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Initial Response and Outcome of Critically Ill Children With Guillain Barre' Syndrome
Hafez M Bazaraa1, Hanaa I Rady1, Shereen A Mohamed1
1Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
Severe pediatric Guillain-Barre syndrome (GBS) cases admitted to the ICU show a guarded response to initial treatments like plasma exchange (PE) or intravenous immunoglobulins (IVIg). Many children with GBS experience axonal neuropathy, impacting their recovery and outcomes.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neuromuscular Disorders
Background:
- Guillain-Barre syndrome (GBS) is a leading cause of acute flaccid paralysis globally.
- Severe GBS can necessitate intensive care unit (ICU) admission and mechanical ventilation.
Purpose of the Study:
- To evaluate pediatric patients with severe GBS admitted to the ICU.
- To assess the clinical course and treatment response to plasma exchange (PE) or intravenous immunoglobulins (IVIg).
- To determine the final outcomes in these critically ill children.
Main Methods:
- Enrolled children with severe GBS presenting with respiratory failure, bulbar involvement, or rapid paralysis progression.
- Administered initial treatment with PE (5 sessions) or IVIg.
- Assessed patient improvement, treatment failure, and functional outcomes at discharge.
Main Results:
- 40 children were included; 16 improved (40%), 2 died, and 22 (55%) showed initial treatment failure.
- Axonal neuropathy, rapid progression, and severe motor weakness predicted a poor treatment response.
- Favorable outcomes (unaided walking) were achieved in 22 cases (58%) at discharge.
Conclusions:
- Critically ill children with severe GBS have a high prevalence of axonal neuropathy.
- Initial therapies (PE or IVIg) yielded a guarded response in this cohort.
- While mortality is relatively low, functional recovery remains a significant challenge.
Abstract:
Background: Guillain-Barre syndrome is the most common cause of acute flaccid paralysis worldwide since the eradication of poliomyelitis. Severe cases may require intensive care and mechanical ventilation. Purpose: was to study pediatric patients with severe GBS requiring intensive care unit (ICU) admission, to assess their course and response to initial treatment modality plasma exchange (PE) or intravenous immunoglobulins (IVIg) and their final outcome. Methods: children with severe GBS who had either actual or impending respiratory failure, bulbar involvement or rapid progression of acute flaccid paralysis with trunk, upper limb and neck involvement within 24 h of the onset of weakness were enrolled. Results: 40 children were included. Following the initial treatment (33 subjects had 5 PE sessions each and IVIg in 7), 16 patients improved (40%), two died and 22 (55%) showed initial treatment failure. Axonal neuropathy, rapid progression and severe motor weakness significantly predicted poor response to therapy. At discharge, favorable outcomes (patient can walk unaided) were present in 22 cases (58%). Conclusion: Despite relatively low mortality, critically ill children with severe GBS have increased prevalence of axonal neuropathy and guarded response to initial therapy with PE or IVIg.
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