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Pediatric Guillain-Barré syndrome: Indicators for a severe course
Muhammet Ali Varkal1, Tuğçe Aksu Uzunhan1, Nur Aydınlı1
1Department of Pediatric Neurology, Istanbul Medical Faculty, Istanbul University, Fatih, Istanbul, Turkey.
Insights
Pediatric Guillain-Barré syndrome recovery is longer following gastrointestinal infections and with acute motor axonal neuropathy. Speech impairment may indicate a need for mechanical ventilation in these cases.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Guillain-Barré syndrome (GBS) is a rare autoimmune disorder affecting the peripheral nervous system.
- Pediatric GBS presents unique diagnostic and management challenges.
- Understanding factors influencing recovery is crucial for optimizing patient outcomes.
Purpose of the Study:
- To retrospectively analyze pediatric Guillain-Barré syndrome cases in a tertiary care setting.
- To identify clinical and electrophysiological factors associated with disease severity and recovery time.
- To evaluate the impact of preceding infections and specific GBS subtypes on patient outcomes.
Main Methods:
- Retrospective review of 40 pediatric GBS cases admitted between 2005-2011.
- Statistical analysis using Mann-Whitney U, Kruskal-Wallis, chi-square, and Fisher's exact tests.
- Classification of GBS subtypes based on nerve conduction studies (NCS).
Main Results:
- The mean age of patients was 5.4 years, with equal gender distribution.
- Preceding infections were identified in 80% of cases.
- Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the most common subtype (52.5%), followed by acute motor axonal neuropathy (AMAN) (35%).
- Recovery and walking times were significantly longer in patients with preceding gastrointestinal infections compared to upper respiratory tract infections.
- Patients with AMAN exhibited longer recovery times than those with AIDP.
- Speech impairment was observed in 6 patients, and 3 of these required mechanical ventilation.
Conclusions:
- Acute gastrointestinal infections and AMAN are associated with prolonged recovery in pediatric GBS.
- Speech impairment may serve as an early indicator for respiratory compromise and the need for mechanical ventilation.
- These findings highlight the importance of identifying specific infection triggers and GBS subtypes for prognostication and tailored treatment strategies.
Objectives:
This study aims to retrospectively evaluate pediatric Guillain-Barré syndrome cases in a tertiary center in Istanbul, Turkey.
Materials And Methods:
The data of 40 patients with Guillain-Barré syndrome who had been admitted to the Department of Pediatrics at the Istanbul University Medical Faculty between 2005 and 2011 were collected. Mann-Whitney U, Kruskal-Wallis, chi-square, and Fisher's exact tests were used for statistical analysis.
Results:
Mean patient age was 5.4 ± 3.0 years; 20 out of 40 patients (50%) were female and 20 (50%) were male. Preceding infection was detected in 32 cases (80%). Six patients had speech impairment. Out of eight patients with respiratory distress (20%), five required respiratory support (12.5%) of which three of them had speech impairment as well. According to nerve conduction studies, 21 patients (52.5%) had acute inflammatory demyelinating polyradiculoneuropathy, 14 (35%) had acute motor axonal neuropathy, and five (12.5%) had acute motor-sensory axonal neuropathy. Thirty-three patients (82.5%) received intravenous immunglobulin, 3 (7.5%) underwent plasmapheresis and 4 (10%) received both. Time until recovery (P = 0.022) and time until aided (P = 0.036) and unaided (P = 0.027) walking were longer in patients with acute gastrointestinal infection than in those with upper respiratory tract infection (P < 0.05). Time until response to treatment (P = 0.001), time until aided (P = 0.001) and unaided (P = 0.002) walking, and time until complete recovery (P = 0.002) were longer in acute motor axonal neuropathy cases as compared to acute inflammatory demyelinating polyradiculoneuropathy cases.
Conclusion:
Recovery was longer with acute gastrointestinal infection and acute motor axonal neuropathy. Speech impairment could be a clinical clue for the need of mechanical ventilation.
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