Guillain- barre syndrome in children; clinicolaboratory features, electrodiagnosis and prongnosis

ABSTRACT

Guillain - barre syndrome [GBS] is an acute post- infectious immune mediated peripheral neuropathy with a highly variable clinical course and outcome[1]. There are several factors claimed to affect the outcome as age, electrophysiologic type, levels of proinflammatory cytokines, and previous diarrhea[2]. This study was performed to evaluate the effect of these previous factors on the outcome of GBS. Fifty patients with GBS were prospectively studied and the following factors were evaluated; age of onset of the disease, days from onset of the disease to nadir level, days required to improve GBS Score from nadir level by one, severity of the disease at nadir, prior diarrhea, bulbar affection, autonomic dysfunction, parasthesia, respiratory failure, need for mechanical ventilation, electrophysiologic classification, Tumour necrosis factor [TNF] alpha in serum on admission and one week after IVIG therapy. Outcome was evaluated using the functional grading scale [FGS] of Hughes[3]. Prognosis of GBS in children is generally good with complete recovery of all patients after one year from the onset of the disease without residual neurologic deficit; however severity of the disease at nadir was increased by older age of onset, axonal type on electrophysiology, prior diarrhea, and higher levels of TNF alpha in serum. Guillan barre syndrome in children carry good prognosis as regard the long term outcome, however there is some risk of mortality and morbidity during the short term outcome. Both long and short term outcomes are improved by younger age of onset, demyelinating nature, and use of IVIG therapy