Guillain Barré syndrome in the paediatric population. Consequence of active infection or long Covid?

Background: Guillain-Barre syndrome is a polyradiculoneuropathy that has been associated with infectious diseases as triggers. There is currently little medical evidence exploring the relationship between the development of Guillain-Barre syndrome caused by SARS-CoV-2 infection and long Covid. Objective: To synthesize the medical evidence that describes the relationship between post Covid syndrome and Guillain-Barre syndrome in the paediatric population. Methodology: A scoping review was developed using Scopus and PubMed databases, including analytical and/or descriptive experimental and observational studies. Results: The main clinical manifestations presented by paediatric patients were distal and ascending weakness in the lower limbs and myalgia. The diagnostic approach was based on clinical findings, imaging findings on spinal magnetic resonance and electromyography. The therapeutic strategy is based on the use of intravenous human immunoglobulins. Conclusion: Guillain-Barre syndrome is a frequent disease in the paediatric population with active SARS-CoV-2 infection or in survivors, however, it is necessary to encourage further clinical studies that increase the medical literature that describes this association.

Introducción: El síndrome de Guillain-Barré es una polirradiculoneuropatía que se ha asociado con enfermedades infecciosas como desencadenantes. En la actualidad es escasa la evidencia médica que explore la relación entre el desarrollo del síndrome de Guillain-Barré causado por la infección por SARS-CoV-2 y la COVID prolongada. Objetivo: Sintetizar la evidencia médica que describe la relación entre el síndrome pos-COVID y el síndrome de Guillain-Barré en la población pediátrica. Metodología: Se realizó una revisión exploratoria utilizando las bases de datos de Scopus y PubMed, incluyendo estudios experimentales y observacionales analíticos o descriptivos. Resultados: Las principales manifestaciones clínicas presentadas por los pacientes fueron debilidad distal y ascendente en miembros inferiores y mialgias. El enfoque diagnóstico se apoyó en los hallazgos clínicos, hallazgos imagenológicos por resonancia magnética de columna y electromiografía. La estrategia terapéutica se basó en el uso de inmunoglobulinas humanas intravenosas. Conclusión: El síndrome de Guillain-Barré es una enfermedad frecuente en la población pediátrica con infección activa por SARS-CoV-2 o en sobrevivientes, sin embargo, es necesario incentivar el desarrollo de estudios clínicos que incrementen la literatura médica que describe esta asociación.

Guillain-barré Syndrome after Multiple Bee Stings

Severe systemic responses including neurologic complications such as myasthenia gravis, myeloradiculopathy, optic neuropathy, parkinsonism, stroke and Guillain-barré syndrome can occur after bee stings. This case describes a 78-year-old female who presented with symptoms of acute progressive bilateral symmetrical weakness in both lower legs after multiple bee stings. Nerve conduction study findings were consistent with acute sensorimotor axonal neuropathy and recovered by treatment with intravenous immunoglobulin. This case highlights that bee stings can result in acute onset Guillain-barré syndrome, although the pathophysiologies of bee venoms need to be investigated accurately.

Polirradiculoneuropatia periférica desmielinizante associada ao uso de carbamazepina em cão: relato de caso / Demyelinating peripheral polyradiculoneuropathy associated with the use of carbamazepine in dog: case report

Diversos fármacos são utilizados no tratamento da epilepsia e, assim como outros medicamentos, podem induzir a ocorrência de efeitos adversos, alguns tão graves que geram a necessidade de descontinuidade e substituição da terapia. A carbamazepina pode levar a alterações nos sistemas cardiovascular, respiratório e neurológico, sendo descritos na literatura casos de indução de miastenia gravis como distúrbio neuromuscular. Este estudo relata o caso de um cão que desenvolveu polirradiculoneuropatia desmielinizante, tendo como provável desencadeante a terapia com carbamazepina. O paciente apresentou tetraplegia, ausência de reflexos espinhais nos quatro membros, fraqueza cervical, diminuição do reflexo palpebral bilateral e esforço respiratório. A eletroneuromiografia demonstrou sinais de desmielinização. Este, portanto, é o primeiro relato de associação entre carbamazepina e polirradiculoneuropatia desmielinizante em cão.(AU)

Different drugs are used in the treatment of epilepsy and, like other drugs, may induce the occurrence of adverse effects, some of them so severe that the drug must be discontinued and replaced. Carbamazepine may lead to changes in the cardiovascular, respiratory, and neurological systems, and cases of induction of myasthenia gravis as a neuromuscular disorder have been described in the literature. This paper reports the case of a dog that developed demyelinating polyradiculoneuropathy, probably triggered by carbamazepine. The patient presented tetraplegia, absence of spinal reflexes in the four limbs, cervical weakness, decreased bilateral eyelid reflex and respiratory effort. Electroneuromyography showed signs of demyelination. This, therefore, is the first report of association between carbamazepine and demyelinating polyradiculoneuropathy in dogs.(AU)

Síndrome de Guillain Barré recurrente: reporte de caso / Guillain Barré Syndrome Recurrent: Case report

El síndrome de Guillain-Barré (SGB) o poli-rradiculoneuritis aguda es una enfermedad autoinmune, desencadenada por una infec-ción viral o bacteriana, su incidencia es de 1.7/100000, únicamente el 3% puede recaer en los años subsiguientes. Es una patología poco frecuente y menos frecuente aún son los casos recurrentes, por lo que realizamos una revisión de su epidemiología, cuadro clínico, criterios diagnósticos y su manejo. Se trata de un paciente masculino de 9 años de edad, que el 13 de octubre de 2008 al primer año de edad fue ingresado durante 1 mes al Instituto Hondureño de Seguridad Social (IHSS) con cuadro de parálisis flácida ascendente progresiva (Síndrome de Guillain Barré), recibió manejo con inmunoglobulina cuya dosis y otros datos sobre su tratamiento, exámenes o estudios realizados se descono-cen. La recuperación completa se dio aproxi-madamente a los 6 meses posteriores al inicio de los síntomas. Sin embargo reingresa el 12 de noviembre de 2014 en IHSS con diagnóstico de Parálisis Flácida ascendente recurrente (segundo episodio), sin recupera-ción completa ya que presentó secuelas en miembros inferiores. Se le realizó Electromio-grafía con datos compatibles con polirradicu-lopatía motora desmielinizante simétrica. En marzo de este año (2017) se presenta con igual sintomatología por lo que se ingresa como síndrome de Guillain barré recurrente (tercer episodio)...(AU)

Polirradiculoneuritis aguda asociada a infección por Virus Herpes Humano 7 en un paciente adulto inmunocompetente / Acute polyradiculoneuropathy associated with human Herpes Virus 7 in an immunocompetent patient: case report

Human herpes virus 7 (HHV-7) is a cause of encephalitis, meningitis and myeloradiculoneuropathy in adults who are immunocompetent or with immunosuppression. The involvement of the peripheral nervous system is always associated with myelitis. We report a case of acute polyradiculoneuropathy due to HHV-7, without involvement of central nervous system, in an immunocompetent patient. A 35-years-old man complained of lumbar pain radiating to both buttocks. On examination muscle strength and tendon reflexes were normal. He had asymmetric pinprick and light touch saddle hypoesthesia and also in the perineal region, dorsum and lateral aspect of the left foot. Magnetic resonance imaging showed mild thickening and contrast enhancement of cauda equina nerve roots. Polymerase chain reaction performed on cerebrospinal fluid was positive for HVV-7. Other inflammatory, infectious and neoplastic etiologies were ruled out. Lumbar pain and hypoesthesia improved progressively and neurological examination was normal after one month. He did not receive antiviral therapy.

Clinical Features of Post-Vaccination Guillain-Barré Syndrome (GBS) in Korea

Guillain-Barré syndrome (GBS) is the most common immune-mediated polyradiculoneuropathy and it is also the most commonly reported severe adverse event following immunization in adults. To evaluate the results of clinical and laboratory features of GBS after vaccination in Korea, we analyzed the claims-based data from 2002 to 2014 using materials collected for the Advisory Committee Vaccination Injury Compensation (ACVIC) meeting including, clinical features, nerve conduction studies (NCSs), cerebrospinal fluid (CSF) profiles, treatment, and outcomes. Forty-eight compensated GBS cases (median age, 15 years; interquartile range [IQR], 13–51; male:female ratio, 1:1) of 68 suspected GBS were found following immunization and all of them with influenza immunizations with either monovalent (n = 35) or trivalent (n = 13). Among them, 30 cases fulfilled the Brighton criteria level 1–3 (62.5%). The median duration between the onset of symptoms to nadir, duration of the nadir, and total admission period were 3 (IQR, 2–7 days), 2 (IQR, 1–5 days), and 14 (IQR, 6–33 days) days, respectively. The most frequently reported symptom was quadriparesis which was present in 36 cases (75%) at nadir. CSF examination revealed albuminocytologic dissociation in 25.0% and NCS was abnormal in 61.8%. After treatment, most of them showed improvement. Clinical features were similar to typical post-infectious GBS and there were both demyelinating and axonal forms suggesting heterogeneous pathogenic mechanism. In order to improve the diagnostic certainty of post-vaccination GBS, careful documentation of clinical features and timely diagnostic work-up with follow-up studies are needed.

Faringo-cérvico-braquial: variante rara do espectro da síndrome de Guillain-Barré / Pharyngeal-Cervical-Brachial: a rare variant of the Guillain-Barré syndrome spectrum

A Síndrome de Guillain-Barré (SGB) é uma polineuropatia autolimitada, na maioria das vezes de mecanismo autoimune pós-infeccioso. Este caso tem por objetivo relatar uma variante rara do espectro da SGB. O método utilizado foi o acompanhamento clínico do paciente e revisão de prontuário. Conclui-se que conhecimento acerca da FCB e alto grau de suspeição são importantes para o diagnóstico diferencial de pacientes que apresentam sintomas bulbares e fraqueza de membros superiores, principalmente pela gama de diagnósticos diferenciais que os sintomas podem sugerir.

Guillain-Barré syndrome (GBS) is a self-limited polyneuropathy, most often by a post-infectious autoimmune mechanism. This case aims at reporting a rare variant of the GBS spectrum. The method used was clinical monitoring of the patient and medical record review. It was concluded that knowledge of the pharyngeal-cervical-brachial variant and high degree of suspicion are important for the differential diagnosis of patients with bulbar symptoms and weakness of the upper limbs, particularly because of the range of differential diagnoses the symptoms may suggest.

Implicaciones anestésicas en paciente embarazada con Síndrome de Guillain Barré / Anesthetic implications in pregnant patient with Guillain-Barré Syndrome

Introducción: el Síndrome de Guillain Barré (SGB) es una enfermedad de baja incidencia en medicina y aún más raro durante la gestación, con una incidencia de 1,7/100.000 embarazos. La presentación GBS durante el embarazo se asocia con un aumento de la necesidad de asistencia respiratoria y aumento de la mortalidad materna. Métodos: describimos en este documento cómo fue el manejo perioperatorio de un caso de una mujer de 25 años de edad multípara que cursa un embarazo a término con SGB. Resultados: discusión del caso clínico. Conclusiones: no hay pautas establecidas para el manejo anestésico de una paciente embarazada con GBS.

Introduction: Guillain Barre Syndrome (GBS) is a rare occurrence in medicine, and possibly even rarer in pregnancies, with an incidence of 1.7/100.000 pregnancies. GBS occurrence in pregnancy is associated with an increased need for ventilatory support and increased maternal mortality. Methods: we describe herein how a case of a 25 year old multiparous at term gestation with GBS was managed in the perioperative period. Results: discussion of the case. Conclusions: there are no established guidelines for the anesthetic management of a pregnant GBS patient.

A Case of Acute Inflammatory Demyelinating Polyradiculoneuropathy in a Patient with Systemic Lupus Erythematosus

Neuropsychiatric manifestations in patients with systemic lupus erythematosus are fairly common, with a prevalence of 37~95%. Among 19 neuropsychiatric manifestations, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is quite rare, and is characterized by progressive, symmetric muscle weakness accompanied by absent or depressed deep tendon reflexes. Generally, plasma exchange and intravenous immunoglobulin are the main treatment modalities. Here, we report a case of AIDP in a 29-year-old SLE patient, who was fully recovered with a treatment of high-dose glucocorticoid and immunosuppressive agents. Ours case suggests that AIDP should be treated differently in SLE patients to avoid disastrous results.

Clinical features, role of mobile plasmapharesis unit and outcome in patients with acute inflammatory demyelinating polyradiculoneuropathy [Guillain-Barr‚ syndrome]

To study the clinical features, role of mobile plasmapharesis unit and outcome in patients with acute inflammatory demyelinating polyradiculoneuropathy [AIDP]. Retrospective Cross Sectional Study. This study was conducted at Neurology Department, KEMU, Lahore from July 2008 till June 2012. Patients from various hospitals [both public and private] fulfilling the Ashbury and Cornblath's Clinical Diagnostic Criteria for GBS and requiring plasmapharesis were included in the study. For this purpose a special proforma was designed to be filled by the primary physician at the time of request for mobile plasmapharesis service. This service was provided by a donor organization namely Pakistan Myasthenia Gravis Welfare Organization [PMWO] based at a public hospital in Lahore. Plasmapharesis was started according to the guidelines, as soon as possible after admission, if patient had history of progressive weakness. The protocol of this treatment was to exchange 200 to 250 ml of plasma per kilogram of body weight in five sessions within 7 to 10 days. The replacement fluids most often consist of 0.9% normal saline, haemaccel and/or albumin. Recovery was assessed by modified Hughes Guillain-Barr‚ syndrome disability scale. A total of 152 patients were included in the study with 94 [61.8%] males and 58 [38.2%] females and M: F ratio of 1.62:1. The mean age was 32.66 [SD 15.89] with range from 7-80 years. One hundred and nine [72%] cases presented between 11-40 years of age. All patients were treated with five sessions of plasmapharesis. Drop out rate for plasmapharesis was 1.5% implying its good tolerability. Out of the total of 152 cases, 149 [98%] cases presented with progressive areflexic weakness and 3 [2%] patients with bilateral external Ophthalmoplegia, areflexia and ataxia [Miller-Fisher variant]. Sensory symptoms were present in 31[20.4%], bulbar weakness in 29[19.1%], and bilateral facial weakness in 25[16.4%] cases. Severe respiratory distress requiring ventilatory support occurred in 36[23.7%] cases. Pearson's correlation revealed that gender and age were not risk factors for the development of ventilatory failure [p=0.354; 0.803], bilateral facial weakness [p = 0.121; 0.473] or bulbar weakness [p= 0.383; 0.745] respectively. Overall mortality was 5% and all these cases developed severe respiratory distress and needed ventilatory support. Complete recovery occurred in 90% cases and 5% had residual deficit [Hughes disability scale severity 1 and 2] at mean follow up of six months. Our study showed that GBS is statistically more frequent in males than females in our local population with maximum frequency between 11-40 years of age range. However, the two factors i.e. gender and age has no significant association with the development of ventilatory failure, bilateral facial weakness and bulbar weakness. Areflexic motor weakness was the commonest presenting feature. Plasmapharesis remained very effective therapeutic option which is cheaper and affordable in our poor socio-economic setting. Mobile unit service provided an excellent opportunity to treat most of these patients at their native hospitals. We recommend that government and donor organizations should develop more mobile plasmapharesis services in all major cities which can cover nearby district and tehsil hospitals

Multiple Cranial Neuropathy with and Polyradiculoneuropathy as a Delayed Sequelae after of Ethylene Glycol Intoxication / 대한임상신경생리학회지

Multiple cranial and peripheral neuropathies as a delayed sequellae of ethylene glycol poisoning is a less well known clinical entity and its information about long-term electrophysiological and clinical outcomes is limited. We report a 45-year-old male who presented with acute renal failure and subsequently developed multiple cranial neuropathy, respiratory failure, and flaccid tetraparesis. Through sequential electrophysiological studies, we would like suggest that the main pathophysiology of ethylene glycol-related neuropathy is a demyelinating polyradiculoneuropathy with secondary axonal degeneration.

Treatment of Dysphagia with Pyridostigmine Bromide in a Patient with the Pharyngeal-Cervical-Brachial Variant of Guillain-Barre Syndrome

A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barre syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia.

A Case of Ankylosing Spondylitis Accompanied by Henoch-Schonlein Purpura and Chronic Inflammatory Demyelinating Polyneuropathy / 대한내과학회지

Peripheral nervous system dysfunction is a rare complication in Henoch-Schonlein purpura, but it tends to recover spontaneously without treatment. A 78-year-old man who had ankylosing spondylitis presented with Henoch-Schonlein purpura associated with progressive sensorimotor polyneuropathy. He was diagnosed with chronic inflammatory demyelinating polyneuropathy, which did not improve despite intravenous immunoglobulin therapy. We describe a case of Henoch-Schonlein purpura, accompanied by chronic inflammatory demyelinating polyneuropathy in a patient with ankylosing spondylitis.

Compromiso vesical en síndrome de Guillain-Barré: a propósito de un caso / Bladder involvement in Guillain-Barre syndrome: a case study

Introducción: El Síndrome de Guillain-Barré (SGB) es una enfermedad autoinmune caracterizada por debilidad muscular, arreflexia y disociación albúmino-citológica en líquido cerebroespinal, cuya incidencia clásica a nivel internacional suele uniformarse alrededor de 0,6 a 4 casos por 100.000 al año. Presentación del caso: Paciente de 45 años, sexo femenino, quien ingresó al Servicio de Urgencia del Hospital de Temuco derivada desde Lonquimay, por debilidad progresiva de las cuatro extremidades. En Lonquimay la paciente requirió sonda vesical por retención urinaria. Es diagnosticada con SGB, hospitalizándose en Unidad de Cuidados Intensivos, requiriendo ventilación asistida y tratada mediante plasmaféresis, presentando neumonía como complicación relacionada a la ventilación mecánica y recuperando íntegramente función vesical. Discusión: El compromiso vesical no es descrito como un factor importante en el diagnóstico, siendo controversial aquella afirmación por varios autores.

Introduction: Guillain-Barre syndrome (GBS) is an autoimmune disease characterized by muscle weakness, areflexia and albumin-cytological dissociation in cerebrospinal fluid, the incidence has been reported to be relatively uniform between 0.6 to 4 cases per 100.000 per year. Case report: Patient of 45 years old, female, admitted to the emergency department of Hospital de Temuco derived from Lonquimay by progressive weakness of four extremities. In Lonquimay the patient required bladder catheterization for urinary retention. It was diagnosed with GBS, hospitalized in intensive care unit, requiring assisted ventilation and treated with plasmapheresis, developing pneumonia as a complication related to mechanical ventilation and fully recovered bladder function. Discussion: The bladder involvement is not described as an important factor in diagnosis and remains controversial this statement by several authors.

Síndrome de Miller Fisher associada à infecção por escherichia coli / Miller Fisher syndrome linked to infeccion by escherichia coli

A síndrome de Miller Fisher (SMF), uma variante da Síndrome de Guillain-Barré, é uma doença incomum na prática médica. Esta doença é caracterizada por inflamação e desmielinização dos nervos periféricos de provável causa infecciosa. Estão descritos casos associados a infecções respiratórias e digestivas. O presente relato descreve o caso de uma paciente de 54 anos que apresentou SMF após sete dias de infecção urinária por Escherichia coli.

Miller Fisher syndrome (MFS), a variant of Guillain-Barré syndrome, is an uncommon disease in medical practice. It is characterized by inflammation and demyelination of peripheral nerves of probable infectious etiology. Cases are associated with respiratory and digestive infections. This report describes the case of a 54-year-old female patient who presented with MFS after seven days of urinary tract infection with Escherichia coli.

A Case of Demyelinating Peripheral Neuropathy Associated with Hashimoto's Thyroiditis

Peripheral neuropathy is somewhat common in hypothyroidism. But, demyelinating peripheral neuropathy in Hashimoto's thyroiditis is extremely rare. The pathophysiology of demyelinating peripheral neuropathy associated with Hashimoto's thyroiditis is unclear and complex and various mechanisms including the cell mediated and antibody mediated responses may be operative. We report a 68-year-old woman who presented with paresthesia and gait disturbance. She was diagnosed with hypothyroidism 7 years prior and has been on thyroid hormone. Serum antithyroglobulin antibody was significantly elevated. Nerve conduction studies revealed sensory-motor demyelinating polyneuropathy with prolonged distal latencies and reduced conduction velocities. She was under the suspicion of the lymphoma of thyroid. Surgery was performed which turned up to be Hashimoto's thyroiditis. With the impression of rare demyelinating peripheral neuropathy associated with Hashimoto's thyroiditis after other causes were excluded, she was treated with steroid which ameliorated rapidly her neurological symptoms.

Co-existence of transient neurological symptoms along with post dural puncture headache [PDPH]: a case report

Regional anaesthesia is well known for complications. Major neurological sequelae after central blockade although rare but can be devastating for the patient and the anaesthetist. Coexistence of transient neurological manifestations along with post dural puncture headache has not been reported in literature. A case with the features of both is presented, although the exact cause for the coexistence could not he ascertained. Also, this patient did not respond to the usual doses of ACTH

Multiorgan involvement due to cytomegalovirus infection in AIDS

Cytomegalovirus (CMV) infection is a relatively late complication of AIDS. Like other viruses contributing to co-morbidity of HIV infection, cytomegalovirus has the propensity to cause multiorgan involvement. We report the case of a 34-year-old seropositive man who presented with bilateral lower limb weakness and symptomatic pallor. He was already on antiretroviral drugs for a month prior to presentation. Detailed clinical examination and laboratory investigations revealed cytomegalovirus polyradiculoneuropathy associated with bone marrow dysplasia. Dysplasia of haematopoeitic cell lines occurs in 30 percent to 70 percent of HIV infected patients, and is often indistinguishable from myelodysplastic syndrome. However, in our case, the bone marrow picture reverted back to normal with treatment of the CMV infection, pointing to a possible role of CMV as the causative agent of bone marrow dysplasia. Moreover, CMV has been incriminated as a pathogen producing the immune reconstitution inflammatory syndrome. The onset of the disease in our case one month after initiation of HAART strongly raises the possibility of this being a case of CMV related IRIS. This is the first reported case where IRIS has presented with CMV polyradiculoneuropathy and bone marrow dysplasia. We would like to highlight that in today's era of HIV care, clinicians should be aware of the possibility of multiorgan involvement by CMV, for appropriate management of this disease in the background of AIDS.

Síndrome de Güillain Barré (sgb) Actualización / Guillain Barre Syndrome

El síndrome de Guillain-Barre, es una polirradiculoneuropatía inflamatoria aguda de carácter progresivo; producto de la inflamación de los nervios periféricos secundaria a factores autoinmunes. El síndrome ha emergido como la causa más frecuente de parálisis flácida en los niños a partir de la eliminación de la poliomielitis y se ha relacionado con infecciones. La secuencia de eventos que conllevan a las manifestaciones clínicas no se ha podido dilucidar y existen dudas con respecto al mecanismo de la lesión. Se ha clasificado en cuatro grupos desde el punto de vista fisiopatológico: polineuropatía sensitivo-motora desmielinizante, neuropatía motora axonal aguda, neuropatía sensitivo-motora axonal aguda y síndrome de Miller Fisher. Es una enfermedad monofásica con una duración menor a doce semanas, generalmente inicia con parestesias y debilidad distal de miembros inferiores. La progresión de la debilidad es ascendente y variable, pudiendo comprometer los miembros superiores, tronco, musculatura facial y orofaringe. En casos severos hay compromiso respiratorio, requiriendo ventilación. Las causas de mortalidad son disautonomía y falla respiratoria. Los criterios necesarios para el diagnóstico son: debilidad motora progresiva de más de un miembro y arreflexia o hiporreflexia marcada. El diagnóstico debe ser confirmado con análisis de LCR y estudios electrodiagnósticos. Una vez se sospeche clínicamente el diagnóstico, el paciente debe ser hospitalizado para vigilancia médica, cuidados de sostén, reconocimiento e intervención de las complicaciones que ponen en riesgo la vida del paciente. La plasmaferesis es el único tratamiento superior al manejo de soporte. El síndrome produce discapacidad muy frecuentemente, más del 40 por ciento de los pacientes requieren rehabilitación. Los pacientes infantiles tienen un mejor pronóstico que los adultos y un menor índice de secuelas, estas son menores, la mayoría de los pacientes se recuperan espontáneamente.