Locked-In Syndrome in Three Children With Guillain-Barré Syndrome

Abstract

We read with interest the case report by Dr. Medici et al. [ [1] Medici C. Gonzalez G. Cerisola A. Scavone C. Locked-in syndrome in three children with Guillain-Barré syndrome. Pediatr Neurol. 2011; 45: 125-128 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar ], in which locked-in syndrome owing to Guillain-Barré Syndrome was diagnosed in three patients. However, we should raise some concerns about the diagnosis of locked-in syndrome in Guillain-Barré syndrome. Here we refer to the first case as an example to argue against their diagnosis. Locked-In Syndrome in Three Children With Guillain-Barré SyndromePediatric NeurologyVol. 45Issue 2PreviewLocked-in syndrome is a rare disorder in childhood. It resembles brain death, but patients are fully conscious, and incapable of communicating because of the complete paralysis of voluntary muscles. Although it can be caused by Guillain-Barré syndrome, it is rarely reported in pediatrics. We describe three pediatric cases of locked-in syndrome in patients with Guillain-Barré syndrome presenting acute tetraplegia, areflexia, cranial nerve involvement, and albuminocytologic dissociation in the cerebrospinal fluid. Full-Text PDF ResponsePediatric NeurologyVol. 46Issue 4PreviewRegarding the remarks by Drs. Wang and Zhu on our report about three patients with Guillain-Barré syndrome presenting with locked-in syndrome, we offer two comments. First of all, Drs. Wang and Zhu considered locked-in syndrome a consequence of brain damage caused by a brainstem lesion in the central nervous system. By definition, locked-in syndrome is a state in which the patient is de-efferented, with paralysis of the four limbs and cranial nerves. Although it resembles coma or brain death, insofar as patients are incapable of communicating or responding to stimuli because of a complete paralysis of voluntary movements, they are not unconscious [1]. Full-Text PDF