Outcome of Guillain - Barré Syndrome in Children
A prospective cohort study in a tertiary hospital in Upper Egypt
Keywords:
Guillain-Barré syndrome (GBS); Nerve conduction study; Intravenous immunoglobulin (IVIg)Abstract
Introduction: Guillain-Barré syndrome is the most common cause of acute flaccid paralysis in children, and defined as an acute inflammatory polyneuropathy. The objective of this study was to assess the clinico-laboratory profile, and outcome of Guillain-Barré syndrome in children at Sohag University Hospital.
Methods: This prospective cohort observational study was conducted in 2014-2015. The included children were subjected to through medical history and detailed systemic and neurological examination. Nerve conduction studies and cerebrospinal fluid analysis were done for all patients. Follow up was done at three and six months both clinically and by nerve conduction studies.
Results: This study included 50 patients (27 males / 23 females) with median age of 2.92 years. Upper respiratory tract infections were the most common antecedent infections (50%) and the neurological findings were weakness of both lower limbs and pain in all patients (100%) followed by sphincteric dysfunction (26%) while cranial neuropathies were found in 4%. Nerve conduction study revealed that acute inflammatory demyelinating polyradiculoneuropathy was found in 52% of cases, acute motor axonal neuropathy in 36% of cases, whereas acute motor-sensory axonal neuropathy was found in 6% of cases. The outcome was good in about 78% of cases, Hughes motor scale revealed that 58% were healthy, 18% had minor signs or symptoms, 12% walked without support, 6% walked with support, and 6% were bed ridden.
Conclusion: The outcome was favorable, although a minority of patients suffered neurological deficit. Immediate administration of intravenous immunoglobulin reduced mortality and disability.
References
Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med. 2012; 366(24): 2294-304. doi:
1056/NEJMra1114525. PMID: 22694000.
Asbury AK. New concepts of Guillain–Barre´ syndrome. J Child Neurol. 2000; 15(3): 183-91. doi:
1177/088307380001500308. PMID: 10757475.
Hughes RA, Cornblath DR. Guillain-Barré syndrome. Lancet. 2005; 366(9497): 1653-66. doi:
1016/S0140-6736(05)67665-9.
Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EF. Anticipating mechanical ventilation in
Guillain-Barre syndrome. Arch Neurol. 2001; 58(6): 893-8. doi: 10.1001/archneur.58.6.893.
Cosi V, Versino M. Guillain-Barre syndrome. Neurol. 2006; 27(Suppl.1): S47-51.
Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP. A prospective study of acute
idiopathic neuropathy. II. Antecedent events. J Neurol Neurosurg Psychiatry. 1988; 51(5): 613-8. doi:
1136/jnnp.51.5.613. PMID: 3404161, PMCID: PMC1033063.
Orlikowski D, Porcher R, Sivadon-Tardy V, Quincampoix JC, Raphael JC, Durand MC, et al. Guillain– Barré syndrome following primary cytomegalovirus infection: a prospective cohort study. Clin Infect Dis.
; 52(7): 837-44. doi: 10.1093/cid/cir074. PMID: 21427390.
Garssen MP, Van Koningsveld R, Van Doorn PA, Merkies IS, Scheltens-de Boer M, Van Leusden JA, et
al. Treatment of Guillain-Barre syndrome with mycophenolatemofetil: a pilot study. J Neurol Neurosurg
Psychiatry. 2007; 78(9): 1012-3. doi: 10.1136/jnnp.2006.102731. PMID: 17702789, PMCID:
PMC2117875.
Overell JR, Hsieh ST, Odaka M, Yuki N, Willison HJ. Treatment for Fisher syndrome, Bickerstaff’s
brainstem encephalitis andrelated disorders. Cochrane Database Syst Rev. 2007; 1: CD004761. doi:
1002/14651858.CD004761.pub2. PMID: 17253522.
Dodd CN, Romio SA, Black S, Vellozzi C, Andrews N, Sturkenboom M, et al. International collaboration
to assess the risk of Guillain Barré Syndrome following Influenza A (H1N1) 2009 monovalent vaccines.
Vaccine. 2013; 31(40): 4448-58. doi: 10.1016/j.vaccine.2013.06.032. PMID: 23770307.
Van Doorn PA. Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS). Presse Med. 2013;
(6 Pt 2): e193-201. doi: 10.1016/j.lpm.2013.02.328. PMID: 23628447.
Khandaker G, Zurynski Y, Buttery J, Marshall H, Richmond PC, Dale RC, et al. Neurologic complications
of influenza A(H1N1)pdm09: surveillance in 6 pediatric hospitals. Neurology. 2012; 79(14): 1474-81. doi:
1212/WNL.0b013e31826d5ea7. PMID: 22993280, PMCID: PMC4098823.
Ho TW, Mishu B, Li CY, Gao CY, Cornblath DR, Griffin JW, et al. Guillain-Barré syndrome in northern
China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. 1995; 118( Pt
: 597-605. doi: 10.1093/brain/118.3.597. PMID: 7600081.
Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, et al. Electrophysiological
classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma
Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol. 1998; 44(5): 780-8. doi:
1002/ana.410440512. PMID: 9818934.
Hughes RA. Treatment of Guillain-Barré syndrome with corticosteroids: lack of benefit? Lancet. 2004;
(9404): 181-2. doi: 10.1016/S0140-6736(03)15367-6.
Hughes RA, Swan AV, Van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome.
Cochrane Database Syst Rev. 2014; 9: CD002063. doi: 10.1002/14651858.cd002063.pub6.
Hughes RA, Newsome-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute
polyneuropathy. Lancet. 1978; 312(8093): 750-3. doi: 10.1016/S0140-6736(78)92644-2.
Hughes RA, Pritchard J, Hadden RD. Pharmacological treatment other than corticosteroids, intravenous
immunoglobulin and plasma exchange for Guillain–Barré syndrome. Cochrane Database Syst Rev. 2011;
(3): CD008630. doi: 10.1002/14651858.cd008630.pub2. PMID: 21412923.
Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain-Barre´ syndrome: a
systematic review and meta-analysis. Neuroepidemiol. 2011; 36(2): 123-33. doi: 10.1159/000324710.
PMID: 21422765.
Kalra V, Sankhyan N, Sharma S, Gulati S, Choudhry R, Dhawan B. Outcome in childhood Guillain-Barré
syndrome. Indian J Pediatr. 2009; 76(8): 795-9. doi: 10.1007/s12098-009-0125-y. PMID: 19381495.
Lee JH, Sung IY, Rew IS. Clinical presentation and prognosis of childhood Guillain-Barré syndrome. J
Paediatr Child Health. 2008; 44(7-8): 449-54. doi: 10.1111/j.1440-1754.2008.01325.x. PMID: 18557809.
Verma R, Chaudhari TS, Raut TP, Garg RK. Clinico-electrophysiological profile and predictors of
functional outcome in Guillain-Barre syndrome (GBS). J Neurol Sci. 2013; 335(1-2): 105-11. doi:
1016/j.jns.2013.09.002. PMID: 24064258.
Tekgul H, Serdaroglu G, Tutuncuoglu S. Outcome of axonal and demyelinating forms of Guillain-Barré
syndrome in children. Pediatr Neurol. 2003; 28(4): 295-9. doi: 10.1016/S0887-8994(02)00626-4. PMID:
Dahbour SS. Clinical experience with Guillain–Barre syndrome over a 6-year period in one hospital in the
Middle East. Jordan Med J. 2009; 43(4): 280-5.
Benamer HT, Bredan A. Guillain-Barré syndrome in Arab countries: a systematic review. J Neurol Sci.
; 343(1-2): 221-3. doi: 10.1016/j.jns.2014.05.065. PMID: 24950899.
Korinthenberg R, Schessl J, Kirschner J. Clinical presentation and course of childhood Guillain-Barre´
syndrome: a prospective multicentre study. Neuropediatrics. 2007; 38(1): 10-7. doi: 10.1055/s-2007- 981686. PMID: 17607598.
Ruts L, Drenthen J, Jacobs BC, Van Doorn PA. Distinguishing acute-onset CIDP from fluctuating
Guillain-Barré syndrome: a prospective study. Neurology. 2010; 74(21): 1680-6. doi:
1212/WNL.0b013e3181e07d14. PMID: 20427754. 28) AbdulJabbar MS. Pattern of Guillain–Barré syndrome in Saudi Arabia. J Trop Geogr Neurol. 1991; 1: 35-8.
Lin JJ, Hsia SH, Wang HS, Lyu RK, Chou ML, Hung PC, et al. Clinical variants of Guillain-Barré
syndrome in children. Pediatr Neurol. 2012; 47(2): 91-6. doi: 10.1016/j.pediatrneurol.2012.05.011. PMID:
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
