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Donaghy F, Pepin B, Sabnani R, Hermos C. A Watchful Eye for the Acutely Unsteady Child. Clin Pediatr (Phila) 2024; 63:1005-1008. [PMID: 37694861 DOI: 10.1177/00099228231199979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Feargal Donaghy
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Children's Medical Center, Worcester, MA, USA
| | - Bryce Pepin
- UMass Chan Medical School, Worcester, MA, USA
| | - Reshma Sabnani
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Children's Medical Center, Worcester, MA, USA
| | - Christina Hermos
- UMass Chan Medical School, Worcester, MA, USA
- UMass Memorial Children's Medical Center, Worcester, MA, USA
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Bhagwat AP, Sharath HV, Warghat PA. Effect of Paediatric Rehabilitation in Children With Guillain-Barré Syndrome: A Case Series. Cureus 2024; 16:e59815. [PMID: 38846247 PMCID: PMC11154077 DOI: 10.7759/cureus.59815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare autoimmune disorder impacting the peripheral nervous system, particularly severe in children. This case series assesses the efficacy of paediatric rehabilitation on functional outcomes in paediatric GBS patients. The interventions focused on balance training, strength enhancement, and activities of daily living (ADLs). Four paediatric GBS patients were enrolled, presenting primarily with weakness and fever. Post-rehabilitation, significant enhancements were noted in motor function, ADLs, and quality of life (QoL). This series underscores the favourable impact of paediatric rehabilitation on GBS, advocating for early initiation to improve recovery and enhance QoL. GBS poses significant challenges, particularly in paediatric populations, necessitating comprehensive management strategies. While the syndrome's acute phase is managed medically, rehabilitation plays a pivotal role in optimizing long-term outcomes. This study aims to evaluate the effect of paediatric rehabilitation interventions on functional outcomes in children diagnosed with GBS. The four paediatric patients diagnosed with GBS underwent paediatric rehabilitation, comprising balance training, strength enhancement, and ADL exercises. Functional outcomes, including motor function, ADLs, and QoL, were assessed pre- and post-rehabilitation using standardized measures. The most common presenting symptoms in the paediatric GBS patients were weakness and fever. Following paediatric rehabilitation, significant improvements were observed in specific functional outcomes, including motor function, ADLs, and QoL. These improvements underscore the efficacy of paediatric rehabilitation in enhancing functional recovery and overall well-being in these patients. The findings of this case series emphasize the crucial role of paediatric rehabilitation in managing GBS in children. Early initiation of rehabilitation interventions may facilitate better recovery trajectories and improve long-term outcomes. Comprehensive rehabilitation strategies addressing motor function, ADLs, and QoL are essential components of holistic GBS management in pediatric patients. Pediatric rehabilitation interventions, encompassing balance training, strength enhancement, and ADL exercises, demonstrate significant benefits in improving functional outcomes in children with GBS. Early initiation of rehabilitation interventions is pivotal for enhancing the recovery process and optimizing the QoL in pediatric GBS patients. Further research is warranted to validate these findings and refine rehabilitation protocols for optimal outcomes.
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Affiliation(s)
- Anushka P Bhagwat
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - H V Sharath
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratiksha A Warghat
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sharma P, Surve RM, Pendharkar HS, Kulkarni GB, Naik SS. Mimics of Guillain-Barré Syndrome in Pediatric Patients Admitted to the Neuro-Intensive Care Unit of a Tertiary Care Hospital-A Case Series. Neurol India 2024; 72:379-383. [PMID: 38817174 DOI: 10.4103/ni.ni_881_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/24/2023] [Indexed: 06/01/2024]
Abstract
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis in children, but several diseases mimic GBS. We aimed to identify and report the clinical pointers and battery of tests required to differentiate Guillain-Barré syndrome from its observed mimics in the pediatric population admitted to our neuro-critical care unit. We conducted a retrospective record analysis of all pediatric patients admitted over ten years from 2008-2018, whose initial presentation was compatible with a clinical diagnosis of GBS. Eighty-three patients were at first treated as GBS, of which seven (8.4%) were found to have an alternate diagnosis-three cases of paralytic rabies, one case each of acute disseminated encephalomyelitis, cervical myeloradiculopathy, neuromyelitis optica, and a case of community-acquired Staphylococcus aureus pneumonia associated sepsis. Neurophysiological and neuro-virological testing, central nervous system imaging, and sepsis screening helped to confirm the alternate diagnosis. Our case series provides knowledge of subtle clinical differences along with the mindful use of diagnostic testing to facilitate the accurate diagnosis of GBS mimics.
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Affiliation(s)
- Prachi Sharma
- Department of Neruroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rohini M Surve
- Department of Neruroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hima S Pendharkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shweta S Naik
- Department of Neruroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Kobayashi Takahashi Y, Hayakawa I, Abe Y. Diagnostic odyssey of Guillain-Barré syndrome in children. Brain Dev 2024; 46:108-113. [PMID: 37914621 DOI: 10.1016/j.braindev.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/04/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES A gap exists between difficulty in diagnosis and importance of early recognition and intervention in pediatric Guillain-Barré syndrome (GBS). Therefore, this study aimed to establish a diagnostic odyssey plot that allows "at-a-glance" overview of the diagnostic odyssey of GBS in children, including overall diagnostic delay, physician-related and patient-related diagnostic delays, and length and frequency of diagnostic errors. METHODS In this single-center retrospective cohort study, standardized data were obtained from children with GBS from 2003 to 2020. Overall diagnostic delay (time between symptom onset and diagnosis), physician-related diagnostic delay (time between the first medical visit and diagnosis), and patient-related diagnostic delay (time between symptom onset and the first medical visit) were analyzed. RESULTS The study examined a total of 21 patients (11 men, median age 4.5 years). Overall, there were 40 misdiagnoses among 17 patients, while four were diagnosed correctly at the first visit. The overall diagnostic delay was 9 days [interquartile range (IQR), 6-17 days]. Physician-related diagnostic delay, but not patient-related diagnostic delay, was correlated with the overall diagnostic delay. Patients in the late-diagnosed group were more frequently misdiagnosed during their diagnostic odyssey than patients in the other groups. Risk factors associated with diagnostic delay included delayed onset of weakness and sensory deficits, absence of swallowing problems, and misdiagnosis as orthopedic disorders or viral infections. DISCUSSION A unique diagnostic odyssey exists in pedaitric GBS. Several clinical risk factors were associated with the diagnostic delay.
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Affiliation(s)
- Yoko Kobayashi Takahashi
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan; Department of Child Neurology, National Center for Neurology and Psychiatry, Tokyo, Japan
| | - Itaru Hayakawa
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, University of Tokyo, Tokyo, Japan.
| | - Yuichi Abe
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
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Kozyreva AA, Bembeeva RT, Druzhinina ES, Zavadenko NN. [Guillain-Barre syndrome in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-32. [PMID: 37942969 DOI: 10.17116/jnevro202312309220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated disease of the peripheral nervous system that can occur in both children and adults. The classic presentation of GBS is characterized by progressive symmetrical, ascending muscle weakness. Patients with GBS require meticulous monitoring due to the risk of bulbar syndrome, respiratory failure and autonomic dysfunction, which can be life-threatening. Early diagnosis and timely prescription of pathogenetic therapy for GBS are particularly important, especially in young children. Meanwhile, the spectrum of disorders covered by GBS has expanded significantly; its eponym is now designate any variant of acute dysimmune polyneuropathy, and its atypical forms pose a serious diagnostic problem for clinicians. This review article provides an analysis of the data available in the medical literature on GBS in children and discusses the tactics for diagnosing and managing patients with GBS, taking into account the Russian and European clinical recommendations.
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Affiliation(s)
- A A Kozyreva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - R Ts Bembeeva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - E S Druzhinina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - N N Zavadenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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Güzin Y, Yılmaz U, Pekuz S, Karaoğlu P, Parlak İbiş İB, Kırkgöz HH, Yavuz M, Ünalp A. Retrospective evaluation of Guillain-Barre syndrome in children: A single-center experience. Pediatr Int 2023; 65:e15650. [PMID: 37817404 DOI: 10.1111/ped.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Although Guillain-Barré syndrome (GBS) is now the most common cause of acute flaccid paralysis in children, information on the long-term follow-up of GBS is still limited. Identification of prognostic factors can play an important role in treatment strategies and the follow-up of patients. This study aimed to evaluate the effectiveness of monitoring the GBS disability score (DS) in predicting morbidity and mortality. METHODS The patients were separated into two groups those with DS≥ or <3 on admission. These groups were compared in respect of demographic data, clinical and laboratory findings, and the DS recorded on admission and at first, third, sixth, 12th, and 24th months. RESULTS The study included 44 patients (54.5% male, 45.5% female) with a median age of 5 years. The most common involvements during the disease were weakness, ataxia, neuropathic pain, cranial neuropathy, respiratory distress, autonomic dysfunction, and psychiatric symptoms, respectively. In patients with a DS of ≥3, the time from onset of symptoms to hospital admission was shorter, and the length of hospital stay was longer. Children with back pain and autonomic dysfunction had a DS of ≥3. A high 3-month DS was found to be a significant predictor for the development of sequelae. CONCLUSIONS Although progressive muscle weakness and inability to walk are the most common symptoms of GBS, it should be kept in mind that atypical manifestations such as hemiplegia and ophthalmoplegia may also occur. For an objective assessment of clinical improvement during follow-up, the DS for motor functions can be used.
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Affiliation(s)
- Yiğithan Güzin
- Department of Pediatric Neurology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Unsal Yılmaz
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Serdar Pekuz
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Pakize Karaoğlu
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - İpek Burcu Parlak İbiş
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Hatice Hilal Kırkgöz
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Merve Yavuz
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
| | - Aycan Ünalp
- Department of Pediatric Neurology, Dr Behcet Uz Child Disease and Surgery Training and Research HospitalI, Izmir, Turkey
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Sugumar K, Chidambaram AC, Gunasekaran D. Assessment of neurological sequelae and new-onset symptoms in the long-term follow-up of paediatric Guillain-Barre syndrome: A longitudinal study from India. J Paediatr Child Health 2022; 58:2211-2217. [PMID: 36054714 DOI: 10.1111/jpc.16185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is the commonest cause of acute flaccid paralysis in children. There is a paucity of studies that assess the long-term outcome of paediatric GBS. AIM To assess the frequency of neurological sequelae and the new-onset symptoms in the long-term follow-up of paediatric GBS and to identify the risk factors associated with them. METHODS This longitudinal study involved 78 children with GBS treated between January 2015 and 2021. The parents of those children were contacted to visit the hospital for a detailed neurological examination and to look for new-onset symptoms after the initial treatment for GBS. RESULTS Of the 78 children, acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, and acute motor-sensory axonal neuropathy variants were observed in 30 (38.5%), 27 (34.6%) and 11 (14.1%) children, respectively. The median (interquartile range (IQR)) duration of follow-up was 3 (2, 4.5) years. The median (IQR) time to independent ambulation was 30 (13.5, 105) days. The neurological sequelae were found in 22 (28.2%) children. GBS disability score at admission (odds ratio (OR) = 4.6; 95% confidence interval (CI): 1.1-19.8; P = 0.04) and axonal variant of GBS (OR = 4.1; 95% CI: 1.5-20.8; P = 0.04) were found to be independent predictors of neurologic sequelae. A total of 28 children experienced new-onset symptoms after GBS, with frequent falls while running and fatigue being the predominant symptoms. Those children with demyelinating variant achieved independent ambulation earlier than the axonal group on survival analysis (log-rank P value = 0.04). CONCLUSION The presence of neurological sequelae and new-onset symptoms were found in 28.2 and 35% of the GBS children, respectively. High GBS disability score at admission and axonal variant of GBS were independent predictors of neurological sequelae. Knowledge about these would help in devising a plan for rehabilitation.
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Affiliation(s)
- Kiruthiga Sugumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Aakash C Chidambaram
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Dhandapany Gunasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Guillain-Barré syndrome in children - High occurrence of Miller Fisher syndrome in East Asian region. Brain Dev 2022; 44:715-724. [PMID: 35906115 DOI: 10.1016/j.braindev.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a rare acquired immune-mediated polyneuropathy. Updated population-based data concerning paediatric GBS is needed. METHODS Paediatric patients aged below 18 years diagnosed with GBS between 2009 and 2018 in all 11 paediatric departments in Hong Kong were identified from the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. The collected data from medical health records were reviewed by paediatric neurologist from each department. Estimated incidence of paediatric GBS was calculated. We also compared our findings with other paediatric GBS studies in Asia. RESULTS 63 subjects of paediatric GBS were identified, giving an estimated annual incidence of 0.62 per 100,000 population. Half of the subjects had acute inflammatory demyelinating polyneuropathy (AIDP) (n = 31; 49.2%), one quarter had Miller Fisher Syndrome (MFS) (n = 16; 25.4%), one-fifth had axonal types of GBS (n = 12; 19.0%), and four were unclassified. Paediatric subjects with axonal subtypes of GBS compared to the other 2 subtypes, had significantly higher intensive care unit (ICU) admission rates (p = 0.001) and longest length of stay (p = 0.009). With immunomodulating therapy, complete recovery was highest in those with MFS (100%), followed by AIDP (87.1%) and axonal GBS (75%). Our study also confirms a higher MFS rate for paediatric GBS in East Asia region and our study has the highest MFS rate (25.4%). CONCLUSION Our population-based 10-year paediatric GBS study provides updated evidence on estimated incidence, healthcare burden and motor outcome of each subtype of paediatric GBS and confirmed a higher occurrence of paediatric MFS in East Asia.
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Síndrome de Guillain-Barré atípico secundario a infección por SARS-CoV-2 en paciente pediátrico: a propósito de un caso. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC9250936 DOI: 10.1016/j.acci.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
El conocimiento sobre las manifestaciones neurológicas secundarias a la infección por síndrome respiratorio agudo grave por coronavirus 2 (SARS-CoV-2) en pacientes pediátricos sigue siendo limitado por la escasez de casos reportados. Sin embargo, se ha documentado la relación entre la infección por SARS-CoV-2 y el síndrome desmielinizante de Guillain-Barré en pacientes escolares y adolescentes. Presentamos un caso clínico de lactante con manifestaciones clínicas de síndrome axonal de Guillain-Barré asociado a serología para SARS-CoV-2 positiva, que requirió ventilación mecánica invasiva y que presentó mejoría posterior a la administración de inmunoglobulina y corticoides sistémicos.
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Ceolin V, Cenna R, Resente F, Spadea M, Fagioli F, Bertorello N. Guillain-Barré syndrome after bortezomib therapy in a child with relapsed acute lymphoblastic leukemia. Pediatr Hematol Oncol 2022; 39:187-192. [PMID: 34369835 DOI: 10.1080/08880018.2021.1959691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 12-year-old male being treated for a high-risk relapsed T-acute lymphoblastic leukemia presented progressive weakness and numbness of both legs after having received a chemotherapy regimen that included bortezomib. Diagnosis of acute Guillain-Barré syndrome-like inflammatory demyelinating polyneuropathy was made following clinical examination, cerebrospinal fluid analysis, electrodiagnostic studies, magnetic resonance imaging, and serum immunoglobulin antibodies to anti-ganglioside. Intravenous immunoglobulin treatment was started, resulting in complete clinical recovery. Although in rare cases, Guillain-Barré syndrome after bortezomib therapy has been reported; this paper suggests that GBS may occur when bortezomib is administered and high‑dose intravenous immunoglobulin lead to a resolution of the symptoms.
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Affiliation(s)
- Valeria Ceolin
- Department of Pediatric and Public Health Sciences, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Rosita Cenna
- Department of Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesca Resente
- Department of Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Turin, Italy
| | - Manuela Spadea
- Department of Pediatric and Public Health Sciences, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Franca Fagioli
- Department of Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Turin, Italy
| | - Nicoletta Bertorello
- Department of Pediatric Onco-Hematology, Regina Margherita Children's Hospital, Turin, Italy
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Vega-Castro R, Garcia-Dominguez M, Tostado-Morales E, Perez-Gaxiola G. A Case Report of Guillain-Barre Syndrome in an Eleven-Month Infant. J Med Cases 2021; 12:115-118. [PMID: 34434441 PMCID: PMC8383587 DOI: 10.14740/jmc3638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022] Open
Abstract
Guillain-Barre syndrome (GBS) is an acute immune-mediated progressive predominantly motor symmetric polyradiculoneuropathy which causes demyelination and leads to weakness, ataxia and areflexia. There are a variety of forms of the syndrome; and despite being the most common cause of acute flaccid paralysis in children, it has a low incidence under 18 years old, and it is even rarer in children less than 2 years of age. Very few cases have been reported under 12 months of age. We describe a case of an 11-month-old male infant presenting with weakness and inability to ambulate who was diagnosed with GBS.
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Affiliation(s)
- Rossela Vega-Castro
- Department of Neurology and Neurophysiology, Hospital Pediatrico de Sinaloa, Culiacan, Mexico
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12
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Anti-GM1 IgM antibody positive axonal variant of Guillain-Barre-syndrome in a pediatric patient with dengue fever. J Neuroimmunol 2021; 355:577572. [PMID: 33862418 DOI: 10.1016/j.jneuroim.2021.577572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION While children of all ages may be affected by Guillain-Barre-Syndrome (GBS), there are no reports of Dengue Fever (DF) as the preceding or concurrent infection in this age group. In addition, the presence of anti-GM1 IgM antibody, commonly seen in Multifocal Motor Neuropathy, is rarely encountered in both axonal and demyelinating variants of GBS. Moreover, only few neuromuscular ultrasound findings of the axonal variant in children were reported in the literature. CASE Here we present a nine-year-old female who developed the classic signs, symptoms and neurophysiologic findings of axonal type of GBS during DF. She had elevated anti-GM1 IgM antibody atypical of this variant and diffusely enlarged nerves via neuromuscular ultrasound. CONCLUSION In a pediatric patient with DF and acute flaccid paralysis, GBS should always be one of the considerations. Although rare, anti-ganglioside GM1 IgM antibody can still be found in axonal variant of GBS.
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Cai L, Hu Z, Liao J, Hong S, Kong L, Chen L, Luo Y, Li T, Jiang L. Clinical Characterization of Anti-GQ1b Antibody Syndrome in Childhood. Front Pediatr 2021; 9:649053. [PMID: 33996691 PMCID: PMC8116501 DOI: 10.3389/fped.2021.649053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: To delineate the comprehensive clinical features of anti-GQ1b antibody syndrome in childhood. Methods: The clinical data of children diagnosed with anti-GQ1b antibody syndrome at two Chinese tertiary pediatric neurology centers were collected and analyzed. We also conducted a systematic literature review on anti-GQ1b antibody syndrome in children. Results: This study included 78 children with anti-GQ1b antibody syndrome, consisting of 12 previously unreported cases from the two Chinese centers. The median onset age was 10 years (range, 2-18 years). The most common phenotype was acute ophthalmoparesis (32%), followed by classic Miller Fisher syndrome (15%), and Bickerstaff brainstem encephalitis (12%). External ophthalmoplegia (48%), sensory disturbance (9%), and bulbar palsy (9%) were the three most frequent onset symptom manifestations. Brain or spinal lesions on MRI and abnormal recordings by nerve conduction study were present in 18% (12/68) and 60% (27/45) of cases, respectively. There was CSF albuminocytologic dissociation in 34% of the patients (23/68). IV immunoglobulin alone or combined with steroids or plasma exchange was administered to 58% of patients (42/72). We did not find a significant correlation between early improvement up to 3 months and age onset and phenotype. All patients showed different degrees of recovery, and 81% (57/70) had complete recovery within 1 year. Conclusions: Acute ophthalmoparesis and classic Miller Fisher syndrome are the most common phenotypes of anti-GQ1b antibody syndrome in childhood. The majority of patients show good response to immunotherapy and have favorable prognosis.
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Affiliation(s)
- Lianhong Cai
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhanqi Hu
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lingyu Kong
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Li Chen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yetao Luo
- Department of and Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Tingsong Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- *Correspondence: Tingsong Li ; orcid.org/0000-0003-4536-3211
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Guillain-Barré syndrome in a heart transplantation recipient. J Am Assoc Nurse Pract 2020; 33:639-645. [PMID: 32282569 DOI: 10.1097/jxx.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT A rare case of a heart transplantation recipient with Guillain-Barré syndrome occurred, which was associated with peripheral nervous system damage. Based on a review of epidemiological research, the symptom development process, and diagnostic tools, the authors highlight the extreme rarity of this postinfectious immune disease. After diagnosis, plasma exchange and immunoregulatory therapy should be performed because they result in rapid recovery. If there is delayed diagnosis and treatment, there is a high risk of disability or death. When patients experience acute limb paralysis as the main symptom, nurse practitioners (NPs) should focus on the patient's history, particularly with regard to infectious agents. Closely monitoring the patient to detect respiratory failure and the need for early respiratory intervention can help the patient to avoid the severe complication of permanent brain injury. For NPs, performance of early differential diagnosis is important, especially among patients who have immunosuppressive dependence after transplantation.
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Iacopi E, Ferranti S, Riitano N, Abbruzzese L, Pieruzzi L, Goretti C, Zampa V, Piaggesi A. Bioactive Glass in a Rare Case of Osteomyelitis of the Heel in a Guillain-Barré Syndrome: A Case Report. INT J LOW EXTR WOUND 2020; 20:60-66. [DOI: 10.1177/1534734619896462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Guillain-Barré syndrome (GBS) represents an acute inflammatory immune-mediated demyelinating polyradiculoneuropathy with an incidence of 0.6 per 100 000 people. In this article, we report the case of a 19-year-old girl affected by GBS since the age of 2 who presented at our clinic complaining for a chronic plantar hindfoot–infected ulceration. Serology showed increase of inflammatory markers and leukocytosis, and magnetic resonance imaging revealed osteomyelitis of calcaneum and soft tissue alterations with air bubbles. The patient was treated in our clinic by an integrated multidisciplinary approach consisting of immediate admission, soft tissue and bone debridement, and administration of antibiotics under the close control of infectious disease specialist. After the control of acute condition, the patient underwent negative pressure therapy associated with instillation of antiseptic solution until the restoration of bone and soft tissue loss of substance and, eventually, to the application of bioactive glass substitute until the achievement of complete wound healing.
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Kim SH, Samadov F, Mukhamedov A, Kong J, Ko A, Kim YM, Lee YJ, Nam SO. Clinical Characteristics and Prognostic Factors of Children with Guillain-Barré Syndrome. ANNALS OF CHILD NEUROLOGY 2019. [DOI: 10.26815/acn.2019.00143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Roach ES. The Many Faces of Guillain-Barré Syndrome. Pediatr Rev 2018; 39:55-56. [PMID: 29437124 DOI: 10.1542/pir.2017-0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- E Steve Roach
- Editorial Board Member, Pediatrics in Review.,Division of Child Neurology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
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