Serial Serum Immunoglobulin G Levels and Correlation with Outcomes in Children with Guillain Barre Syndrome

Guillain-Barré Syndrome (GBS) has variable severity, inconsistent therapy response, and uncertain recovery. Intravenous immunoglobulins (IVIG) are used to treat this immune-mediated disorder. The authors investigated serial IgG levels and outcomes in IVIG-treated GBS patients.

This prospective observational study from July 2019 and December 2021 in a tertiary pediatric referral hospital included children ≤12 y with GBS diagnosis. Children with recurrent GBS or chronic neuromuscular disorders were excluded. All patients received IVIG (2 g/kg). Serum IgG levels were measured at enrolment, 2 wk, 4 wk, and 3 mo. IgG levels and change in IgG levels from baseline were correlated with outcome. The authors hypothesize that IgG levels before and after therapy may affect functional status outcomes [Medical Research Council (MRC) sum score, GBS disability score].

Seventy patients, median age 6.5 y, were enrolled. Acute motor axonal neuropathy predominated in nerve conduction studies (n = 46, 66%). Admission, 2 wk, 4 wk, and 3 mo median IgG levels were 10.1, 17.9, 13.0, and 9.9 g/L. At 2 wk, higher IgG levels and increments were associated with better functional status. Higher ΔIgG at 2 wk correlated with a shorter hospital stay (r = -0.381, p = 0.001). Lower levels of IgG (16.01 vs. 20.56, p = 0.006) and ΔIgG (6.83 vs. 10.03, p = 0.041) at 2 wk were associated with inability to walk independently at 3 mo.

The increase in serum IgG after IVIG therapy weakly correlates with GBS outcomes in children. A second IVIG dose for non-responders did not improve outcomes at 3 mo, suggesting unknown factors causing severe disease and poor recovery that need further studies.