Особливості маніфестації неврологічних симптомів гострих полінейропатій та їх диференційна діагностика в дітей при коронавірусній хворобі (COVID-19)

Abstract

The relevance of the problem of diagnosis and treatment of polyneuropathy in children is due to the diverse clinical manifestations of this pathology, which are often acute and can lead to severe, life-threatening complications. Guillain-Barré syndrome (GBS) refers to acute or subacute, often post-infectious, immune-mediated polyneuropathies accompanied by axonal damage to nerve trunks and peripheral nerves. The present study is devoted to the assessment of neurological symptoms in the acute course of GBS, including its differential diagnosis with musculoskeletal lesions in coronavirus disease (COVID-19) in childhood. Purpose - to determine the features of the debut and characterize the neurological symptoms of acute polyneuropathies in children, including GBS in COVID-19. Materials and methods. We examined 10 children with confirmed GBS. Clinical-anamnestic, general clinical, clinical-neurological, clinical-instrumental and clinical-laboratory methods of examination were used. Results. In 1 of the examined patients aged 6 years, GBS developed in the acute period of COVID-19 and manifested as acute flaccid paresis in the distal, and after 4 days - severe weakness of the thigh muscles in combination with leg pain. In 8 of the examined patients, the debut of GBS occurred within 7-21 days after an acute respiratory viral infection. Of these, 6 children had the acute phase of COVID-19 14-21 days before the onset of GBS, which was confirmed by the results of an oropharyngeal PCR-test. The acute phase of COVID-19 in these patients was manifested by fever up to 38.0º, ague, hyposmia, lasting from 3 to 5 days. Severe pain in the legs was noted in all patients with GBS. The absence of elevated levels of creatine phosphokinase, alanine aminotransferase, aspartate aminotransferase according to biochemical blood tests in patients and the absence of myoglobin in the urine excluded rhabdomyolysis of skeletal muscles. Electroneuromyography (ENMG) confirmed the neural type of lesion in the legs. Conclusions. In most patients, the debut of GBS occurred 3 weeks after the acute phase of COVID-19. Pain syndrome and symmetrical flaccid paresis were the leading symptoms of the course of GBS in children. Reduced excitation conduction velocity along the motor fibres of the tibial and peroneal nerves, according to the results of ENMG, allowed confirming the diagnosis of GBS. Differential diagnosis of GBS with musculoskeletal lesions, in particular, the exclusion of the diagnosis of rhabdomyolysis in COVID-19 in children, allowed for timely prescription of adequate therapy. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.