[Pain in the Guillain-Barré syndrome in children]

In Guillain-Barré syndrome (GBS) painful involvement has not been considered as a major clinical manifestation for diagnostic criteria among children. Was to evaluate whether clinical our purpose painful sensations are the main manifestations in pediatric patients with GBS. Twenty patients that fulfilled the Asbury criteria for diagnosis of GBS were studied prospectively from January, 1992 to June, 1994. Painful sensations were evaluated considering segmentary level with special focus in intensity, modality, topography distribution from the beginning to the resolution of the paralysis and effect to analgesic therapy every day for the first week and weekly thereafter. Patients had a mean age of 9.6 years (SD 5.4). Twelve patients were males and eight were females. All the patients but one complained of pain during some time of the course of illness, (19/20, 95%). At the illness onset, pain sensations were spontaneously referred in 12/20 (60%) of the cases, after anamnesis in 3/20 (15%) and physical exam in 4/20 (20%). Pain distribution during acme occurred in feet, thighs and legs in 95% of patients; back, arms and forearms in 65%, buttocks, shoulders and hands in 35%. The highest intensity of pain took place the first week of the illness course, and the mean time of decreasing occurred with a median of three days after onset with complete resolution three weeks later. We report that pain was an early and main clinical manifestation of GBS in children. We suggest that pain must be considered as a relevant criterium for GBS diagnosis in pediatric patients.