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How Different is AMAN from AIDP in Childhood GBS? A Prospective Study from North India
Pradeep Kumar Gupta1, Pratibha Singhi2, Sunit Singhi3
1Department of Pediatrics, Siddhi Memorial Hospital, Kathmandu, Nepal.
Insights
Children with acute motor axonal neuropathy (AMAN) experience more severe Guillain Barré syndrome (GBS) courses and slower recovery compared to acute inflammatory demyelinating polyneuropathy (AIDP). AMAN is linked to higher short-term morbidity.
Area of Science:
- Neurology
- Pediatrics
- Clinical Medicine
Background:
- Childhood Guillain Barré syndrome (GBS) is a rare autoimmune disorder affecting the peripheral nervous system.
- GBS presents with diverse subtypes, primarily axonal and demyelinating forms, impacting clinical presentation and prognosis.
- Understanding subtype-specific characteristics is crucial for effective management and predicting outcomes in pediatric GBS.
Purpose of the Study:
- To compare the clinical profiles of children diagnosed with axonal and demyelinating subtypes of GBS.
- To evaluate and contrast the short-term clinical outcomes between these GBS subtypes in pediatric patients.
- To identify distinct clinical features and recovery trajectories associated with acute motor axonal neuropathy (AMAN) versus acute inflammatory demyelinating polyneuropathy (AIDP) in children.
Main Methods:
- A prospective observational study was conducted in a North Indian tertiary care hospital.
- Consecutive pediatric GBS cases were recruited, and electrophysiological studies were performed to classify subtypes.
- Clinical data, including preceding infections, neurological deficits, and short-term outcomes, were systematically collected and compared between AMAN and AIDP groups.
Main Results:
- Out of 57 GBS patients, 19 had AMAN and 20 had AIDP. AMAN cases more frequently followed gastroenteritis, while AIDP followed upper respiratory infections.
- Specific symptoms like ataxia were unique to AIDP, whereas wrist drop, foot drop, and hyperreflexia were observed only in AMAN.
- AMAN patients exhibited higher rates of respiratory muscle involvement, artificial ventilation, and worse disability scores at discharge and follow-up, with slower recovery compared to AIDP patients.
Conclusions:
- Children with AMAN subtype of GBS demonstrate a more severe clinical course and greater short-term morbidity.
- Recovery is notably slower in pediatric patients with AMAN compared to those with AIDP.
- AIDP subtype is associated with a higher likelihood of achieving normalcy upon follow-up.
Objectives:
To compare the clinical profile and short-term outcome of children with axonal and demyelinating subtypes of childhood Guillain Barré syndrome (GBS).
Methods:
This is a prospective observational study conducted in a tertiary care teaching hospital in North India. Consecutive children with Guillain Barré syndrome were recruited to compare the clinical profile and short term outcome among the subtypes.
Results:
Among 9847 children admitted to the emergency, 95 had acute flaccid paralysis; 57 of whom had GBS. Electrophysiological studies were completed in 57; of whom 20 had acute inflammatory demyelinating polyneuropathy (AIDP); 19 had acute motor axonal neuropathy (AMAN); 12 had non-reactive nerves; five were unclassifiable; 1 had acute motor sensory axonal neuropathy (AMSAN). More children in AMAN group had preceding gastroenteritis (4 vs. 2), while AIDP group had upper respiratory infections (12 vs. 7). Ataxia was only seen in AIDP subtype while wrist drop, foot drop and hyperreflexia were seen only with AMAN subtype. Respiratory muscle involvement (6 vs. 3) and artificial ventilation (5 vs. 2) was more in AMAN. At discharge, children with AIDP were less likely to be non-ambulant (12 vs. 6, p = 0.036). Mean disability scores at hospital discharge (4.9 ± 1.2 vs. 4 ± 0.9, p = 0.015) and at last follow-up (0.7 ± 1.01 vs. 0.05 ± 0.2, p = 0.016) were higher in AMAN. Children with AIDP were more likely to achieve normalcy on follow-up (19 vs. 12, p = 0.023).
Conclusions:
Children with AMAN appear to have a more severe clinical course; higher short-term morbidity; and slower recovery than those with AIDP.
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