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Guillain-Barré syndrome in children
1Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Guillain-Barré syndrome is a pediatric neurologic emergency causing rapid weakness. Early diagnosis and monitoring are crucial for preventing fatal outcomes in children, with treatments showing encouraging results.
Area of Science:
- Pediatric Neurology
- Clinical Neuroscience
Background:
- Guillain-Barré syndrome (GBS) is a critical pediatric neurologic emergency.
- It is the leading cause of acute, flaccid paralysis with areflexia in children.
- Differential diagnosis must exclude treatable conditions like tick paralysis and acute cord compression, and rarely, poliomyelitis.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and management of Guillain-Barré syndrome in children.
- To highlight the importance of early recognition and monitoring for potential respiratory and autonomic complications.
- To discuss current and emerging diagnostic modalities and treatment options.
Main Methods:
- Review of existing literature on childhood Guillain-Barré syndrome.
- Discussion of diagnostic tools including cerebrospinal fluid analysis, electromyography, anti-GM1 antibodies, MRI, and magnetic stimulation.
- Synopsis of treatment outcomes with plasmapheresis and intravenous immunoglobulin.
Main Results:
- Specific infections, such as Campylobacter jejuni, are identified as precursors.
- Cerebrospinal fluid evaluation and electromyography are typically diagnostic.
- Newer diagnostic modalities are under investigation for pediatric GBS.
- While most cases have benign courses, respiratory and autonomic monitoring is vital.
- Treatment with plasmapheresis or intravenous immunoglobulin shows encouraging results, though comparative pediatric studies are lacking.
Conclusions:
- Guillain-Barré syndrome in children requires prompt diagnosis and intensive monitoring.
- While specific precursor infections are recognized, diagnostic approaches are evolving.
- Current treatments like plasmapheresis and IVIg offer hope, necessitating further pediatric-focused research.
Abstract:
The Guillain-Barré syndrome is a pediatric neurologic emergency and the most common cause in children of rapidly evolving, usually flaccid, weakness with associated areflexia. Two treatable illnesses, namely tick paralysis and acute cord compression, demand immediate differential diagnosis. Rarely, poliomyelitis still mimics infantile Guillain-Barré syndrome. Specific precursor infections, such as Campylobacter jejuni, are now recognized to affect the clinical presentation of Guillain-Barré syndrome. Cerebrospinal fluid evaluation and electromyography are usually diagnostic; new modalities, such as anti-GM1 antibodies, magnetic resonance imaging, and magnetic stimulation, are being evaluated in childhood Guillain-Barré syndrome. Although most cases of Guillain-Barré syndrome have benign courses, all require initial respiratory and autonomic monitoring to prevent fatal outcomes. No well-controlled pediatric studies comparing plasmapheresis with intravenous immunoglobulin have occurred. Results of treatment with either modality are encouraging. A synopsis of these reports is included in this review.
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