[Acute polyradiculoneuritis (Guillain-Barré syndrome) in childhood]

Natural history and treatment effects in Guillain-Barré syndrome: a multicentre study

A retrospective multicentre study was performed to investigate the natural history and treatment effects in childhood Guillain-Barré syndrome in a large number of patients. Structured questionnaires were sent to 155 paediatric hospitals for details of patients who conformed to internationally accepted diagnostic criteria and who were treated from spring 1989 to summer 1994. Sixty nine hospitals reported data of 175 patients aged 11 months to 17.7 years. At the height of the disease 26% of the patients remained able to walk, but 16% had to be artificially ventilated. The median time from onset of symptoms to first recovery was 17 days, to walk unaided 37 days, and to be free of symptoms 66 days. There was a large group with a benign and a smaller one with a more protracted course. At long term follow up, 98/106 patients were free of symptoms and the remainder were able to walk unaided. Maximum disability grade was the most powerful prognostic factor. In children unable to walk but not yet tetraplegic, immunoglobulins were able to accelerate recovery. Corticosteroids were less potent. Plasmapheresis could not be evaluated because it was administered only in the most severe cases. The natural history of Guillain-Barré syndrome in children is extremely variable and more benign than in adults. Treatment with immunoglobulins should be considered in patients unable to walk. Corticosteroids are not as effective and should be withheld except when, in protracted courses, suspicion of chronic inflammatory demyelinating polyneuropathy arises.

Childhood Guillain-Barré syndrome: clinical presentation, diagnosis, and therapy

A rapidly progressive, generally symmetric, ascending flaccid paraparesis or quadriparesis that develops in an infant or child constitutes an uncommon but important pediatric neurologic emergency that requires immediate evaluation and treatment. The differential diagnosis primarily includes acute neuropathies, most commonly the childhood Guillain-Barré syndrome and, rarely, acute transverse myelitis or infantile poliomyelitis. A clinical distinction may be difficult in the younger child in whom detailed sensory examination is not possible. Although most children with Guillain-Barré syndrome usually have a benign and relatively limited clinical illness, some become severely ill, requiring intubation and careful intensive monitoring. To date, no well-controlled multi-institutional studies of treatment with either plasmapheresis or intravenously administered immunoglobulin have been developed in children despite the success of these modalities in adults. A review of the data available using these therapies is included in this study.