Guillain-Barre Syndrome In Children Research Articles

Long-term Disability and Poor Outcome Predictors of Guillain-Barre Syndrome in Children: A Systematic Review

Background: Guillain-Barre syndrome (GBS) is an immune-mediated polyneuropathy and a common cause of acute ascending weakness in children. Objectives: This study aims to report long-term disability and poor outcome predictors of GBS in children. Medline (via Pubmed), Embase, Cochrane Library, Web of Science, and Scopus database was searched for relevant studies until April 2022, with a designated search strategy, using MeSH terms and free keywords. Methods: Studies evaluating functional outcomes of GBS in children with at least one year of follow-up were included. All studies achieved acceptable quality for inclusion. After selecting studies based on inclusion criteria, data were extracted based on a modified standardized Joanna Briggs Institute (JBI) data extraction tool, and the methodological quality of studies were reviewed using the Joanna Briggs Institute (JBI) critical appraisal tool. Results: Fourteen studies were included in this systematic review consisting of 1141 patients (647 males, 466 females, and 28 unclassified). Follow-up duration varied from one year to 11 years. The prevalence of the GBS subtype was as follows, acute inflammatory demyelinating polyneuropathies (AIDP) 46.6%, acute motor axonal neuropathy (AMAN) 30.2%, acute motor and sensory axonal neuropathy (AMSAN) 6.8% and Miller fisher 6.1%. The most commonly reported poor outcome after at least one year of follow-up was walking disabilities and gait disorders. Motor deficits and weakness, sensory complaints, including pain or paresthesia and fatigue were other prevalent residual symptoms. Axonal form of GBS was the most reported poor outcome predictor, followed by Hughes disability score >3, a delay in independent walking, artificial ventilation, and rapid progression of symptoms. Conclusions: Despite the good prognosis of GBS in children, they could suffer long-term sequels, especially in walking abilities and gait. The axonal form is considered a crucial poor predictive factor.

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.

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

A novel prognostic system based on clinical and laboratory parameters for childhood Guillain-Barre syndrome.

To develop a score based on clinical and laboratory parameters in acute-phase of GBS to predict outcome at 6months. Clinical and laboratory assessment at admission including blood neutrophil-to-lymphocyte ratio (NLR), pre and post-immunotherapy serum albumin was prospectively performed in pediatric-GBS cases at a tertiary-care hospital over 1year. Clinical features and laboratory test results were compared between children with complete (Hughes Disability Score; HDS ≤ 1) and incomplete recovery (HDS > 1) at 6months from onset, using univariate and multivariate analysis. Area-under-receiver-operating-characteristic-curve (AUC) of predictors of prognosisand their optimal cutoffs were assessed. Forty-six patients were enrolled (mean age 69.1 ± 35.2months; male 57.6%). Factors on admission that independently predicted poor-outcome at 6months were older age, feeble voice, lower NLR and lower post-immunotherapy serum albumin. AUCs and optimal cutoffs of NLR and post-immunotherapy serum albumin for predicting disability at 6 monthswere 0.729, 0.781 and ≤ 1.65, ≤ 34.5 g/L, respectively. AUCs of clinical parameters such as older age and feeble voice were 0.749 and 0.713 respectively. King GBS outcomescore including all predictors had maximum AUC of 0.971 (95% CI 0.921-1.02). The score at cutoff ≥ 3 demonstrated excellent sensitivity (92.3%) and specificity (96.7%) to determine poor outcome. This new prognostic system may be beneficial in recognising children-at-risk of poor prognosis who may benefit from additional treatment.

A rare subtype of Guillain Barre syndrome in children: Acute axonal motor neuropathy

Guillan Barre Sendromu en sık görülen akut, immün aracılı demiyelinizan poliradikulonöropatidir. Guillan Barre Sendromu klinik ve elektrofizyolojik bulgularına göre alt türlere ayrılır. Bu alt türlerden birisi olan akut aksonal motor nöropati çocuklarda çok nadir görülür. Bu çalışmada ayaklarında ve ellerinde uyuşma, gözlerini tam olarak kapatamama, peltek konuşma, ıslık çalamama şikâyeti ile başvuran ve fizik muayenesinde hiperrefleksi saptanan akut aksonal motor nöropati tanılı on altı yaşındaki erkek olguyu sunuyoruz.

Nationwide Survey of Childhood Guillain-Barré Syndrome, Fisher Syndrome, and Bickerstaff Brainstem Encephalitis in Japan

Background: Guillain-Barre syndrome (GBS), Fisher syndrome (FS), and Bickerstaff brainstem encephalitis (BBE) are immune-mediated neuropathies presenting with symptoms such as muscle weakness, ophthalmoplegia, ataxia, and consciousness disturbances. Although the epidemiology of GBS and BBE in patients of all ages has been reported, childhood data have not been well-investigated. We aimed to determine the clinical features, therapeutics, and prognoses of childhood GBS, FS, and BBE in Japan. Methods: We sent questionnaires to 1068 pediatric neurologists in Japan from 2014 to 2016 to determine the number of children less than 15 years old with GBS, FS, or BBE and their age and sex. We subsequently performed a secondary survey to investigate the clinical features, laboratory data, treatment, and prognosis. This study was approved by the local ethics committee of the Graduate School of Medicine, Chiba University. Findings: Five-hundred thirty-eight pediatric neurology specialists (50·4%) responded to the first survey. The total number of children with GBS, FS, and BBE in Japan from 2014 to 2016 were 87, 10, and 6, respectively, suggesting annual incidence rates of was 0·19, 0·023, and 0·0071 per 100,000 children, respectively, in the pediatric population (0-14 years). GBS was classified as acute inflammatory demyelinating neuropathy (39·7%), acute motor axonal neuropathy (24·4%), or acute motor-sensory axonal neuropathy (11·5%), with a male-to-female ratio of 1·29:1·0 and a wide distribution of onset ages. The disease severities of GBS, FS, and BBE were variable, but all children were able to walk within one year, indicating an excellent childhood prognosis. No in-hospital deaths occurred in this study. Interpretation: The prognoses of childhood GBS, FS, and BBE were generally favorable, as long as the patient was promptly treated with either intravenous immunoglobulin or plasma exchange. Clinical Trial Registration Details: The research scheme was registered at the UMIN Clinical Trials Registry (UMIN-CTR) as UMI18739. Funding Information: This work was supported by the institutional budget of the Chiba University Graduate School of Medicine (grant reference J09KF00284). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study protocol was approved by the institutional ethics committee of the Graduate School of Medicine, Chiba University (No. 319), and the Collaborative Research Committee of the Japanese Society of Child Neurology (No. 13-04).

Clinical and serological prognostic factors in childhood Guillain-Barré syndrome: A prospective cohort study in Bangladesh.

Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in children. The objective of this study was to investigate the preceding infections, clinical, serological and electrophysiological characteristics and outcome of childhood GBS in Bangladesh. We included 174 patients with GBS aged <18 years from a prospective cohort in Bangladesh between 2010 and 2018. We performed multivariate logistic regression to determine the risk factors for poor outcome. Among 174 children with GBS, 74% (n = 129) were male. Around half of the patients (49%, n = 86) had severe muscle weakness, 65% (n = 113) were bedbound (GBS disability score 4) and 17% (n = 29) patients required mechanical ventilation at admission. Campylobacter jejuni serology and anti-GM1 IgG antibody were positive in 66% and 21% of the patients respectively. One hundred and forty-three (82%) patients did not receive standard treatment and half of them recovered fully or with minor deficits at 6-month. Twenty patients (11%) died throughout the study period. At 3-month of onset of weakness, complete recovery or recovery with minor deficit was significantly higher in demyelinating GBS patients compared to axonal GBS patients (86% vs 51%, P = .001). Cranial nerve palsy (OR = 4.00, 95%CI = 1.55-10.30, P = .004) and severe muscle weakness (OR = 0.16, 95%CI = 0.06-0.45, P = .001) were the important risk factors of poor outcome in children with GBS. Further large-scale studies are required for better understanding of factors associated with mortality and morbidity in childhood GBS.

Clinical features of children with Guillain-Barré syndrome and the significance of Brighton criteria

OBJECTIVE To study the clinical features of children with Guillain-Barre syndrome (GBS) and the significance of Brighton criteria in childhood GBS. METHODS A retrospective analysis was performed on the medical data of 72 children with GBS. Brighton criteria were used for the grading of diagnostic certainty (level 1 as the highest level, and level 4 as the lowest level). A Spearman's rank correlation analysis was used to evaluate the correlation of auxiliary examinations with the level of diagnostic certainty of Brighton criteria. RESULTS A total of 72 children with GBS were enrolled, with a mean age of onset of (98±32) months. All children (100%, 72/72) had weakness of bilateral limbs and disappearance or reduction of tendon reflex, and limb weakness reached the highest level of severity within 4 weeks. Of all the 72 children, 68 (94%) had positive results of neural electrophysiological examination and 51 (71%) had positive results of cerebrospinal fluid (CSF) examination, and the positive rate of neural electrophysiological examination was significantly higher than that of CSF examination (P < 0.01). The median interval time from disease onset to neural electrophysiological examination was significantly shorter than from disease onset to CSF examination (11 days vs 14 days, P < 0.01). Of all the 72 children, 49 (68%) met Brighton criteria level 1 and 21 (29%) met Brighton criteria level 2. Neural electrophysiological examination and CSF examination were positively correlated with the level of diagnostic certainty of Brighton criteria (rs=0.953 and 0.420 respectively, P < 0.01). CONCLUSIONS Most of the children with GBS meet Brighton criteria level 1, and the positive results of CSF examination and neural electrophysiological examination play an important role in improving the level of diagnostic certainty of Brighton criteria. Neural electrophysiological examination has a higher positive rate than CSF examination in the early stage of the disease.

Senkopla Başvuran Bir Guillain-Barre Sendromu: Olgu Sunumu

Guillain Barre Syndrome (GBS) is an acute inflammatory polyneuropathy, often characterized by symmetrical weakness and areflexia. It is considered to be an autoimmune disease triggered by previous bacterial or viral infections. Miller Fisher’s syndrome is one of the most common variants of GBS, and it is characterized by trauma with areflexia, ataxia, and ophthalmoparesis. Mortality is 1-2% in childhood GBS and generally develops due to respiratory failure. Here, a case with Guillain-Barre Syndrome (GBS) developed after parvovirus B19 infection was reviewed because the symptom of the application was syncope, which is thought to be developed due to autonomic involvement.

Comparison of Five Different Electrophysiological Criteria for Childhood Guillain Barre Syndrome.

Background:Internationally approved electrodiagnostic criteria for Guillain Barre syndrome lack in children. We intended to compare the diagnostic accuracy of the currently available five electrophysiological criteria for childhood Guillain Barre Syndrome (GBS) at the time of sentinel assessment.Methodology:In this single-center study, data of children diagnosed with GBS between January 2013 to December 2017 were retrieved. Patient charts were reviewed for clinical features, electrophysiological recordings. The electrodiagnostic results (4 motor nerves and two sensory nerves in upper limbs and lower limbs) were reanalyzed and were classified based on Dutch group; Ho; Hadden; Hughes and Rajabally criteria for GBS.Results:During this study period, of the 205 children with clinical features of GBS, 15 children had incomplete electrophysiological data, and four children were excluded due to missing data. The mean age of onset of the 186 children enrolled was 77 months; the median duration from symptom onset to electrodiagnostic evaluation was seven days; pure motor and motor-sensory form of GBS was seen in 71 and 115 children. Based on the Hadden criteria, a demyelinating pattern was noted in 57 children; axonal in 37; Inexcitable in 84 and Equivocal in 8 children. The sensitivity of the various criteria ranged from 71% to 100% for demyelination, 97% to 100% for axonal. The degree of agreement using Hadden and Rajabally criteria for Equivocal subtypes was 0.93.Conclusions:The Rajabally criteria showed the best sensitivity, specificity and diagnostic accuracy for electrodiagnosis of GBS in children when compared against Hadden criteria.

Clinical audit on the management of Guillain-Barre syndrome cases admitted to Assiut University Children Hospital

Introduction Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis in children. It is characterized by progressive, symmetrical weakness, and areflexia in a previously healthy child. GBS should be diagnosed quickly in patients presenting with rapidly progressive paralysis. Meticulous monitoring and supportive care are needed in all GBS patients. Efforts focus on the follow-up of clinical course and outcome to improve the care and treatment of individual patients. Materials and methods The study included pediatric patients with GBS referred to Assiut University Children Hospital in 9 months from November 2016 to July 2017. Information was taken from resident doctors and mothers. Results Intravenous immunoglobulin (IVIG) was administered to 17 (80.95%) cases. Four (19.05%) cases who presented in the improving phase of motor disability were managed supportively and recovered completely. Plasmapheresis was done to three (14.3%) cases, who did not respond well to IVIG. Complete recovery was observed in 17 (80.95%) cases and four (19.05%) cases experienced only incomplete recovery. Discussion Nerve conduction velocity is very useful to diagnose GBS. IVIG and supportive care are considered key elements in the management of childhood GBS. IVIG administration early in the course of the disease results in better recovery. Plasmapheresis may be an effective option in cases with poor response to IVIG therapy.

Efektivitas Immunoterapi Dalam Tatalaksana Guillain-Barré Syndrome Pada Anak

Guillain-Barré Syndrome (GBS) merupakan suatu kelainan mediator imun dari sistem saraf perifer dimana respon autoimun menjadi aktif dan menargetkan saraf perifer. Patogenesis GBS dipercaya sebagai sebuah respon imun yang abnormal terhadap sebuah kejadian yang terjadi sebelumnya, paling sering didahului oleh suatu infeksi, dan pada sebagian kecil kasus dilaporkan pasca imunisasi terutama untuk pasien anak-anak. Manifestasi klinis GBS berupa kelemahan ekstremitas bilateral progresif yang cepat dan bersifat ascending. Terapi yang masih digunakan dan dianggap efektif untuk saat ini yaitu immunoglobulin intravena (IVIg), dan plasmaferesis. Modalitas terapi baru seperti Interferon-β (IFN-β), Siklofosfamid, dan antibodi monoklonal manusia masih memerlukan penelitian lebih lanjut terkait efektivitas dan efek samping yang bisa terjadi. Prognosis GBS anak didapatkan lebih baik, mortalitas juga ditemukan lebih rendah yaitu sekitar 1-2% pada anak dengan GBS, dan hanya 4% dari seluruh pasien anak yang membutuhkan alat bantu pernapasan selama perawatan.

How Different is AMAN from AIDP in Childhood GBS? A Prospective Study from North India.

To compare the clinical profile and short-term outcome of children with axonal and demyelinating subtypes of childhood Guillain Barré syndrome (GBS). This is a prospective observational study conducted in a tertiary care teaching hospital in North India. Consecutive children with Guillain Barré syndrome were recruited to compare the clinical profile and short term outcome among the subtypes. Among 9847 children admitted to the emergency, 95 had acute flaccid paralysis; 57 of whom had GBS. Electrophysiological studies were completed in 57; of whom 20 had acute inflammatory demyelinating polyneuropathy (AIDP); 19 had acute motor axonal neuropathy (AMAN); 12 had non-reactive nerves; five were unclassifiable; 1 had acute motor sensory axonal neuropathy (AMSAN). More children in AMAN group had preceding gastroenteritis (4 vs. 2), while AIDP group had upper respiratory infections (12 vs. 7). Ataxia was only seen in AIDP subtype while wrist drop, foot drop and hyperreflexia were seen only with AMAN subtype. Respiratory muscle involvement (6 vs. 3) and artificial ventilation (5 vs. 2) was more in AMAN. At discharge, children with AIDP were less likely to be non-ambulant (12 vs. 6, p = 0.036). Mean disability scores at hospital discharge (4.9 ± 1.2 vs. 4 ± 0.9, p = 0.015) and at last follow-up (0.7 ± 1.01 vs. 0.05 ± 0.2, p = 0.016) were higher in AMAN. Children with AIDP were more likely to achieve normalcy on follow-up (19 vs. 12, p = 0.023). Children with AMAN appear to have a more severe clinical course; higher short-term morbidity; and slower recovery than those with AIDP.

Seasonal variations of childhood Guillain-Barre Syndrome in South west Iran

Background: It was found that the occurrence of Guillain-Barre Syndrome (GBS) varies in respect tothe month and season; this variation has not been adequately studied.Objective: To determine the month and seasonal variation of GBS in children in the Khuzestanprovince, south west Iran, during a 10-year period (2006-2015).Patients and methods: We extracted data retrospectively from acute flaccid paralysis committeefrom healthcare centers in all cities of the province, over a 10-year period (from January 1, 2006 toDecember 31, 2015). In this study all children under 15 years of age with Guillain-Barre syndromewere surveyed. In order to compare the frequency of GBS in different seasons and months we used theChi Square test.Results: From 187 cases of GBS, 101 (54%) were males, 86 (46%) females with sex ratio 1.17:1. Themean age of the children was 5.39 ± 4.02 years. The highest occurrence of GBS was observed inautumn (32.1%) followed by winter (27.3%). The highest number of cases (28; 15%) occurred inDecember and the lowest (8; 4.3%) in September. There was seasonal (P=0.006) and monthly(P=0.036) variation in occurrence of GBS throughout the year with more prevalence in autumn ,September and December.Conclusion: Our study showed that there is a significant monthly and seasonal variation in childrenwith GBS in Khuzestan province.

Seasonal variations of childhood Guillain-Barre Syndrome in South west Iran

Background: It was found that the occurrence of Guillain-Barre Syndrome (GBS) varies in respect tothe month and season; this variation has not been adequately studied.Objective: To determine the month and seasonal variation of GBS in children in the Khuzestanprovince, south west Iran, during a 10-year period (2006-2015).Patients and methods: We extracted data retrospectively from acute flaccid paralysis committeefrom healthcare centers in all cities of the province, over a 10-year period (from January 1, 2006 toDecember 31, 2015). In this study all children under 15 years of age with Guillain-Barre syndromewere surveyed. In order to compare the frequency of GBS in different seasons and months we used theChi Square test.Results: From 187 cases of GBS, 101 (54%) were males, 86 (46%) females with sex ratio 1.17:1. Themean age of the children was 5.39 ± 4.02 years. The highest occurrence of GBS was observed inautumn (32.1%) followed by winter (27.3%). The highest number of cases (28; 15%) occurred inDecember and the lowest (8; 4.3%) in September. There was seasonal (P=0.006) and monthly(P=0.036) variation in occurrence of GBS throughout the year with more prevalence in autumn ,September and December.Conclusion: Our study showed that there is a significant monthly and seasonal variation in childrenwith GBS in Khuzestan province.

Incidence of Guillain–Barre's Syndrome in Children under 15 Years of Age in Oman

Objective Guillain–Barre's syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy seen in all ages but mostly in the adult population. We aim to report the incidence of GBS in children under 15 years of age in Oman, a Gulf country. Materials and Methods All children with GBS under 15 years of age were included in the study from January 2002 to December 2016. The data were compiled in Microsoft Excel format and analysis was performed using SPSS, version 17.0. Population-based age- and sex-specific rates of GBS were calculated using the estimated population for each 5-year period based on 2004, 2009, and 2014 mid-year population, respectively. Relative risk and 95% confidence intervals of GBS at different age categories were calculated using the overall incidence of GBS in those under 15 years as reference. Results The average annual incidence in those under 15 years was 3.1/100,000. Age-specific incidence was 4.0/100,000 in the age group 0 to 9 years and 4.7/100,000 in age group 0 to 4 years. Sixty percent had evidence of preceding infections, and the male to female ratio was 1.8:1. Fifty percent had cranial nerve involvement and 18% needed mechanical ventilation. Five percent had residual weakness. Intravenous immunoglobulins (IVIGs) were used in all, and 3.3% required plasmapheresis when they did not improve with IVIG. Clinical profile of the GBS was not different from the rest reported in the literature. Conclusion The incidence of GBS in Oman was 3.1/100,000 (range: 2.7–3.5 cases/100,000) in children under 15 years of age. The GBS is a smaller proportion among the total acute flaccid paralysis cases.

P284 Early differential diagnostic between axonal and demyelinating form of Guillain-Barré syndrome in children

Aim of our work was to determine specificity and sensitivity of conduction studies parameters for differential diagnostics between acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in children. Methods 38 children were enrolled: 20 controls (7–14 years old) and 18 patients with AMAN or AIDP, later established according to current criteria. All patients undergo conduction studies on 3–7 day from the first symptoms occurrence. Conduction velocity (CV) and distal compound action potential (CMAP) amplitudes were evaluated for nn. Tibialis, Peroneus, Medianus, Ulnaris;CV and amplitude of sensory nerve action potential (SNAP) were registered for nn Medianus, Suralis, Peroneus superficialis et Ulnaris. ROC-analysis was applied for sensitivity and specificity evaluation. Results Significantly lower SNAP amplitude for n.Medianus was registered in AIDP group comparing with controls and AMAN. For AMAN development, SNAP amplitude for n. Medianus >8.9 μ V was a value with very good predictive ability (AUROC > 0.8), SNAP amplitude for n.Peroneus superficialis >3.6 μ B and CMAP amplitude for n.Peroneus ⩽0.4 m A were values with a good predictive ability (AUROC > 0.7). Conclusions Conduction studies parameters on the early stage of Guillain-Barre syndrome in children are specific enough for differential diagnostics between AMAN and AIDP in children. SNAP amplitudes for n.Medianus >8.9 μ V, n.Peroneus superficialis >3.6 μ A and CMAP amplitude for n.Peroneus ⩽0.4 m A and CV along the motor pathways remains within normal values are parameters that may indicate to AMAN diagnosis.

Electrophysiological Subtypes and Prognostic Factors of Childhood Guillain-Barré Syndrome.

We assessed the clinical, epidemiologic, electrophysiological and prognostic characteristics of childhood Guillain-Barré Syndrome admitted to 13 pediatric neurology centers in Turkey. Using a standard data recording form age, sex, duration of symptoms, distribution of weakness at onset, cranial nerve involvement, cerebrospinal fluid findings, electrophysiological findings, duration of hospitalization, requirement of ventilation, treatment and clinical evaluation scale at onset, discharge and 1, 3, 6, and 12 months after discharge were recorded. Among the 236 children with a median age of 6.8 years there was a male to female ratio of 1.3. Based on the electrophysiological features; 84 patients were classified as acute inflammatory demyelinating polyrediculoneuropathy (AIDP), 61 as acute motor axonal neuropathy (AMAN), 21 as acute motor-sensory axonal neuropathy (AMSAN). The incidence of cranial nerve involvement was 16%, and was related to lower clinical scores at discharge and 6 months after discharge. Clinical scale scores between axonal and demyelinating subgroups did not show statistically significant difference except for admission (p<0.05). Electrophysiological subtypes are not important in prognosis in our series. However, duration of weakness, duration of hospitalization and ventilation requirement can affect prognosis negatively.

Predictive factors for achieving independent walking in children with Guillain-Barre syndrome.

BackgroundTo determine the predictors of achieving independent walking at 2 and 6 months after onset of weakness in children with Guillain-Barre syndrome (GBS).MethodsChildren with GBS admitted to the Tabriz Children's Hospital were studied prospectively. All patients had frequent clinical evaluations until achieving independent walking. Unaided walking at 2 and 6 months and factors influencing these outcomes were determined using both univariate and multiple analyses.ResultsBetween 2003 and 2014, 324 children (mean age: 5.3±3.66 years) were admitted. The mean duration to independent walking was 2.97±3.02 months; 90.5% of patients could walk independently at 6 months. In the univariate analysis, disability score of >3 (P=0.03), autonomic nerve involvement (P=0.003), cranial nerve involvement (P=0.008), and absent compound muscle action potential (CMAP; P=0.048) were found to be significantly associated with poor walking outcome at 6 months. In the multivariate analysis, cranial nerve involvement (P=0.008) and absence of CMAP (P=0.022) were independently associated with poor functional outcome.ConclusionDisability score >3, cranial and autonomic nerve involvement, and absence of CMAP were predictors of independent walking in childhood GBS in this study; early rehabilitation program may prevent further impairments secondary to immobility in these patients.

Clinical importance of F-waves as a prognostic factor in Guillain-Barre Syndrome in children

Clinical importance of F-waves as a prognostic factor in Guillain-Barre Syndrome in children