An epidemiologic, clinical, and therapeutic study of childhood Guillain-Barré syndrome in Kuwait: is it related to the oral polio vaccine?

We studied Guillain-Barré syndrome, affecting children 12 years old or less, throughout Kuwait, in the period between January 1, 1992, and March 31, 1997. Nineteen children had the diagnostic criteria of Guillain-Barré syndrome, with an overall annual incidence rate of 0.95/100,000 population at risk. Female patients outnumbered male patients with a sex ratio of 1.4:1. There was a clustering of cases in winter and spring and in the year 1996. The disease symptoms were relatively severe in our patients because only 16% (3 of 19) of them were able to walk at the height of their illness, whereas the rest were bed or chair bound or needed assisted ventilation. Two patients had the electrodiagnostic features of axonal neuropathy and both had residual deficits on follow-up, whereas the rest recovered fully. All the patients received intravenous immunoglobulin. The mean time to walk unaided was 23.5 days (range, 2-84 days) after intravenous immunoglobulin and excluding the two patients with axonal neuropathy, and full recovery was achieved in a mean time of 103 days (range, 30-300 days). Contrary to previous studies, we found no correlation between oral polio vaccine administration and Guillain-Barré syndrome in 2 successive years (1995 and 1996) during a nationwide campaign targeting children less than 5 years old.

Transient hypocalcemia with elevated serum parathormone in an infant of a hyperparathyroid mother.

An infant presented at the age of 80 days with a hypocalcemic fit. The mother was found to have asymptomatic parathyroid adenoma. The infant's intact parathyroid hormone was high in the absence of hypomagnesemia, renal failure or overt rickets, which are known causes of secondary end-organ refractoriness. The patient was treated with calcium and 1-alpha-hydroxyvitamin D for only 2 weeks, but has remained asymptomatic and normocalcemic on follow-up to--the age of 2 years. It is believed that this has not been previously described and it is speculated that end-organ refractoriness, though brief, can account for all the symptoms.