Kuwabara S. The electrodiagnosis of Guillain-Barré syndrome subtypes: Where do we stand? Clin Neurophysiol. 2018;129(12):2586–2593. https://doi.org/10.1016/j.clinph.2018.09.025

42. López-Hernández J.C., Galnares-Olalde J.A., Jorge de Saráchaga A., Briseño-Godínez M.E., Pérez-Valdez E., May-Mas R.N., Arista-Ramírez J.L., Bazán-Rodríguez L., León-Manriquez E., Burgos-Centeno J., Vargas-Cañas E.S. Very low peroneal nerve compound muscle action potential amplitude predicts poor outcome in patients with Guillain-Barré syndrome: a prospective cohort. Neurol Sci. 2022;43(6):3923–3928. https://doi.org/10.1007/s10072-021-05834-7

43. Sung E.J., Kim D.Y., Chang M.C., Ko E.J. Prediction of Functional Outcome in Axonal Guillain-Barre Syndrome. Ann Rehabil Med. 2016;40(3):481–488. https://doi.org/10.5535/arm.2016.40.3.481

44. Naresh K., Roy A., Srivastava S., Premkumar P., Nair A., Mani A.M., Shaikh A., Thirumal P.A., Sivadasan A., Mathew V., Premkumar P.S., Benjamin R. Sensitivity and specificity of phrenic nerve electrophysiology to predict mechanical ventilation in the Guillain-Barré syndrome. Muscle Nerve. 2023;68(2):191–197. https://doi.org/10.1002/mus.27918

45. Pasutharnchat N., Ratanasirisawad V., Santananukarn M., Taychargumpoo C., Amornvit J., Chunharas C. Sural-sparing pattern: A study against electrodiagnostic subtypes of Guillain-Barre syndrome. Clin Neurophysiol Pract. 2022;7:266–272. https://doi.org/10.1016/j.cnp.2022.09.001

46. Liu L., Ye Y., Wang L., Song X., Cao J., Qi Y., Xing Y. Nerve ultrasound evaluation of Guillain-Barré syndrome subtypes in northern China. Muscle Nerve. 2021;64(5):560–566. https://doi.org/10.1002/mus.27386

47. Mori A., Nodera H., Takamatsu N., Maruyama-Saladini K., Osaki Y., Shimatani Y., Kaji R. Sonographic evaluation of peripheral nerves in subtypes of Guillain-Barré syndrome. J Neurol Sci. 2016;364:154–159. https://doi.org/10.1016/j.jns.2016.03.042

48. Пирадов М.А., Супонева Н.А., Гришина Д.А., Гнедовская Е.В. Качество жизни и социальная адаптация пациентов после синдрома Гийена–Барре. Журнал неврологии и психиатрии им. С.С. Корсакова. 2013;8:61–67. https://www.mediasphera.ru/myfirst_app/issues/zhurnal-nevrologii-i-psikhiatrii-im-s-s-korsakova/2013/8/031997-72982013811 (доступ не ограничен).

49. Shang P., Feng J., Wu W., Zhang H.L. Intensive Care and Treatment of Severe Guillain-Barré Syndrome. Front Pharmacol. 2021;12:608130. https://doi.org/10.3389/fphar.2021.608130

50. Zaki H.A., Iftikhar H., Najam M., Masood M., Al-Marri N.D.R., Elgassim M., Fayed M., Shaban E.E. Plasma exchange (PE) versus intravenous immunoglobulin (IVIG) for the treatment of Guillain-Barré syndrome (GBS) in patients with severe symptoms: A systematic review and meta-analysis. eNeurologicalSci. 2023;31:100468. https://doi.org/10.1016/j.ensci.2023.100468

51. Nandeesha S.S., Kasagga A., Hawrami C., Ricci E., Hailu K.T., Salib K., Butt S. Treatment Efficacy of Plasmapheresis Versus Intravenous Immunoglobulin in Guillain-Barré Syndrome Management: A Systematic Review. Cureus. 2024;16(3):e57066. https://doi.org/10.7759/cureus.57066

52. Haridy N.A., Shehab M.M., Khedr E.M. Long-term outcomes of plasma exchange versus intravenous immunoglobulin for the treatment of Guillain-Barré Syndrome: A double-blind, randomized clinical trial. Restor Neurol Neurosci. 2023;41(5-6):203–217. https://doi.org/10.3233/RNN-231369

53. Bondi M., Engel-Haber E., Wolff J., Grosman-Rimon L., Bloch A., Zeilig G. Functional outcomes following inpatient rehabilitation of Guillain-Barré syndrome patients: Intravenous immunoglobulins versus plasma exchange. Neurorehabilitation. 2021;48(4):543–551. https://doi.org/10.3233/NRE-201640

54. Hughes R.A.C. Guillain-Barré syndrome: History, pathogenesis, treatment, and future directions. Eur J Neurol. 2024;31(11):e16346. https://doi.org/10.1111/ene.16346

55. Shastri A., Al Aiyan A., Kishore U., Farrugia M.E. Immune-Mediated Neuropathies: Pathophysiology and Management. Int J Mol Sci. 2023;24(8):7288. https://doi.org/10.3390/ijms24087288

56. Busl K.M., Fried H., Muehlschlegel S., Wartenberg K.E., Rajajee V., Alexander S.A., Creutzfeldt C.J., Fontaine G.V., Hocker S.E., Hwang D.Y., Kim K.S., Madzar D., Mahanes D., Mainali S., Meixensberger J., Sakowitz O.W., Varelas P.N., Westermaier T., Weimar C. Guidelines for Neuroprognostication in Adults with Guillain-Barré Syndrome. Neurocrit Care. 2023;38:564–583. https://doi.org/10.1007/s12028-023-01707-3

57. Bazaraa H.M., Rady H.I., Mohamed S.A., Rabie W.A., ElAnwar N.H. Initial Response and Outcome of Critically Ill Children With Guillain Barre’ Syndrome. Front Pediatr. 2019;7:378. https://doi.org/10.3389/fped.2019.00378

58. Bhagwat A.P., Sharath H.V., Warghat P.A. Effect of Paediatric Rehabilitation in Children With Guillain-Barré Syndrome: A Case Series. Cureus. 2024;16(5):e59815. https://doi.org/10.7759/cureus.59815

59. Пономаренко Г.Н. Физиотерапия: перспективы системного развития. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2017;94(6):59-64. https://doi.org/10.17116/kurort201794659-64

60. Arya N.P., Seth N.H., Raghuveer R., Sewani Y. Exploring the Efficacy of Physiotherapy in Guillain-Barré Syndrome Through Virtual Reality-Based Rehabilitation: A Case Report. Cureus. 2024;16(4):e59042. https://doi.org/10.7759/cureus.59042

61. Agnihotri S., Srivastava A., Gupta D., Naeem F. Rehabilitation of a Chronic Guillain-Barré Syndrome Patient With Vibratory Motor Stimulation of Dorsiflexors: A Case Report. Cureus. 2024;16(2):e53936. https://doi.org/10.7759/cureus.53936

62. Gawande I., Akhuj A., Samal S.. Effectiveness of Physiotherapy Intervention in Guillain Barre Syndrome: A Case Report. Cureus. 2024;16(1):e52062. https://doi.org/10.7759/cureus.52062

63. Kariya G., Salphale V.G., Dadgal R. Effectiveness of Symptomatic Physiotherapy in Enhancing the Psychological Parameters of a Patient With Guillain-Barré Syndrome: A Case Report. Cureus. 2024;16(3):e55389. https://doi.org/10.7759/cureus.55389

64. Uz F.B., Uz C., Karaahmet O.Z. Three-year follow-up outcomes of adult patients with Guillain-Barré Syndrome after rehabilitation. Malawi Med J. 2023;35(3):156–162. https://doi.org/10.4314/mmj.v35i3.4

65. Касьяненко К.В., Козлов К.В., Жданов К.В., Лапиков И.И., Беликов В.В. Прогноз степени тяжести течения SARS-CoV-2-инфекции у лиц молодого возраста с применением методов искусственного интеллекта. Журнал инфектологии. 2022;14(5):14–25. https://doi.org/10.22625/2072-6732-2022-14-5-14-25

66. Супонева Н.А., Мочалова Е.Г., Гришина Д.А., Пирадов М.А. Особенности течения СГБ в России: анализ 186 случаев. Нервно-мышечные болезни. 2014;(1):37–46. https://doi.org/10.17650/2222-8721-2014-0-1-40-47

67. Козырева А.А., Бембеева Р.Ц., Дружинина Е.С., Заваденко Н.Н. Синдром Гийена-Барре у детей. Журнал неврологии и психиатрии им. С.С. Корсакова. 2023;123(9-2):20–32. https://doi.org/10.17116/jnevro202312309220