Re-evaluation of different electrophysiological criteria for Guillain-Barré syndrome in a single cohort from China

Background and aims We aimed to compare electrophysiological subtypes of Guillain-Barré syndrome (GBS) in a single cohort from northern China using three criteria (Ho’s, Hadden’s, Rajabally’s), to clarify whether GBS subtypes are affected by electrophysiological criteria and nerve conduction studies (NCS) examination timing, to explore the value of sural sparing in subtype classification, and analyze the association between conduction block (CB) and short-term prognosis of Acute Motor Axonal Neuropathy (AMAN). Methods We retrospectively collected GBS patients hospitalized in the Department of Neurology, the Second Hospital of Hebei Medical University (Jan 2017–Jan 2022), who met Brighton diagnostic criteria and had complete NCS data. Patients were classified via three electrophysiological criteria (Ho’s, Hadden’s, Rajabally’s); we analyzed subtype distribution by NCS timing (1, 2, or ≥3 weeks post-onset) and used discharge Hughes Functional Grading Scale (HFGS) to assess short-term prognosis. Results A total of 262 patients were enrolled. AMAN was the main subtype (40.1% by Hadden’s, 46.6% by Ho’s, 59.5% by Rajabally’s criteria). Fleiss Kappa showed strong consistency among the three electrophysiological criteria ( κ = 0.75, p < 0.001); Subtype composition showed greater consistency at ≥3 weeks post-onset ( p > 0.05). Acute Inflammatory Demyelinating Polyneuropathy (AIDP)had higher sural sparing than AMAN (32.4%–50% vs. 0.9%–4%, p < 0.001). AMAN with CB had lower discharge HFGS ( p = 0.012). Serial NCS enhanced the accuracy of GBS subtype classification. Conclusion GBS electrodiagnosis depends on criteria and NCS timing (≥3 weeks more consistent). AMAN is predominant in our cohort from northern China regardless of criteria used. Sural sparing and serial NCS enhance subtype classification accuracy.