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Clinical and Electrophysiological Factors Predicting Prolonged Recovery in Children with Guillain–Barré Syndrome

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To compare clinical and nerve conduction studies (NCS) parameters predictive of outcome in children with acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN).

Methods

In this prospective observational study, NCS was done on all children at admission and repeated before discharge. Functional status of patients was graded as per Hughes Disability score. These children were followed up till they achieved independent walking. Clinical and NCS criteria were compared between (a) AMAN and AIDP and (b) two subgroups of children with AMAN—those who achieved early (within 60 d) versus delayed (i.e., after 60 d) walking.

Results

Fifty-seven children were initially enrolled, first NCS showed inexcitable nerves in 10, AMAN in 29, acute motor-sensory axonal neuropathy (AMSAN) in 3, AIDP in 13, and 2 were normal. Subsequent NCS showed AMAN in 37, AIDP in 15, AMSAN in 3 patients. There were no deaths, 16 required ventilation. Follow-up till independent walking, was available for 40 patients. AMAN was associated with faster progression, greater peak disability, prolonged hospital stay, and delayed walking (p < 0.05). Asymmetrical nerve involvement predicted prolonged hospital stay as well as delayed walking. In the AMAN group, prolonged ulnar F-wave latencies were significantly associated with delayed walking (p = 0.02).

Conclusion

Long term prognosis of pediatric GBS is generally satisfactory. AMAN, asymmetric involvement and prolonged ulnar F-wave latencies in children with AMAN were associated with delayed walking.

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References

  1. Tang J, Dai Y, Li M, et al. Guillain-Barré syndrome in chinese children: a retrospective analysis. Pediatr Neurol. 2011;45:233–7.

    Article  Google Scholar 

  2. Kalra V, Sankhyan N, Sharma S, Gulati S, Choudhry R, Dhawan B. Outcome in childhood Guillain-Barré syndrome. Indian J Pediatr. 2009;76:795–9.

    Article  Google Scholar 

  3. Akbayram S, Doğan M, Akgün C, et al. Clinical features and prognosis with Guillain-Barré syndrome. Ann Indian Acad Neurol. 2011;14:98–102.

    Article  Google Scholar 

  4. Salehiomran MR, Nikkhah A, Mahdavi M. Prognosis of Guillain-Barré syndrome in children. Iran J Child Neurol. 2016;10:38–41.

    PubMed  PubMed Central  Google Scholar 

  5. Hu MH, Chen CM, Lin KL, et al. Risk factors of respiratory failure in children with Guillain-Barre´ syndrome. Pediatr Neonatol. 2012;53:295–9.

  6. Kumar M, Aroor S, Mundkur S, Kumar S. Guillain-Barré syndrome: a clinical study of twenty children. J Clin Diagn Res. 2015;9:SC09–12.

    PubMed  PubMed Central  Google Scholar 

  7. Lee JH, Sung IY, Rew IS. Clinical presentation and prognosis of childhood Guillain–Barré syndrome. J Paediatr Child Health. 2008;44:449–54.

  8. Sankhyan N, Sharma S, Konanki R, Gulati S. Childhood Guillain-Barré syndrome subtypes in northern India. J Clin Neurosci. 2014;2:427–30.

    Article  Google Scholar 

  9. Yadav S, Jain P, Sharma S, Kumar V, Aneja S. Guillain–Barre syndrome in north Indian children: clinical and serial electrophysiological features. Neurol India. 2019;67:724–7.

    PubMed  Google Scholar 

  10. Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol. 1990;27(suppl):S21–S4.

    Article  Google Scholar 

  11. Hughes RAC, Wijdicks EFM, Barohn R, et al. Practice parameter: immunotherapy for Guillain–Barrésyndrome:report of the quality standards Subcommittee of the American Academy of Neurology. Neurol. 2003;61:736–40.

    Article  CAS  Google Scholar 

  12. Van Koningsveld R, Steyerberg EW, Hughes RAC, Swan AV, van Doorn PA, Jacobs BC. A clinical prognostic scoring system for Guillain-Barré syndrome. Lancet Neurol. 2007;6:589–94.

    Article  Google Scholar 

  13. Ryan CS, Conlee EM, Sharma R, Sorenson EJ, Boon AJ, Laughlin RS. Nerve conduction normal values for electrodiagnosis in pediatric patients. Muscle Nerve. 2019;60:155–60.

    Article  Google Scholar 

  14. Kang PB. Pediatric nerve conduction studies and EMG. In: Blum AS, Rutkove SB,editors. Totowa, NJ Humana Press Clin Neurophysiol Primer; 2007.p.369–89.

  15. Hung PL, Chang WN, Huang LT, et al. A clinical and electrophysiologic survey of childhood Guillain-Barre´ syndrome. Pediatr Neurol. 2004;30:86–91.

  16. Barzegar M, Jalali Z, Topchizadeh V. Epidemiological, clinical and electrodiagnostic findings in childhood Guillain-Barre syndrome. Med J Islam Repub Iran. 2003;17:123–7.

    Google Scholar 

  17. Islam Z, Jacobs BC, van Belkum A, et al. Axonal variant of Guillain-Barre’syndrome associated with campylobacter infection in Bangladesh. Neurology. 2010;74:581–7.

  18. Hosokawa T, Nakajima H, Unoda K, et al. Serial electrophysiological findings in Guillain-Barré syndrome not fulfilling AIDP or AMAN criteria. J Neurol. 2016;263:1709–18.

  19. Uncini A, Kuwabara S. Electrodiagnostic criteria for Guillain–Barrè syndrome: a critical revision and the need for an update. Clin Neurophysiol. 2012;123:1487–95.

  20. Kalita J, Kumar M, Misra UK. Prospective comparison of AMAN and AIDP in 140 children with Guillain-Barré syndrome in India. Muscle Nerve. 2018;57:761–5.

    Article  CAS  Google Scholar 

  21. Varkal MA, Uzunhan TA, Aydınlı N, Ekici B, Çalışkan M, Özmen M. Pediatric Guillain-Barré syndrome: indicators for a severe course. Ann Indian Acad Neurol. 2015;18:24–8.

    PubMed  PubMed Central  Google Scholar 

  22. Kiriyama T, Hirano M, Kusunoki S, et al. Asymmetrical weakness associated with central nervous system involvement in a patient with Guillain-Barrè syndrome. Clin Med Case Rep. 2009;2:51–4.

  23. Logullo F, Manicone M, Di Bella P, Provinciali L. Asymmetric Guillain-Barré syndrome. Neurol Sci. 2006;27:355–9.

    Article  CAS  Google Scholar 

  24. Tekgul H, Serdaroglu G, Tutuncuoglu S. Outcome of axonal and demyelinating forms of Guillain-Barre´ syndrome in children. Pediatr Neurol. 2003;28:295–9.

    Article  Google Scholar 

  25. Barzegar M, Toopchizadeh V, Maher M, et al. Predictive factors for achieving independent walking in children with Guillain-Barre syndrome. Pediatr Res. 2017;82:333–9.

    Article  Google Scholar 

  26. Sung EJ, Kim DY, Chang MC, Ko EJ. Prediction of functional outcome in axonal Guillain-Barre syndrome. Ann Rehabil Med. 2016;40:481–8.

    Article  Google Scholar 

  27. Nagasawa K, Kuwabara S, Misawa S, et al. Electrophysiological subtypes and prognosis of childhood Guillain-Barré syndrome in Japan. Muscle Nerve. 2006;33:766–70.

  28. Hiraga A, Mori M, Ogawara K, et al. Recovery patterns and long term prognosis for axonal Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 2005;76:719–22.

  29. Yadegari S, Nafissi S, Kazemi N. Comparison of electrophysiological findings in axonal and demyelinating Guillain-Barre syndrome. Iran J Neurol. 2014;13:138–43.

  30. Lee E-B, Lee YY, Lee JM, et al. Clinical importance of F-waves as a prognostic factor in Guillain-Barré syndrome in children. Korean J Pediatr. 2016;59:271–5.

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Acknowledgments

The authors thank their technicians Mr. Santosh Taru and Ms. Monica for conducting detailed nerve conduction studies; their biostatistician Mr. Rupesh Deshmukh for analyzing the data and completing the statistical analysis; and their Head of the Department, Dr. (Prof) Sanjay Lalwani for the logistic support to conduct the study.

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Authors and Affiliations

  1. Pediatric Neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, 411043, India

    Ekta Agarwal, Ankita Bhagat, Kavita Srivastava, Bina Thakore, Sujit Jagtap, Umesh Kalane & Surekha Rajadhyaksha

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  1. Ekta Agarwal
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  2. Ankita Bhagat
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  3. Kavita Srivastava
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  4. Bina Thakore
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  5. Sujit Jagtap
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  6. Umesh Kalane
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  7. Surekha Rajadhyaksha
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Contributions

KS and EA conceptualized the study; EA and AB did the data collection during hospitalization and follow-up; UK and SJ analyzed the nerve conduction studies; EA and BT helped in data analysis and manuscript writing, referencing etc.; KS and SR finalized the manuscript.

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Correspondence to Kavita Srivastava.

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Agarwal, E., Bhagat, A., Srivastava, K. et al. Clinical and Electrophysiological Factors Predicting Prolonged Recovery in Children with Guillain–Barré Syndrome. Indian J Pediatr 89, 452–458 (2022). https://doi.org/10.1007/s12098-021-03804-7

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  • DOI: https://doi.org/10.1007/s12098-021-03804-7

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