Guillain-Barré syndrome. A prospective clinical study in 25 children and comparison with adults
C Sarada1, J K Tharakan, M Nair
1Department of Neurology, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Insights
Pediatric Guillain-Barré syndrome (GBS) presents acutely, often with cranial nerve palsies. Children with GBS show a better prognosis than adults, with most achieving ambulation within a year.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Guillain-Barré syndrome (GBS) is a rare autoimmune disorder affecting the peripheral nervous system.
- Understanding pediatric GBS is crucial for effective management and prognosis.
Purpose of the Study:
- To prospectively study children diagnosed with Guillain-Barré syndrome.
- To compare the clinical course and outcomes of pediatric GBS with adult cases.
Main Methods:
- Prospective study of 25 children meeting GBS diagnostic criteria from 1982-1989.
- Clinical evaluation, disability grading (1-6), and tracking of clinical milestones.
- Comparison with 92 adult GBS patients seen during the same period.
Main Results:
- Children experienced a more acute onset (80% bedbound within 7 days) and higher cranial nerve palsy rates (76%) than adults.
- Respiratory paralysis (40%) and dysautonomia (20%) incidence were similar in both groups.
- At 1 year, 72% of children were ambulant versus poorer outcomes for adults; hyperacute pediatric GBS cases had better walking prognosis.
Conclusions:
- Pediatric Guillain-Barré syndrome has a distinct, acute presentation but a marginally better prognosis than adult GBS.
- Despite severe forms, children demonstrate a higher likelihood of functional recovery, particularly independent walking.
- Ventilated patients in both groups had a poor prognosis, highlighting the severity of GBS.
Abstract:
Children who fulfilled the recognized diagnostic criteria for Guillain-Barré syndrome (GBS) were studied prospectively from 1982. After detailed clinical evaluation and investigation, severity of disease was graded on a disability scale ranging from 1 to 6, and the time taken from the 1st day of illness to reach important clinical landmarks was noted. All children were monitored for a minimum of 1 year and observations on them were then compared with those on 92 adults with GBS seen during the same period. Twenty-five children, evenly distributed between the sexes, were seen between 1982 and 1989 and constituted 22% of all GBS patients seen during this period. Children had a more acute form of onset than adults, 80% becoming bedbound within 7 days, and a higher incidence of cranial nerve palsies (76% vs 55%). The incidence of respiratory paralysis was 40% and of dysautonomia 20%, which was similar to findings in adults. Children fared marginally better than adults: 72% were ambulant at 1 year, 12% bedbound and 16% decreased. The prognosis of ventilated patients was relatively poor in both groups, but children with the hyperacute form of the disease had twice the probability of adults to attain independent walking at 1 year (0.63 vs 0.33).
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