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Motor recovery after Guillain-Barré syndrome in childhood
Fernando Ortiz-Corredor1, Marta Peña-Preciado, Jorge Díaz-Ruíz
1Department of Physical Medicine and Rehabilitation, Universidad Nacional de Colombia and Instituto de Ortopedia Infantil Roosevelt, Colombia. foritzc@unal.edu.co
Insights
In children with Guillain-Barré syndrome (GBS), assessing muscular strength by day 10 is key for predicting gait recovery time. Quadriplegia also indicates a slower recovery in pediatric GBS patients.
Area of Science:
- Pediatric Neurology
- Neuromuscular Disorders
- Clinical Outcomes Research
Background:
- Guillain-Barré syndrome (GBS) is an autoimmune disorder affecting peripheral nerves, leading to muscle weakness and potential gait impairment.
- Understanding factors influencing recovery time is crucial for managing pediatric GBS cases and optimizing patient outcomes.
Purpose of the Study:
- To identify clinical factors that predict the duration of gait recovery in children diagnosed with Guillain-Barré syndrome.
- To establish prognostic indicators for motor function restoration in pediatric GBS.
Main Methods:
- Retrospective review of medical records for 215 children (under 15 years) admitted between 1991-2001.
- Independent variables included age, sex, cranial nerve impairment, ventilation needs, muscular strength at day 10, quadriplegia, and IVIG treatment.
- Major outcome measured was days to reach Hughes State III; statistical analyses included univariate, multiple linear regression, and Cox regression.
Main Results:
- Cranial nerve impairment, need for ventilation, quadriplegia, and non-excitable nerves were linked to delayed recovery in univariate analysis.
- While IVIG showed faster recovery in some cases (especially AIDP), its significance diminished in Cox regression.
- Muscular strength at day 10 and presence of quadriplegia were the strongest predictors of motor recovery time in multivariate analysis.
Conclusions:
- Muscular strength assessed on day 10 is the most significant clinical predictor for motor recovery prognosis in pediatric Guillain-Barré syndrome.
- Quadriplegia is strongly associated with significantly delayed recovery, highlighting its prognostic importance.
Purpose:
To determine the clinical factors that modify the recovery time for gait after Guillain-Barré syndrome (GBS) in childhood.
Method:
Medical records of patients admitted to Instituto de Ortopedia Infantil Roosevelt (IOIR) between years 1991 and 2001, were reviewed. Age, sex, cranial nerve impairment, requirement of assisted ventilation, number of days of assisted ventilation, muscular strength at day 10 of the disease, presence of quadriplegia, intravenous infusion of human gamma globulins (IVIG), were taken as independent variables. The number of needed days to reach Hughes State III was taken as the major outcome. First, univariate analysis was performed and with the factors that showed a statistically significant association with recovery time, multiple linear regression analysis and Cox regression were also performed.
Results:
Data of 332 children under 15 years old was collected. (Mean age: 7.1 years). A sample of 215 children was gathered for the study, all of them were regarded as functional states IV or V. Acute Motor Axonal Neuropathy (AMAN) was found in 30% of all cases. In the univariate analysis Cranial nerve impairment, requirement of assisted ventilation, presence of quadriplegia and presence of non-excitable motor nerves were associated with delayed motor recovery time. Patients who received IVIG reached Hughes state III faster than those who received only support treatment. This finding, that was more important in the presence of Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP), lost its value in the Cox regression analysis. In the multivariate analysis, muscular strength, assessed at day 10 of the disease was the most important predictor to determine motor recovery. The presence of quadriplegia was strongly associated with a delayed recovery time. Relative risk: 3.3 (95% Confidence Interval 2.1 - 5.2).
Conclusions:
Muscular strength at day 10 of the disease is the most useful clinical factor to determine prognosis of motor recovery in children who have suffered Guillain-Barré syndrome.
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