Cause Of Acute Flaccid Paralysis Research Articles

Clinical spectrum of acute flaccid paralysis among pediatric patients at the National Institute of Child Health, Karachi, Pakistan.

Objective: To evaluate the clinical spectrum and immediate outcomes of acute flaccid paralysis (AFP) in children presenting at National Institute of Child Health, Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Department of Pediatrics, NICH, Karachi, Pakistan. Period: August 2023 to January 2024. Methods: A total of 121 children of either gender, aged 1-15 years, and presenting with AFP were analyzed. AFP was diagnosed by nerve conduction study. Causes of AFP, like Guillian Barre Syndrome (GBS), transverse myelitis, traumatic neuritis were noted. Outcomes were noted in terms of discharged from hospital, left against medical advice, and mortality. Results: In a total of 121 children, 75 (62.0%) were boys. The mean age was 6.00±2.88 years, ranging between 1-12 years. There were 74 (61.2%) children who were fully vaccinated as per age. The most common cause of AFP were GBS, transverse myelitis, and hypokalemic paralysis, noted in 49 (40.5%), 19 (15.7%), and 15 (12.4%) children, respectively. Ninety (74.4%) children were discharged after the treatment, 10 (8.3%) left against medical advice, whereas mortality was noted in 21 (17.4%) children. Children leaving against medical advice were left out from the analysis to compared final outcomes with respect to various study variables. Incomplete vaccination status (p=0.0006), and presentation with sensory loss (p=0.0003) were found to have significant association with mortality. Conclusion: Guillian Barre Syndrome was found to be the most common cause behind acute flaccid paralysis in children. Incomplete vaccination history, and presenting with sensory loss were associated with poor outcomes.

When Guillain–Barré Syndrome Defies Expectations: A Case of Atypical Features

Abstract Guillain–Barré syndrome (GBS) is one of the most common causes of acute flaccid paralysis. In typical GBS, there are no central nervous system (CNS) features. GBS with prominent CNS involvement can be seen in uncommon variants of GBS (such as Miller Fisher Syndrome and Bickerstaff brainstem encephalitis [BBE]) or rarely, when it coexists with other conditions such as acute disseminated encephalomyelitis (ADEM). We report a case of a 35-year-old male who presented with fever followed by ascending lower motor neuron type paraparesis suggestive of GBS which progressed rapidly to involve the respiratory muscles necessitating invasive mechanical ventilation. The patient had many atypical features, namely, persistent fever, early bladder and bowel involvement, facial twitching, ophthalmoplegia with ptosis, and a comatose state. Based on these clinical features and the investigations done, a diagnosis of GBS with BBE with a possibility of ADEM was made. The patient was managed intensively, but there was no improvement in the neurological manifestations and the patient succumbed to the illness due to ventilator-associated complications.

Rise Of Guillain Barre Cases Associated With Campylobacter Jejuni Infection In Mexico 2024

Guillain-Barré syndrome is an autoimmune neurological disease that is currently the leading cause of acute flaccid paralysis in first and second level hospitals in Mexico, usually with a history of precursor infection by Campylobacter Jejuni described as gram- negative, aerobic and motile bacilli bacteria. In Mexico, an epidemiological alert was launched on March 5, 2024, which refers to an increase in cases of Guillain-Barré with a high suspicion of a previous infection by Campylobacter Jejuni, this in the state of Tlaxcala, Mexico. As of March 29, 2024, 81 cases of acute flaccid paralysis have been reported, of these, 42 cases have been positive for Campylobacter Jejuni bacteria and 34 have been classified as Guillain-Barré syndrome, and four deaths associated with this condition have been reported.

Thirteen-year surveillance results of acute flaccid paralysis cases in Southeast Turkey and the effect of refugee movements on surveillance results.

Acute flaccid paralysis (AFP) is a major neurological problem. Turkey has accepted over 4 million refugees since 2011 due to the wars in neighbouring countries. In the long term, refugees can have adverse effects on the limited resources of health, sanitation, water supply, foodstuff, and shelter services of host countries, precipitating the transmission and spread of enteroviruses causing AFP. This study examines the 13-year surveillance and incidence of AFP cases in southeast Turkey, and questions possible impact of refugee movements on these parameters, comparing the periods before (2007-2010) and after (2011-2019) 2011, when the refugee movements emerged. The records of cases reported from southeast part of Turkey with suspected AFP between January 2007 and December 2019 were reviewed retrospectively. Of the patients, 121 (58.5%) were male. Mean age was 80.36 ± 46.67 months. Eighty-five (41.1%) were aged 60 months or younger. The number of patients under 60 months increased significantly after 2011. Mean incidence was calculated as 0.88 cases/100,000 person years versus 1.58 cases/100,000 person years in the period before and after 2011, respectively. Guillain-Barré syndrome (GBS) was the most common cause of AFP in both periods. As of 2011, however, the incidence of acute transverse myelitis increased approximately 4 times and GBS decreased proportionally. Non-polio enteroviruses were the most frequent isolates, detected from 9.1% of stool samples. Although refugee movements appear to may have adverse effects on AFP incidence and surveillance outcomes, larger studies involving the whole country, particularly at places where no refugees settled, are needed to achieve more conclusive evidence.

Mimics of Guillain-Barré Syndrome in Pediatric Patients Admitted to the Neuro-Intensive Care Unit of a Tertiary Care Hospital-A Case Series.

Guillain-Barré syndrome is the most common cause of acute flaccid paralysis in children, but several diseases mimic GBS. We aimed to identify and report the clinical pointers and battery of tests required to differentiate Guillain-Barré syndrome from its observed mimics in the pediatric population admitted to our neuro-critical care unit. We conducted a retrospective record analysis of all pediatric patients admitted over ten years from 2008-2018, whose initial presentation was compatible with a clinical diagnosis of GBS. Eighty-three patients were at first treated as GBS, of which seven (8.4%) were found to have an alternate diagnosis-three cases of paralytic rabies, one case each of acute disseminated encephalomyelitis, cervical myeloradiculopathy, neuromyelitis optica, and a case of community-acquired Staphylococcus aureus pneumonia associated sepsis. Neurophysiological and neuro-virological testing, central nervous system imaging, and sepsis screening helped to confirm the alternate diagnosis. Our case series provides knowledge of subtle clinical differences along with the mindful use of diagnostic testing to facilitate the accurate diagnosis of GBS mimics.

Differential diagnosis of acute flaccid paralysis in children with Guillain—Barré syndrome and neuromyelitis optica spectrum disorder: Clinical cases

Background. Acute flaccid paralysis is a clinical syndrome characterized by a sudden onset of weakness in one or more limbs with decreased or absent tendon reflexes in the affected limbs. This condition may be a manifestation of such pathologies as Guillain-Barré syndrome and neuromyelitis optica spectrum disorder. Clinical cases description. We describe two clinical cases of Guillain-Barré syndrome in patient M., 7 years old, and neuromyelitis optica spectrum disorder in patient D., 3 years old. In both children, the main clinical manifestation was acute flaccid paralysis. Patient M. was admitted to the Neurological Department of the Moscow Regional Center for Maternity and Childhood Protection with complaints of sharp pronounced weakness in the limbs, inability to walk. According to the disease history, the patient had an acute respiratory viral infection in October 2022. The conducted neurologic examination revealed decreased muscle tone and muscle strength in all limbs, absence of reflexes from the lower limbs. A liquor test was conducted, which revealed increased protein contents. Electroneuromyography detected a pronounced axonal lesion of all motor fibers in the arms and legs. The formulated diagnosis was “Guillain-Barré syndrome, variant of acute motor axonal neuropathy.” The treatment with plasmapheresis and intravenous immunoglobulins showed positive dynamics. In the second case, patient D. was admitted to the Pediatric Infectious Disease Department of Naro-Fominsk Hospital with similar complaints of sharp weakness in the limbs. Neurological examination showed a diffuse decrease in muscle tone, absence of reflexes from all limbs. Elevated protein contents were determined in the liquor. MRI of the cervical spinal cord showed myelitis of segments C3–C7. Negative antibodies to aquaporin-4 were found. The patient was treated with ceftriaxone, methylprednisolone, and plasmapheresis. Then he was transferred to the Neurological Department of the Moscow Regional Center for Maternity and Childhood Protection, where a repeated MRI of the cervicothoracic spinal cord revealed, in addition to myelitis at the level of C3–C7, a lesion of segments from the level of C2 to the medulla oblongata. The formulated diagnosis was “Neuromyelitis optica spectrum disease, seronegative form. Flaccid tetraparesis.” The continued treatment with prednisolone and intravenous immunoglobulin produced positive effect. Conclusion. The presented clinical cases will help neurologists to improve timely diagnosis and treatment of causes of acute flaccid paralysis in children, thereby reducing possible complications, disability, and mortality.

¿Guillain Barre syndrome and inadequate secretion of antidiuretic hormone, is their relationship possible?

Guillain-Barré syndrome (GBS) is a polyradiculoneuropathy of acute onset and the most common cause of acute flaccid paralysis. It is characterized by the appearance of sensory and/or motor symptoms, accompanied by a decrease or absence of muscle stretch reflexes and other symptoms such as facial paralysis, altered eye movements, bulbar symptoms, altered wakefulness, dysautonomia and ataxia. On the other hand, hydroelectrolyte disorders are associated with serious neurological diseases as a poor prognostic factor; the most affected electrolyte is sodium; in fact, hyponatremia is the most common disorder in hospitalized patients, regardless of the cause; in GBS, it is a frequent finding on admission. It is important to recognize hyponatremia, due to its high morbidity and mortality; it is also a marker of an underlying disease. Syndrome of inappropriate secretion of antidiuretic hormone (SSIADH) is the most common cause of hyponatremia and has been associated with Guillain Barre syndrome; in this way, its diagnosis is a challenge for the doctor; finally, below we describe details of a 70-year-old male patient who was admitted to the intensive care unit, with hyponatremia with a SSIHAD, with good subsequent evolution.

CLINICAL OUTCOME OF GUILLAIN BARRE SYNDROME IN THE INTENSIVE CARE UNIT OF A PEDIATRIC TERTIARY CARE HOSPITAL

Since poliomyelitis was eradicated, Guillain-Barre syndrome has been the leading cause of acute flaccid paralysis globally. Critical care and mechanical breathing may be necessary in extreme circumstances. Among paediatric patients hospitalized in the intensive care unit of a Karachi tertiary hospital, we aimed to quantify the incidence of Guillain-Barré Syndrome clinical outcomes. Cardiology Intensive Care Unit (NICH) in Karachi, Pakistan. January 9, 2020, to July 10, 2020—six months. Children admitted to the intensive care unit at NICH with GBS, as defined operationally, ranging in age from six months to twelve years, were included in the study. They stimulated the posterior tibial nerve (PTN) and common peroneal nerve (CPN), allowing for studying motor nerve conduction and using the median and ulnar nerves to measure compound muscle action potentials' onset delay, amplitude and conduction velocity (CMAPs). Research on the conduction of sensory nerves was carried out to quantify SNAPs in the sural, median, and ulnar regions. All patients were given intravenous immunoglobulin for five days at a 400 mg/kg/day dosage, as per the protocol. Clinical outcomes were evaluated using the HFG scale at discharge and four weeks. The average patient age was 5.81 ± 3.26 years out of 30. Thirteen men (43.3%) and seventeen females (56.7%) were present. Fifteen patients (53.3%) had a history of upper respiratory illness, while seven (23.3%) had a history of gastrointestinal infection. A mean HFG score of 3.03 ±1.90 was recorded. Outcomes were good for 21 patients (56.7%) and deficient for 9 (43.3%). A tertiary care hospital in Karachi reported that 56.7% of children admitted with Guillain-Barre Syndrome had good clinical results in the intensive care unit.

PEDIATRIC GUILLAIN-BARRÉ SYNDROME IN MÉXICO CLINICAL FEATURES BEFORE AND DURING SARS-COV-2 PANDEMIC

Introduction: Guillain-Barré Syndrome is the most common cause of acute flaccid paralysis in childhood. It is a post infectious disease immune-mediated with a rapidly progressive course, usually without relapse. The main features are progressive weakness of more than one limb, areflexia or hyporeflexia, which gets progressively worst over days-to-weeks, to potentially life-threatening severity requiring mechanical ventilation. Objective: We aimed to describe the clinical features of pediatric Guillain-Barré Syndrome in México before and during SARS-CoV-2 pandemic. Methods: We performed an ambispective, observational, cross-sectional study in a Mexican reference hospital from January 2013 to December 2021. Data were obtained through records: demographic, clinical, laboratories, neurophysiological variants and treatment. Results: Here we show that of the 96 patients, 55 were males with mean age of 9 years, 72% had history of infection; progressive weakness was present in 97%, areflexia/hyporeflexia 97%, progression of symptoms 99%, mean cells of 9/mm3 and mean proteins 88 mg/dL. Admission to Pediatric Intensive Care Unit was 20%. Acute Motor Axonal Neuropathy was the most frequent subtype. Nineteen patients required mechanical ventilation. Immunoglobulin was administered in 88%. Most frequent Disability Score at discharge was bedridden/wheelchair-bound. During 2020-2021 we found two SARS-CoV-2 cases and one associated with BNT162b2 vaccine. Conclusions: Our results demonstrate that clinical features of pediatric Guillain-Barré Syndrome are similar before and during SARS-CoV-2 pandemic, nevertheless the number of cases associated with SARS-CoV-2 infection did not find increase.

Aetiology, Clinical Presentation and Outcome of Patients Presenting with Acute Flaccid Paralysis in a Tertiary Care Hospital

Objective: To determine the aetiology, clinical presentation and outcome of patients presenting with acute flaccid paralysis.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Pediatric Medicine, Agha Khan Hospital, Karachi Pakistan, from Jan 2015 to Dec 2019.
 Methodology: Medical record of 150 children fulfilling the selection criteria were selected. The clinical presentations of the patient were recorded in terms of the following: fever, cough, vomiting, weakness, difficulty in swallowing, altered sensorium, changes in heart rate and blood pressure and difficulty in breathing. The outcome of children with acute flaccid paralysis, i.e. clinical improvement in symptoms, complete recovery or death during the hospital stay, was noted. 
 Results: The mean age of patients was 10.13±5.01 years. The most common disease at presentation was Guillain bare syndrome 55(36.7%), followed by viral myositis 37(24.7%). Weakness was noted in all patients (100%), fever and headache in 64(42.7%), vomiting in 25(16.7%), and difficulty in breathing in 19(12.7%). After treatment, some improvement was noted in 104(69.3%) cases, while 27(18.0%) patients had no improvement; residual neurological disability was noted in 19(12.7%) cases, and 3(2.0%) died during follow-up.
 Conclusion: Acute Flaccid Paralysis (AFP) in children is a big challenge for physicians, and Guillian Barre Syndrome is the most common cause of acute flaccid paralysis in children. It almost invariably presents with weakness of the body. Keywords: Acute flaccid paralysis, Aetiology, Clinical presentation, Residual neurological disability.

CLINICAL AND ETIOLOGICAL PROFILE OF ACUTE FLACCID PARALYSIS IN CHILDREN

Objective: This study was conducted to determine the clinical characteristics and differential diagnosis of individual cases of acute flaccid paralysis (AFP) reporting to tertiary care teaching hospital of Jaipur. Methods: This prospective observational study was conducted among patients attending outdoor, indoor, and neurology clinics with provisional diagnosis of AFP. The diagnosis was based on the available clinical data, vaccination status, and laboratory results (stool examination, arterial blood gas analysis, thyroid profile, serum electrolytes, electrophysiological studies, cerebrospinal fluid analysis, urinary pH, and imaging). Results: A total of 60 patients were evaluated over a study duration of 1 year. About 81.7% were male. Most common presenting complaint was lower-limb weakness (100%). None of the cases were identified as acute poliomyelitis or polio-compatible. Guillain–Barré syndrome (GBS) was the most common cause of non-poliovirus AFP (75%). Most common nerve conduction velocity findings in our study were bilateral motor axonal affection of common peroneal nerve (55%). Conclusion: The most common cause of AFP was GBS in all age groups. No case was diagnosed as poliomyelitis. All of the patients of GBS had progressive muscle weakness in a roughly symmetrical distribution, with areflexia of lower limbs.

Impact of infections on the incidence of acute inflammatory demyelinating polyneuropathy in children

AbstractObjectivesAcute inflammatory demyelinating polyneuropathy (AIDP) is the leading cause of acute flaccid paralysis in children and hypothesized to be triggered by antecedent infection. We sought to determine the association between AIDP and commonly acquired community infections in children. We utilized the reduction in these infections due to measures during coronavirus disease 2019 (COVID‐19) to serve as a natural experiment and determine their contribution to AIDP.MethodsThis cross‐sectional study used administrative and billing data from children's hospitals contributing to the Pediatric Health Information System. We included hospitalizations of children with a diagnosis of AIDP from (January 2017 through February 2021). Encounters for infection‐ (including respiratory, gastrointestinal, and COVID‐19) related diagnoses were measured as a marker of community incidence.ResultsA total of 1111 index encounters for AIDP were included. Pre‐COVID‐19, AIDP was not associated with respiratory or gastrointestinal infections, specifically, influenza or campylobacter. During the COVID‐19 period from March 2020 to February 2021, respiratory, gastrointestinal, and influenza infections decreased compared to expected (for the same time of year pre‐COVID‐19) by 59.6%–90.1%, 51.5%–68.9%, and 54.5%–97.9%, respectively. In contrast, AIDP hospitalizations and all hospitalizations only decreased by 11.5%–39.3% and 14.2%–25%, respectively. COVID‐19 was not positively associated with AIDP overall or at individual hospitals.InterpretationCommon community‐acquired infections including COVID‐19 were not strongly associated with hospitalizations for AIDP in children. AIDP persisted despite the dramatic reduction in infection‐related encounters during the pandemic. These results suggest that recent antecedent community‐acquired infections were not the primary driver of AIDP and that alternative triggers should be explored.

Pediatric acute flaccid myelitis: Evaluation of diagnostic criteria and differentiation from other causes of acute flaccid paralysis.

Acute flaccid paralysis (AFP) is characterized by rapidly progressive limb weakness with low muscle tone. It has a broad differential diagnosis, which includes acute flaccid myelitis (AFM), a rare polio-like condition that mainly affects young children. Differentiation between AFM and other causes of AFP may be difficult, particularly at onset of disease. Here, we evaluate the diagnostic criteria for AFM and compare AFM to other causes of acute weakness in children, aiming to identify differentiating clinical and diagnostic features. The diagnostic criteria for AFM were applied to a cohort of children with acute onset of limb weakness. An initial classification based on positive diagnostic criteria was compared to the final classification, based on application of features suggestive for an alternative diagnosis and discussion with expert neurologists. Cases classified as definite, probable, or possible AFM or uncertain, were compared to cases with an alternative diagnosis. Of 141 patients, seven out of nine patients initially classified as definite AFM, retained this label after further classification. For probable AFM, this was 3/11, for possible AFM 3/14 and for uncertain 11/43. Patients initially classified as probable or possible AFM were most commonly diagnosed with transverse myelitis (16/25). If the initial classification was uncertain, Guillain-Barré syndrome was the most common diagnosis (31/43). Clinical and diagnostic features not included in the diagnostic criteria, were often used for the final classification. The current diagnostic criteria for AFM usually perform well, but additional features are sometimes required to distinguish AFM from other conditions.

Clinical and biochemical features of hypokalemic paralysis: a study from rural Eastern India

BackgroundHypokalemic paralysis is characterized by episodic attacks of flaccid muscle weakness of variable duration and severity associated with hypokalemia. Overall, there is a scarcity of data regarding hypokalemic paralysis from Indian subcontinent particularly from rural areas.MethodsA total of 50 consecutive patients of hypokalemic paralysis who were admitted in our hospital were recruited in this study.ResultsFifty patients of hypokalemic paralysis were admitted to our department over a period of 4 years. Forty-two (84%) patients presented with classic acute onset quadriparesis, while eight patients had atypical presentation. Five patients had paraparesis, two had hemiparesis and one patient presented with isolated neck muscle weakness without any limb weakness. Thirty-two patients had primary hypokalemic periodic paralysis (HoPP) and 18 had secondary hypokalemic paralysis. There was no significant difference in severity of weakness (p = 0.53), number of episodes of weakness (p = 0.66) and serum CPK levels (p = 0.36) between primary and secondary hypokalemic paralysis. Secondary cases required significantly prolonged time for recovery as well as higher potassium supplements as compared to the primary HoPP. The severity of weakness of proximal muscles measured in MRC grading showed a significant correlation with serum potassium levels (p = 0.010), but did not show any correlation with CPK Levels (p = 0.86).ConclusionHypokalemic paralysis is an important cause of acute flaccid paralysis in the Emergency Room that often improves dramatically with potassium supplements. While secondary cases often require treatment of underlying etiology, primary hypokalemic paralysis often requires chronic treatment with acetazolamide and/or potassium-sparing diuretics.

Retrospective evaluation of Guillain-Barre syndrome in children: Asingle-center experience.

Although Guillain-Barré syndrome (GBS) is now the most common cause of acute flaccid paralysis in children, information on the long-term follow-up of GBS is still limited. Identification of prognostic factors can play an important role in treatment strategies and the follow-up of patients. This study aimed to evaluate the effectiveness of monitoring the GBS disability score (DS) in predicting morbidity and mortality. The patients were separated into two groups those with DS≥ or <3 on admission. These groups were compared in respect of demographic data, clinical and laboratory findings, and the DS recorded on admission and at first, third, sixth, 12th, and 24th months. The study included 44 patients (54.5% male, 45.5% female) with a median age of 5 years. The most common involvements during the disease were weakness, ataxia, neuropathic pain, cranial neuropathy, respiratory distress, autonomic dysfunction, and psychiatric symptoms, respectively. In patients with a DS of ≥3, the time from onset of symptoms to hospital admission was shorter, and the length of hospital stay was longer. Children with back pain and autonomic dysfunction had a DS of ≥3. A high 3-month DS was found to be a significant predictor for the development of sequelae. Although progressive muscle weakness and inability to walk are the most common symptoms of GBS, it should be kept in mind that atypical manifestations such as hemiplegia and ophthalmoplegia may also occur. For an objective assessment of clinical improvement during follow-up, the DS for motor functions can be used.

Acute Flaccid Paralysis in Australian Children from 2007 to 2017

Introduction: Acute flaccid paralysis (AFP) surveillance continues globally as part of the World Health Organization’s goal to eradicate poliomyelitis. The Australian Paediatric Surveillance Unit (APSU), Paediatric Active Enhanced Disease Surveillance (PAEDS) network, and National Enterovirus Reference Laboratory (NERL) collaborate in AFP surveillance in Australia, capturing and reviewing cases of AFP for all aetiologies in order to exclude poliovirus. We aimed to describe the AFP epidemiology in childhood over an 11 year period. Methods: Data were reported nationally by paediatricians via prospective APSU surveillance, PAEDS surveillance nurses at five tertiary paediatric hospitals and NERL from 2007 to 2017. Children aged 0–15 years with AFP were included. We combined APSU, PAEDS, and NERL datasets, analysed epidemiological trends, and described clinical features and investigations for major diagnoses. Results: Of 590 AFP-compatible cases, 49% were male; 47% were aged 0–4 years, 9% aged <1 year. Annual incidence of AFP was 1.3 cases per 100,000 children aged <15 years. Lower limb paralysis was the most frequent presenting symptom. The most frequent diagnoses were Guillain-Barre syndrome (GBS; 36%), transverse myelitis (TM; 17%), and acute disseminated encephalomyelitis (ADEM; 15%). No secular trend was seen in frequency of AFP cases nor amongst major diagnoses. Seasonality was observed with ADEM occurring more frequently in winter. We observed periods of increased AFP frequency in 2013 and 2016, coinciding with increased reporting of non-polio anterior horn cell disease (AHCD) and detection of non-polio enterovirus (NPEV). Conclusions: Estimated incidence of GBS, ADEM, and TM in Australian children was comparable with international rates. There was stable incidence of AFP in Australian children between 2007 and 2017. GBS, ADEM, and TM are the major causes of AFP. We observed clustering of cases associated with NPEV that emphasises a need for ongoing vigilance in surveillance given continue emerging infectious disease threats.

The rehabilitation management in children with Guillain-Barré syndrome

Introduction: Guillain-Barré syndrome (GBS) is a rare condition that is the most common cause of acute flaccid paralysis in children. It is an acquired syndrome characterized by gradual, symmetrical, proximal and distal tingling and weakening. The purpose of this case report is to report a case of GBS focused on rehabilitation management. Case: An eighth years old girl patient was referred to the emergency room complaining of weakness in both leg and arm. She was admitted to the intensive care unit and given intravenous immunoglobulin. After the condition was stable, the patient planned for exercise rehabilitation. Conclusion: Rehabilitation therapy is essential in children with GBS to improve patients' quality of life

Pediatric rehabilitation post Guillain-Barré syndrome: a case report at Federal Medical Centre, Abeokuta

Guillain-Barre syndrome (GBS), a lower motor neuron autoimmune disease, primarily damages the myelin sheaths of the peripheral nervous system. Around the world, it is the main cause of acute flaccid paralysis. This case study's aim was to outline the physical therapy interventions provided to a patient at the Federal Medical Center in Abeokuta (FMCA) who was diagnosed of GBS. An 8-year-old child who arrived at the children emergency unit complaining of weariness, a headache and difficulty walking. This patient had physiotherapy interventions, which included free active exercises for the upper and lower limbs, grip strengthening and passive movements to all joints. Resisted active exercises and bridging was also incorporated. Patient was able to do standing and walking re-education at week 5th and 10th week respectively. Following physical therapy rehabilitation, the patient demonstrated improvements with range of motion (ROM), strength, balance, ambulation and endurance. Early referral for physical therapy, clinical compliance, commitment to home programme exercises, and support from family were all proven to significantly improve recovery.

Children with Guillain-Barre Syndrome: A Comparison between AIDP and AMAN variants among Patients admitted in a Tertiary Care Hospital

Background: Guillain-Barre syndrome (GBS) is the leading cause of acute flaccid paralysis in children. This study was aimed to compare the clinical spectrum and shortterm outcome of children with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) subtypes of GBS in children. Methods: The study was a prospective cohort study done in a tertiary neurology hospital for 3 years. Children under 18 years of age fulfilling the Brighton diagnostic criteria for GBS were enrolled in the study. Based on the nerve conduction study, patients were subclassified as AIDP, AMAN, AMSAN, and others. Finally, a comparison was done in children with AIDP and AMAN subtypes. Results: A total of 102 children have fulfilled the Brighton diagnostic criteria of GBS during that study period. Among them, 83 children were included in the final analysis as NCS findings suggestive of AIDP and AMAN were found in 29(28.43%) and 54(52.94%) of cases respectively. No patient died in this cohort and follow-up was done at 3 months after discharge. A comparison of clinical data between the two groups revealed similar clinical features in most of the cases. The mean age difference between the two groups was statistically significant and AIDP was found to be more frequent in the 1-5 years age group. There was a significant association between gastroenteritis and AMAN subtypes. On symptom analysis, pain and tingling sensation were found predominantly in AMAN subtypes. Children having AMAN variants developed respiratory distress more than AIDP. Assisted ventilation were needed in 14.45% of cases and the majority of them were from the AMAN group. The mean duration of hospital stay and the mean disability scores at three months after discharge were significantly higher in the AMAN group. Conclusions: AMAN was the commonest GBS subtypes in children. AIDP was more frequent in the younger age group. Children with AMAN appeared to have higher short-term morbidity and slower recovery than those with AIDP. Bang. J Neurosurgery 2022; 11(2): 94-100

Assessment of neurological sequelae and new-onset symptoms in the long-term follow-up of paediatric Guillain-Barre syndrome: A longitudinal study from India.

Guillain-Barre syndrome (GBS) is the commonest cause of acute flaccid paralysis in children. There is a paucity of studies that assess the long-term outcome of paediatric GBS. To assess the frequency of neurological sequelae and the new-onset symptoms in the long-term follow-up of paediatric GBS and to identify the risk factors associated with them. This longitudinal study involved 78 children with GBS treated between January 2015 and 2021. The parents of those children were contacted to visit the hospital for a detailed neurological examination and to look for new-onset symptoms after the initial treatment for GBS. Of the 78 children, acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, and acute motor-sensory axonal neuropathy variants were observed in 30 (38.5%), 27 (34.6%) and 11 (14.1%) children, respectively. The median (interquartile range (IQR)) duration of follow-up was 3 (2, 4.5) years. The median (IQR) time to independent ambulation was 30 (13.5, 105) days. The neurological sequelae were found in 22 (28.2%) children. GBS disability score at admission (odds ratio (OR)=4.6; 95% confidence interval (CI): 1.1-19.8; P=0.04) and axonal variant of GBS (OR=4.1; 95% CI: 1.5-20.8; P=0.04) were found to be independent predictors of neurologic sequelae. A total of 28 children experienced new-onset symptoms after GBS, with frequent falls while running and fatigue being the predominant symptoms. Those children with demyelinating variant achieved independent ambulation earlier than the axonal group on survival analysis (log-rank P value=0.04). The presence of neurological sequelae and new-onset symptoms were found in 28.2 and 35% of the GBS children, respectively. High GBS disability score at admission and axonal variant of GBS were independent predictors of neurological sequelae. Knowledge about these would help in devising a plan for rehabilitation.