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[Prognostic factors for walking in childhood Guillain-Barré syndrome]
F Ortiz Corredor1, K W Mieth Alviar
1Departamento de Medicina Física y Rehabilitación, Instituto de Ortopedia Infantil Roosevelt, Universidad Nacional de Colombia. Bogota, Colombia. fortiz200@hotmail.com
Insights
In children with Guillain Barre syndrome (GBS), a lack of nerve electrical excitability and quadriceps muscle activity at day 10 indicates a longer recovery. Early signs of nerve response and muscle strength predict faster functional improvement.
Area of Science:
- Pediatric Neurology
- Clinical Electrophysiology
- Neuromuscular Disorders
Context:
- Guillain Barre syndrome (GBS) is a rare autoimmune disorder affecting children.
- Prognostic indicators in pediatric GBS are crucial for guiding clinical management.
- Understanding factors influencing recovery time is essential for patient and family counseling.
Purpose:
- To identify clinical and electrophysiological predictors of prognosis in pediatric Guillain Barre syndrome.
- To evaluate the association between nerve excitability, muscle strength, and recovery duration.
- To determine variables linked to prolonged recovery in children diagnosed with GBS.
Summary:
- This retrospective study analyzed 99 children with GBS, focusing on time to reach functional grade III (Hughes scale).
- Key predictors identified include electrical excitability of motor nerves and presence of quadriceps muscle activity on day 10 post-onset.
- Absence of nerve excitability and quadriceps activity independently correlated with extended recovery times.
Impact:
- Findings highlight the prognostic value of electrophysiological and early clinical assessments in pediatric GBS.
- Identified predictors can aid clinicians in anticipating recovery trajectories and tailoring interventions.
- This research contributes to a better understanding of GBS pathophysiology and its impact on pediatric recovery.
Aims:
The purpose of this study was to evaluate the clinical and electrophysiological variables that are linked to prognosis in Guillain Barre syndrome (GBS) in children.
Patients And Methods:
A retrospective cohort study was conducted on 99 children admitted to hospital after being diagnosed as suffering from GBS over a 3 year period. The time before reaching functional grade III on the Hughes scale was taken into account for the outcome, and the following factors were considered to be prediction variables: the electrical excitability of the motor nerves, the need for assisted ventilation, the presence of dysautonomia, age, the degree of maximum weakness on day 10 after the onset of the disease, cranial nerve involvement and origin (town or country).
Results:
Patients with an excitable pattern, i.e. the presence of an electrical response in at least one of the three motor nerves, at the onset of the disease reached functional grade III on Hughes scale 3.55 times (CI 95% 1.5 6.0) quicker than individuals with a non excitable pattern after adjusting the variable with the strength of the quadriceps and a electromyography study that revealed signs of denervation in the anterior tibial muscle. The clinical variable associated with a favourable prognosis was the presence of any kind of muscular activity in the quadriceps (muscular strength between 1 and 5), regardless of different degrees of strength. Thus, patients with some muscular activity in the quadriceps on day 10 after the onset of the disease reached functional grade III 3.6 times (CI 95% 1.8 7.1) quicker than those who did not present any activity (muscular strength= 0). No differences were found in the time the two physiopathological types, acute axonal neuropathy and demyelinating polyneuropathy, required to reach Hughes grade III.
Conclusion:
The absence of electrical excitability in the motor nerves and the absence of muscular activity in the quadriceps on day 10 of the disease are factors that are independently related to a prolonged recovery time in children with GBS.