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Zhang J, Gan J, Wang J. Anti-sulfatide antibody associated GBS with headache and abdominal pain: a case report. BMC Pediatr 2024; 24:414. [PMID: 38926645 PMCID: PMC11201369 DOI: 10.1186/s12887-023-04287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 09/01/2023] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Guillain‒Barre syndrome (GBS) is an acute inflammatory peripheral neuropathy caused by autoimmunity. Gangliosides and sulfatides are important components of peripheral nerves. Anti-sulfatide antibody-mediated complement is associated with acute sensorimotor peripheral neuropathy in GBS, which is characterized by pain and paresthesias. CASE PRESENTATION The child was a 7-year-old girl with headache and abdominal pain, followed by limb numbness and pain. Cranial imaging showed ventricular dilatation, peripheral nerve function conduction examination showed polyradiculopathy, and cerebrospinal fluid tests showed normal cell counts but elevated protein levels, all of which led to the diagnosis of GBS. After treatment with intravenous immunoglobulin (400 mg/kg × 5 days), the symptoms did not improve, and muscle strength progressively worsened, accompanied by paroxysmal complexion flushing, heart rate fluctuation, hyperhidrosis, and a progressive increase in cerebrospinal fluid protein (up to 3780.1 mg/L). On the basis of these findings combined with serum anti-sulfatide IgM positivity, anti-sulfatide antibody-related GBS was considered, and treatment with low-dose prednisolone (1 mg/kg/d) led to symptom improvement. CONCLUSIONS Anti-sulfatide antibody-associated GBS is associated with small fiber peripheral neuropathy. The main manifestations are pain, paresthesias and autonomic dysfunction. In addition to the dysfunction of spinal nerve root absorption caused by increased cerebrospinal fluid protein, autonomic dysfunction may be involved in pain. When the therapeutic effect of immunoglobulin is not satisfactory, a low dose and short course of corticosteroids can be considered, and the prognosis is good.
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Affiliation(s)
- Jia Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jing Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jianjun Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China.
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Plante V, Basu M, Gettings JV, Luchette M, LaRovere KL. Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know. Semin Neurol 2024; 44:362-388. [PMID: 38788765 DOI: 10.1055/s-0044-1787047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Currently nearly one-quarter of admissions to pediatric intensive care units (PICUs) worldwide are for neurocritical care diagnoses that are associated with significant morbidity and mortality. Pediatric neurocritical care is a rapidly evolving field with unique challenges due to not only age-related responses to primary neurologic insults and their treatments but also the rarity of pediatric neurocritical care conditions at any given institution. The structure of pediatric neurocritical care services therefore is most commonly a collaborative model where critical care medicine physicians coordinate care and are supported by a multidisciplinary team of pediatric subspecialists, including neurologists. While pediatric neurocritical care lies at the intersection between critical care and the neurosciences, this narrative review focuses on the most common clinical scenarios encountered by pediatric neurologists as consultants in the PICU and synthesizes the recent evidence, best practices, and ongoing research in these cases. We provide an in-depth review of (1) the evaluation and management of abnormal movements (seizures/status epilepticus and status dystonicus); (2) acute weakness and paralysis (focusing on pediatric stroke and select pediatric neuroimmune conditions); (3) neuromonitoring modalities using a pathophysiology-driven approach; (4) neuroprotective strategies for which there is evidence (e.g., pediatric severe traumatic brain injury, post-cardiac arrest care, and ischemic stroke and hemorrhagic stroke); and (5) best practices for neuroprognostication in pediatric traumatic brain injury, cardiac arrest, and disorders of consciousness, with highlights of the 2023 updates on Brain Death/Death by Neurological Criteria. Our review of the current state of pediatric neurocritical care from the viewpoint of what a pediatric neurologist in the PICU needs to know is intended to improve knowledge for providers at the bedside with the goal of better patient care and outcomes.
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Affiliation(s)
- Virginie Plante
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Meera Basu
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Matthew Luchette
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
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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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Finsterer J. Before SARS-CoV-2 Vaccine is Held Responsible for Guillain-Barre Syndrome, Other Causes Must be Removed From the Table. J Clin Neuromuscul Dis 2024; 25:146-148. [PMID: 38441933 DOI: 10.1097/cnd.0000000000000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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Liu S, Zhang WW, Jia L, Zhang HL. Guillain-Barré syndrome: immunopathogenesis and therapeutic targets. Expert Opin Ther Targets 2024; 28:131-143. [PMID: 38470316 DOI: 10.1080/14728222.2024.2330435] [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] [Received: 09/17/2023] [Accepted: 03/10/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a group of acute immune-mediated disorders in the peripheral nervous system. Both infectious and noninfectious factors are associated with GBS, which may act as triggers of autoimmune responses leading to neural damage and dysfunction. AREAS COVERED Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccines as well as flaviviruses have been associated with GBS, although a robust conclusion has yet to be reached. Immunomodulatory treatments, including intravenous immunoglobulins (IVIg) and plasma exchange (PE), have long been the first-line therapies for GBS. Depending on GBS subtype and severity at initial presentation, the efficacy of IVIg and PE can be variable. Several new therapies showing benefits to experimental animals merit further investigation before translation into clinical practice. We review the state-of-the-art knowledge on the immunopathogenesis of GBS in the context of coronavirus disease 2019 (COVID-19). Immunomodulatory therapies in GBS, including IVIg, PE, corticosteroids, and potential therapies, are summarized. EXPERT OPINION The association with SARS-CoV-2 remains uncertain, with geographical differences that are difficult to explain. Evidence and guidelines are lacking for the decision-making of initiating immunomodulatory therapies in mildly affected patients or patients with regional subtypes of GBS.
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Affiliation(s)
- Shan Liu
- Department of Nuclear Medicine, Second Hospital of Jilin University, Changchun, China
| | - Wei Wei Zhang
- Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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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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A P, Shende V, Pawar S. A Study of Sensory Nerve Conduction in Pre- and Post-immunoglobulin Treatment of Guillain-Barré Syndrome. Cureus 2024; 16:e51673. [PMID: 38313916 PMCID: PMC10838190 DOI: 10.7759/cureus.51673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a condition characterized by acute and progressive weakness that impacts the limbs, facial muscles, and bulbar muscles due to acute polyneuro-radiculopathy. Typically, an infection that results in immune-mediated nerve dysfunction is what starts the disease. Patients often encounter paresthesia or discomfort before progressing to muscle weakness, initially in the lower extremities (which may include some proximal components) and subsequently in the upper extremities. The features of polyneuropathy identified during electrophysiology tests, bolstered by evidence of acquired demyelination in the nerve conduction study (NCS), support the clinical diagnosis of GBS. In peripheral neuropathies, NCS often reveals abnormalities in nerve conduction parameters. A specific pattern observed in the sensory nerve conduction study (SNCS), referred to as "sural sparing," signifies that the sural nerve, located near the calf muscles, remains relatively unaffected compared to other sensory nerves. Very few studies have been conducted to investigate improvements in sensory nerve conduction (SNC) parameters before and after intravenous immunoglobulin (IVIG), offering limited clinical correlation for the recovery and prognosis of the disease. The study aimed to observe the NCS parameters of the sensory nerves in both the upper and lower limbs, before and after the infusion of IVIG. METHODOLOGY This study was an observational investigation conducted in the neurophysiology laboratory of the Physiology Department at a rural medical college in central India. Fifty clinically diagnosed cases of GBS aged between 18 and 60 years were referred from the Department of Medicine to the Physiology Department for conducting the NCS. Basic sociodemographic information, along with clinical history, was collected. Subsequently, the RMS EMG EP Mark-II machine was employed to examine the sensory nerve action potentials (SNAPs), such as amplitude (in mV) and conduction velocity (in ms), of the sensory nerves in both the upper and lower limbs before and after IVIG infusion. The IVIG infusion occurs within one week of clinically diagnosing GBS. Following an initial NCS, a second NCS follow-up study was conducted one week after the IVIG infusion to analyze the changing trend in sensory nerves. RESULTS Upon analysis, no significant correlation was observed between the pre- and post-IVIG SNAPs of the median and ulnar nerves. However, the sural nerve conduction velocity's p-value of 0.033 demonstrated statistical significance, suggesting that the sural nerve is comparatively spared, confirming sural sparing. However, the SNAP of the sensory nerves in GBS patients showed a significant improvement overall, and only NCS quantified the percentage of improvement. CONCLUSION According to the study, the NCS of sensory nerves showed a positive change in the parameters examined before and after the infusion of IVIG. This underscores the timely intervention of GBS with IVIG, and conducting the sensory conduction study diligently will enhance knowledge about the recovery period. Additionally, it supports the treating physician in making informed interventions based on the results post-IVIG infusion. This enhancement in the sensory nerves can only be quantified through NCS.
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Affiliation(s)
- Prashanth A
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, IND
| | - Vinod Shende
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, IND
| | - Sachin Pawar
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, IND
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Wachira VK, Farinasso CM, Silva RB, Peixoto HM, de Oliveira MRF. Incidence of Guillain-Barré syndrome in the world between 1985 and 2020: A systematic review. GLOBAL EPIDEMIOLOGY 2023; 5:100098. [PMID: 37638372 PMCID: PMC10445966 DOI: 10.1016/j.gloepi.2023.100098] [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: 08/08/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy that affects the peripheral nervous system. The study aimed to describe the incidence of GBS in the world up to the year 2020. Methods A systematic review was conducted. Searches were done in four databases, PUBMED, EMBASE, EBSCO and Biblioteca virtual em Saude (BVS), and in grey literature and manual search in the reference lists of eligible studies. Results A total of 72 studies were included. The incidence of GBS among the cohort studies varied from 0.30 to 6.08 cases per 100.000 habitants and 0.42 to 6.58 cases per 100.000 person-years. Among the self-controlled studies, the risk incidence ranged from 0.072 to 1 case per 100.000 habitants and 1.73 to 4.30 cases per 100.000 person-years. Conclusions The reported incidence of GBS in the world among the studies included in the review is slightly higher than that reported in previous studies. The highest incidence rates were associated with public health events of international concern.
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Affiliation(s)
- Virginia Kagure Wachira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | | | | | - Henry Maia Peixoto
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
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Scorrano G, Russo M, Prezioso G, Sensi SL, Chiarelli F. A case of pediatric Guillain-Barré syndrome following hand-foot-and-mouth disease and the need for Brighton criteria revision in children. Acta Neurol Belg 2023; 123:2397-2399. [PMID: 36826716 DOI: 10.1007/s13760-023-02216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Giovanna Scorrano
- Department of Pediatrics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Mirella Russo
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- CAST Center for Advanced Studies and Technology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Prezioso
- Department of Pediatrics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neurosciences, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- CAST Center for Advanced Studies and Technology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- ITAB Institute of Advanced Biomedical Technology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
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Aguirre AS, Terán KL, López D. Acute meningitis followed by Campylobacter jejuni associated Guillain-Barré Syndrome in a pediatric patient with COVID-19: a case report. Int J Neurosci 2023:1-4. [PMID: 37930336 DOI: 10.1080/00207454.2023.2280452] [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: 08/16/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
Aim of the study: The association of GBS and meningitis in a pediatric population is infrequent. Given the limited number of reported cases from pediatric patients and considering that treatment guidelines are predominantly based on data gathered from adult patients; this is an opportunity to pay attention to different perspectives.Materials and methods: We present a case of a pediatric patient with a positive SARS-CoV2 test and acute meningitis followed by Campylobacter jejuni associated Guillain-Barré Syndrome.Results: To our knowledge, this is the first case of a pediatric patient presenting with the combination Guillain-Barré Syndrome following acute meningitis in the setting of a SARS-CoV2 infection.Conclusions: This case highlights the importance of recognizing vague and non-specific symptoms in pediatric patients, such as gait unsteadiness. Improving awareness of uncommon associations improves treatment and patient outcomes.
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Affiliation(s)
- Alex S Aguirre
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
- Hospital Metropolitano de Quito, Quito, Ecuador
| | - Kelly L Terán
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
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Conti F, Moratti M, Leonardi L, Catelli A, Bortolamedi E, Filice E, Fetta A, Fabi M, Facchini E, Cantarini ME, Miniaci A, Cordelli DM, Lanari M, Pession A, Zama D. Anti-Inflammatory and Immunomodulatory Effect of High-Dose Immunoglobulins in Children: From Approved Indications to Off-Label Use. Cells 2023; 12:2417. [PMID: 37830631 PMCID: PMC10572613 DOI: 10.3390/cells12192417] [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] [Received: 08/07/2023] [Revised: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The large-scale utilization of immunoglobulins in patients with inborn errors of immunity (IEIs) since 1952 prompted the discovery of their key role at high doses as immunomodulatory and anti-inflammatory therapy, in the treatment of IEI-related immune dysregulation disorders, according to labelled and off-label indications. Recent years have been dominated by a progressive imbalance between the gradual but constant increase in the use of immunoglobulins and their availability, exacerbated by the SARS-CoV-2 pandemic. OBJECTIVES To provide pragmatic indications for a need-based application of high-dose immunoglobulins in the pediatric context. SOURCES A literature search was performed using PubMed, from inception until 1st August 2023, including the following keywords: anti-inflammatory; children; high dose gammaglobulin; high dose immunoglobulin; immune dysregulation; immunomodulation; immunomodulatory; inflammation; intravenous gammaglobulin; intravenous immunoglobulin; off-label; pediatric; subcutaneous gammaglobulin; subcutaneous immunoglobulin. All article types were considered. IMPLICATIONS In the light of the current imbalance between gammaglobulins' demand and availability, this review advocates the urgency of a more conscious utilization of this medical product, giving indications about benefits, risks, cost-effectiveness, and administration routes of high-dose immunoglobulins in children with hematologic, neurologic, and inflammatory immune dysregulation disorders, prompting further research towards a responsible employment of gammaglobulins and improving the therapeutical decisional process.
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Affiliation(s)
- Francesca Conti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
| | - Mattia Moratti
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Lucia Leonardi
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Arianna Catelli
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Elisa Bortolamedi
- Specialty School of Paediatrics, University of Bologna, 40138 Bologna, Italy; (A.C.); (E.B.)
| | - Emanuele Filice
- Department of Pediatrics, Maggiore Hospital, 40133 Bologna, Italy;
| | - Anna Fetta
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy
| | - Marianna Fabi
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Elena Facchini
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.F.); (M.E.C.)
| | - Maria Elena Cantarini
- Pediatric Oncology and Hematology Unit “Lalla Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.F.); (M.E.C.)
| | - Angela Miniaci
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
| | - Duccio Maria Cordelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (A.M.); (A.P.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
| | - Daniele Zama
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (A.F.); (D.M.C.); (M.L.); (D.Z.)
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
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Roodbol J, Korinthenberg R, Venema E, de Wit MCY, Lingsma HF, Catsman-Berrevoets CE, Jacobs BC. Predicting respiratory failure and outcome in pediatric Guillain-Barré syndrome. Eur J Paediatr Neurol 2023; 44:18-24. [PMID: 36931152 DOI: 10.1016/j.ejpn.2023.02.007] [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: 10/09/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) has a highly variable clinical course and outcome as indicated by the risk of developing respiratory failure and residual inability to walk. Prognostic models as Erasmus GBS Respiratory Insufficiency Score (EGRIS) developed in adult patients are inaccurate in children. Our aim was to determine the prognostic factors of respiratory failure and inability to walk in children with GBS and to develop a new clinical prognostic model for individual patients (EGRIS-Kids). METHODS A multicenter retrospective cohort study was performed using the data of children (younger than 18 years) fulfilling the diagnostic criteria for GBS from the NINDS. This study was performed in two independent cohorts from centers in Germany, Switzerland, Austria (N = 265, collected 1989-2002) and The Netherlands (N = 156, collected 1987-2016). The predicted main outcomes were occurrence of respiratory failure during the disease course and inability to walk independent at one year after diagnosis. RESULTS In the combined cohort of 421 children, 79 (19%) required mechanical ventilation and one patient died. The EGRIS-kids was developed including: age, cranial nerve involvement and GBS disability score at admission, resulting in a 9 point score predicting risks of respiratory failure ranging from 4 to 50% (AUC = 0.71). A lower GBS disability score at nadir was the strongest predictor of recovery to independent walking (at one month: OR 0.43 95%CI 0.25-0.74). CONCLUSIONS EGRIS-Kids and GBS disability score at admission accurately predict the risk of respiratory failure and inability to walk respectively in children with GBS, as tools to personalize the monitoring and treatment.
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Affiliation(s)
- Joyce Roodbol
- Department of Neurology Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands; Department of Paediatric Neurology Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Rudolf Korinthenberg
- Division of Neuropaediatrics and Muscular Disorders, Department of Paediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Esmee Venema
- Emergency Department Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Public Health, Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Marie-Claire Y de Wit
- Department of Paediatric Neurology Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Coriene E Catsman-Berrevoets
- Department of Paediatric Neurology Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Bart C Jacobs
- Department of Neurology Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands; Department of Immunology Erasmus MC- Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands.
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Qinrong H, Yuxia C, Ling L, Huayu L, Lei X, Xiaoli L, Nong X. Reliability and validity of prognostic indicators for Guillain-Barré syndrome in children. Dev Med Child Neurol 2023; 65:563-570. [PMID: 36175376 DOI: 10.1111/dmcn.15418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
AIM To explore the clinical characteristics and prognostic predictors of Guillain-Barré syndrome (GBS) in Chinese paediatric patients. METHOD The clinical features of children with GBS hospitalized in the Children's Hospital of Chongqing Medical University were summarized retrospectively. The correlation between the Erasmus GBS Outcome Score (EGOS)/modified Erasmus GBS Outcome Score (mEGOS), GBS disability score (GDS)/modified Rankin Scale (MRS), Erasmus GBS Respiratory Insufficiency Score (EGRIS), and mechanical ventilation were evaluated. RESULTS One hundred forty-two patients (86 males, 56 females; median 62.50 months [interquartile range 41.00-97.50]) with classic GBS were enrolled in the study. In the present GBS cohort, 134 (94.37%) patients could walk independently (GDS ≤2) and 121 (85.21%) could manage without assistance (MRS ≤2) at 6 months. Eighteen (12.68%) patients with GBS required mechanical ventilation. The performance of mEGOS on admission, mEGOS on day 7, and EGOS-predicted GDS outcome at 4 weeks, 3 months, and 6 months in the paediatric patients with GBS admitted within 2 weeks of disease onset and that of the MRS outcome were evaluated. The EGRIS in individuals who required mechanical ventilation was significantly higher than in patients without mechanical ventilation (median = 6 vs median = 3, p < 0.001). INTERPRETATION In Chinese paediatric patients with GBS who were admitted 2 weeks after disease onset, the mEGOS and EGOS are validated indicators for the prediction of clinical outcomes 6 months after onset. EGRIS is helpful in predicting the implementation of mechanical ventilation in the acute phase. WHAT THIS PAPER ADDS The Erasmus Guillain-Barré syndrome (GBS) Outcome Score (EGOS) and modified EGOS are reliable prognostic predictors in paediatric patients with GBS. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is an effective predictor of mechanical ventilation in paediatric patients with GBS. An EGRIS of ≥5 indicates a high risk of mechanical ventilation in the acute phase.
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Affiliation(s)
- Huang Qinrong
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Chen Yuxia
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Liu Ling
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Luo Huayu
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xu Lei
- Department of Rehabilitation Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Li Xiaoli
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xiao Nong
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
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Chauvet E, Blanchard Rohner G, Manel V, Delmont E, Boucraut J, Garcia-Tarodo S. Autoantibodies to a Nodal Isoform of Neurofascin in Pediatric Chronic Inflammatory Demyelinating Polyneuropathy. Child Neurol Open 2023; 10:2329048X221149618. [PMID: 36816544 PMCID: PMC9936388 DOI: 10.1177/2329048x221149618] [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: 07/25/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 02/18/2023] Open
Abstract
Pediatric chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired immune-mediated disorder of the peripheral nervous system with a number of diagnostic pitfalls. A subset of treatment-resistant CIDP adult patients have been found with antibodies against paranodal proteins. We report the first pediatric case in a 14 year-old adolescent with a severe CIDP phenotype in whom positive anti-neurofascin 155 antibodies were found in his serum. Resistant to conventional therapies, he showed dramatic improvement when treated with Rituximab with mild to moderate functional motor disability at 24 month follow-up. In pediatric CIDP patients that remain refractory to conventional treatments, the presence of antibodies to paranodal proteins warrants investigation as it can have potential therapeutic guidance.
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Affiliation(s)
- Eline Chauvet
- Unit of Neuropediatrics, Department of Women, Children and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Geraldine Blanchard Rohner
- Immunology, Department of Women, Children and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Véroniqu Manel
- Hospices Civils De Lyon, Groupement Hospitalier EST, Hopital Femme Mere Enfant, Bron, France
| | - Emilien Delmont
- Referral Centre for Neuromuscular Disease and ALS, La Timone Hospital, Marseille, France
| | - Joseph Boucraut
- immunology Department, La Conception Hospital, Marseille, France
| | - Stephanie Garcia-Tarodo
- Unit of Neuropediatrics, Department of Women, Children and Adolescent, Geneva University Hospitals, Geneva, Switzerland,Stephanie Garcia-Tarodo, Unit of Neuropediatrics, Department of Women, Children and Adolescent, Geneva University Hospitals, Switzerland.
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15
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Günay Ç, Sarıkaya Uzan G, Hız Kurul S, Yiş U. Sural Sparing Pattern and Sensory Ratio as Electrodiagnostic and Prognostic Markers in Pediatric Guillain-Barré Syndrome. Neuropediatrics 2023; 54:20-30. [PMID: 36096153 DOI: 10.1055/a-1941-4513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to evaluate the presence of sural sparing pattern (SSP) and sensory ratio in pediatric Guillain-Barré syndrome (GBS), their distribution to subtypes, and their relationship with demographic and clinical features with a focus on the disability and muscle strength. METHODS This single-center retrospective study was conducted on pediatric GBS patients of both sexes with 2 years follow-up and two nerve conduction studies in which SSP and sensory ratio were calculated. Three subgroups of SSP were formed by separate calculation of median (SSP-m) and ulnar (SSP-u) and both median and ulnar sensory nerve action potentials (SNAPs; SSP-total). Muscle strength and disability were evaluated with the Medical Research Council (MRC) sum score and Hughes functional grading scale (HFGS), respectively. RESULTS SSP total was identified in 70.6% (n: 24) of the patients, while sensory ratio >1 was observed in 20 (66.7%) patients. Patients with SSP-m, SSP-u, SSP-total, or sensory ratio >1 had higher HFGS scores, while patients with SSP-m, SSP-u, or SSP-total had lower MRC sum scores. SSP parameters were significantly associated with muscle strength and disability scores in acute motor axonal neuropathy patients. CONCLUSION Both SSP and sensory ratio can be used for diagnostic and prognostic purposes. Disability and muscle strength are associated with SSP and sensory ratio in pediatric GBS.
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Affiliation(s)
- Çağatay Günay
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | - Gamze Sarıkaya Uzan
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | - Semra Hız Kurul
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | - Uluç Yiş
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
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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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Shibeshi MS, Mengesha AA, Gari KT. Pediatric Guillain-Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management Challenges, and Hospital Outcome. Pediatric Health Med Ther 2023; 14:107-115. [PMID: 36993874 PMCID: PMC10040339 DOI: 10.2147/phmt.s401461] [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: 12/14/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Background Guillain-Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. There remain diagnostic and treatment challenges in resource limited settings. This study aimed to describe the clinical presentation, diagnostic and management challenges, and hospital outcome of children with GBS in southern Ethiopia. Methods A retrospective chart review of children aged ≤14 years who were admitted with a diagnosis of GBS to Hawassa University Comprehensive Specialized Hospital from 2017 to 2021 was done. Medical records of 102 children who fulfilled the Brighton Criteria for GBS were reviewed, and data on demographic, clinical characteristics, investigation findings, treatment, and outcome were collected. Logistic regression analysis was done to determine factors associated with mortality. Results The mean age of the study subjects was 7.25±3.91 years and 63.7% were male. Antecedent event was present in 48% of the cases, and the most common triggering factor was upper respiratory tract infection (63.8%). The mean Hughes disability score was 4.23±0.54, 4.48±0.71, and 4.03±0.86 at admission, nadir and discharge from hospital, respectively. Cranial nerve involvement was present in 27.5% of patients and bulbar palsy was the most common finding. Dysautonomia was observed in 57.8% of the participants. Sixty-three patients (61.8%) needed ICU care but only 43 of them (68.3%) were admitted to ICU. Similarly, 31 patients (30.4%) required respiratory support but only 24 of them (77.4%) were on mechanical ventilator. No patient had nerve conduction study. Only 5.9% of patients received IVIG. Thirteen patients (12.7%) died of GBS and the presence of respiratory failure was the only determinant of mortality [AOR = 11.40 (95% CI: 1.818, 71.52), p = 0.009]. Conclusion There is a gap in the diagnosis and management of children with GBS; and mortality from the disease is higher than reports from other settings.
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Affiliation(s)
- Mulugeta Sitot Shibeshi
- Department of Pediatrics and Child Health, Hawassa University, Hawassa, Ethiopia
- Correspondence: Mulugeta Sitot Shibeshi, Email
| | - Adane Alto Mengesha
- Department of Pediatrics and Child Health, Arba Minch University, Arba Minch, Ethiopia
| | - Kefyalew Taye Gari
- Department of Pediatrics and Child Health, Hawassa University, Hawassa, Ethiopia
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Lupu VV, Miron I, Cianga AL, Gavrilovici C, Grigore I, David AG, Pertea LI, Grigore E, David DE, Lupu A. Diagnostic Pitfalls in Guillain-Barré Syndrome: Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1969. [PMID: 36553412 PMCID: PMC9776903 DOI: 10.3390/children9121969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Guillain-Barré syndrome (GBS) represents a group of acute immune-mediated polyradiculoneuropathies that is usually characterized by symmetrical limb weakness and areflexia. GBS can also lead to atypical clinical findings, which may lead to confusion and errors in the diagnosis. In this report, we describe a case of Guillain-Barré syndrome in a 7-year-old child who presented with neck stiffness, headache and vomiting mimicking acute meningoencephalitis, arthritis and myositis. Symptoms of ascending paralysis developed subsequently. Clearly, the atypical presentation of GBS is a significant dilemma for pediatricians and may lead to delays in diagnosis and treatment.
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Affiliation(s)
- Vasile Valeriu Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ingrith Miron
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Lavinia Cianga
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Gavrilovici
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Grigore
- “St. Mary” Children Emergency Hospital, 700309 Iasi, Romania
| | | | - Leonard Iosif Pertea
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ecaterina Grigore
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Ancuta Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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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: 2] [Impact Index Per Article: 1.0] [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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Gerard R, Nolent P, Lerouge-Bailhache M, Sagardoy T, Dienst T. When Stridor is Not Croup: A Case Report. J Emerg Med 2022; 63:673-677. [PMID: 36369121 DOI: 10.1016/j.jemermed.2022.09.010] [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: 04/06/2022] [Revised: 06/17/2022] [Accepted: 09/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Croup is one of the most common causes of acute respiratory disorder in children. It presents as acute laryngeal symptoms in the context of viral infection. Treatment consists of systemic steroids and aerosolized adrenaline, after which the symptoms must resolve rapidly. There are many differential diagnoses, including neurological causes. In these cases, clinical presentation is atypical and the outcome can be less favorable. CASE REPORT We present the cases of three children who presented with stridor, which was initially treated as croup but eventually turned out to have a neurological origin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians need to be aware of the differential diagnoses of croup. We suggest a few key points to help emergency physicians manage these patients, including adequate use of monitoring and nasofibroscopy. Early identification is a key element in the effective management of certain rapidly progressive neurological diseases.
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Affiliation(s)
| | | | | | - Thomas Sagardoy
- Department of Otolaryngology and Skull Base Surgery, Bordeaux University Hospital, Bordeaux, France
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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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Mussinatto I, Benevenuta C, Caci A, Calvo M, Impastato M, Barra M, Genovese E, Timeus F. Possible association between Guillain‑Barré syndrome and SARS‑CoV‑2 infection in children: A case report and literature review. Exp Ther Med 2022; 24:462. [PMID: 35747147 PMCID: PMC9204538 DOI: 10.3892/etm.2022.11389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
Abstract
Neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in adults and in children, varying from mild to more debilitant symptoms, including fatigue, headache and dizziness. A series of studies have revealed a possible association between Guillain-Barré syndrome (GBS), the most common cause of acute flaccid paralysis at all ages, and SARS-CoV-2 infection. Case reports of novel coronavirus disease 2019 (COVID-19)-associated GBS mainly include adult patients, while only a few pediatric cases have been reported. The present study describes a case of GBS in an Italian 9-year-old girl with previous SARS-CoV-2 infection as a possible trigger, and also conducts a literature review on pediatric COVID-19-associated GBS cases.
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Affiliation(s)
| | | | - Anna Caci
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
| | - Mario Calvo
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
| | - Maria Impastato
- Department of Child Neuropsychiatry, ASL TO 4, Chivasso Hospital, I‑10034 Turin, Italy
| | - Massimo Barra
- Department of Neurology, Chivasso Hospital, I‑10034 Turin, Italy
| | - Egidio Genovese
- Department of Neuroradiology, Chivasso Hospital, I‑10034 Turin, Italy
| | - Fabio Timeus
- Department of Pediatrics, Chivasso Hospital, I‑10034 Turin, Italy
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Characterization of Guillain-Barré Syndrome in the integrated development region of the Federal District and Surrounding Areas (RIDE), Brazil, between 2017 and 2019. Acta Trop 2022; 229:106366. [PMID: 35150642 DOI: 10.1016/j.actatropica.2022.106366] [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: 11/25/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy that primarily affects the peripheral nerves. Following the Zika virus outbreak in Latin America, all the Latin American and Brazilian studies conducted reported an increase in the incidence of GBS. The present study aims to characterize the clinical and demographic profile of patients with GBS, according to electrophysiological estudies. METHODS This is a clinical cohort study based on data from medical charts and interviews conducted at the homes of GBS cases identified by three data sources, admitted to and treated at a tertiary referral hospital between March 2017 and May 2019. RESULTS There was a high level of diagnostic certainty among the 51 GBS cases monitored, with most classified as exhibiting acute inflammatory demyelinating polyneuropathy (AIDP). The majority of the individuals were of working age, with an average schooling level. Diarrhea and upper respiratory tract infection were the previous events most reported. Most cases were admitted to the hospital unable to walk and the main complication identified was aspiration pneumonia. CONCLUSION The findings indicate the need to rethink the care of patients with GBS in order to minimize the possibility of future complications during hospitalization that may lead to unfavorable outcomes.
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Rapid Onset of Neuromuscular Paralysis or Weakness. Crit Care Clin 2022; 38:413-428. [DOI: 10.1016/j.ccc.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nejad JH, Heiat M, Hosseini MJ, Allahyari F, Torabi R, Ranjbar R. Response to "a fatal case of Guillain-Barré syndrome after infection with COVID-19". J Neurovirol 2022; 28:624-625. [PMID: 35674934 PMCID: PMC9175526 DOI: 10.1007/s13365-022-01069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Javad Hosseini Nejad
- grid.411521.20000 0000 9975 294XNeuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Heiat
- grid.411521.20000 0000 9975 294XBaqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Hosseini
- grid.411521.20000 0000 9975 294XMolecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Fakhri Allahyari
- grid.411521.20000 0000 9975 294XNeuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Raheleh Torabi
- grid.46072.370000 0004 0612 7950Laboratory of Bioanalysis, Institute of Biochemistry & Biophysics, University of Tehran, Tehran, Iran
| | - Reza Ranjbar
- grid.411521.20000 0000 9975 294XMolecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Vishnu V, Garg D, Dhamija R, Choudhary A, Shree R, Kumar S, Samal P, Pathak A, Vijaya P, Sireesha Y, Nair S, Sharma S, Desai S, Sinha H, Agarwal A, Upadhyay A, Padma Srivastava MV, Bhatia R, Pandit A, Singh R, Reyaz A, Yogeesh PM, Salunkhe M, Lal V, Modi M, Singh G, Singla M, Panda S, Gopalakrishnan M, Puri I, Sharma S, Kumar B, Kushwaha P, Chovatiya H, Ferreira T, Bhoi S, Bhartiya M, Kaul S, Patil A, Mathukumalli N, Nagappa M, Sharma PP, Basheer A, Ramachandran D, Balaram N, Sebastian J. Impact of the COVID-19 pandemic on the frequency, clinical spectrum and outcomes of pediatric guillain-Barré syndrome in India: A multicentric ambispective cohort study. Ann Indian Acad Neurol 2022; 25:60-67. [PMID: 35342256 PMCID: PMC8954314 DOI: 10.4103/aian.aian_392_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To study impact of COVID-19 pandemic on frequency, clinical/electrophysiological profile and treatment outcomes in pediatric Guillain-Barré syndrome (GBS). Background: GBS is the most frequent cause of pediatric acute flaccid paralysis. The effect of the COVID-19 pandemic on pediatric GBS is unclear in the literature. Methods: We conducted an ambispective, multicentric, cohort study involving 12 of 27 centres in GBS Consortium, during two periods: pre-COVID-19 (March-August 2019) and during COVID-19 (March-August 2020). Children ≤12 years who satisfied National Institute of Neurological Diseases and Stroke criteria for GBS/variants were enrolled. Details pertaining to clinical/laboratory parameters, treatment and outcomes (modified Rankin Scale (mRS) at discharge, GBS Disability score at discharge and 3 months) were analysed. Results: We enrolled 33 children in 2019 and 10 in 2020. Children in 2020 were older (median 10.4 [interquartile range 6.75–11.25] years versus 5 (2.5–8.4) years; P = 0.022) and had more sensory symptoms (50% versus 18.2%; P = 0.043). The 2020 group had relatively favourable mRS at discharge (median 1 (1–3.5) versus 3 (2–4); P = 0.042) and GBS disability score at 3 months (median 0 (0–0.75) versus 2 (0–3); P = 0.009) compared to 2019. Multivariate analysis revealed bowel involvement (P = 0.000) and ventilatory support (P = 0.001) as independent predictors of disability. No child in 2020 had preceding/concurrent SARS-CoV2 infection. Conclusions: The COVID-19 pandemic led to a marked decline in pediatric GBS presenting to hospitals. Antecedent illnesses, clinical and electrophysiological profile of GBS remained largely unchanged from the pre-pandemic era.
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Beshir E, Belt E, Chencheri N, Saqib A, Pallavidino M, Terheggen U, Abdalla A, Herlitz L, Sharif E, Bitzan M. Case Report: Guillain-Barré Syndrome as Primary Presentation of Systemic Lupus Erythematosus (SLE-GBS) in a Teenage Girl. Front Pediatr 2022; 10:838927. [PMID: 35372162 PMCID: PMC8968442 DOI: 10.3389/fped.2022.838927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Peripheral nervous system involvement accounts for fewer than 10% of SLE cases with neuropsychiatric manifestations. Guillain-Barré syndrome (GBS) as the presenting, major manifestation of pediatric SLE is extremely rare, and the best treatment approach is unknown. A 14-year-old, previously healthy female teenager developed classic features of GBS with ascending bilateral muscle weakness leading to respiratory insufficiency, associated with protein-cell dissociation in cerebro-spinal fluid, nerve root enhancement by MRI and reduction in compound muscle action potential amplitude. SLE was diagnosed serologically and histologically (lupus nephritis WHO class II). Despite immediate treatment with intravenous immunoglobulin (IVIg), methylprednisolone pulses and subsequently, rituximab, the patient required prolonged mechanical ventilation. She achieved full recovery following 14 PLEX treatments and two more rituximab infusions. Anti-dsDNA, C3, C4 and urinalysis normalized while anti-Smith and Sjögren antibodies persisted 15 months after disease onset, with no other lupus manifestations. Review of the literature revealed two pediatric cases of GBS at the onset of SLE and a third case with GBS 6 years after the diagnosis of SLE. Conventional GBS therapy may not be adequate to treat SLE-GBS. SLE should be included in the differential diagnosis of GBS. Importantly, treatment experiences and outcomes of such cases need be reported to inform future treatment recommendations.
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Affiliation(s)
- Elham Beshir
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates
| | - Ernestina Belt
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates
| | - Nidheesh Chencheri
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates
| | - Aqdas Saqib
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates
| | - Marco Pallavidino
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates.,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ulrich Terheggen
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates
| | - Abdalla Abdalla
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates
| | - Leal Herlitz
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, United States
| | - Elsadeg Sharif
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates
| | - Martin Bitzan
- Department of Paediatrics, Al Jalila Specialty Children's Hospital, Dubai, United Arab Emirates.,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Meregildo-Rodriguez ED, Bardales-Zuta VH. Mortality and disability reported after immunoglobulins or plasmapheresis treatment of Guillain-Barré syndrome. LE INFEZIONI IN MEDICINA 2021; 29:589-599. [PMID: 35146369 PMCID: PMC8805471 DOI: 10.53854/liim-2904-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the clinical results (28-day mortality and disability at discharge) in patients with Guillain-Barré Syndrome (GBS) treated with immunoglobulin or plasmapheresis at the Regional Lambayeque in Peru Hospital. PATIENTS AND METHODS Retrospective Cohort Study. Brighton criteria was used for diagnosing GBS, and modified Rankin scale (MRS) was employed for evaluating functional outcome. We used logistic regression for data analyses. RESULTS A total of 142 cases of GBS diagnosed from 2011 to 2020 were included. GBS presented in a seasonal pattern; 60% of cases occurred in winter and spring. Motor variants (AMAN and AMSAN) accounted for 60% of cases, whereas only 8.5% of cases were typical GBS (AIDP). About 60% of patients were males, and 56% of cases corresponded to the age range of 20-59 years. Patients aged ≥60 years accounted for only 24% of total cases of GBS, but this group had a lethality of 58.3%. Although 28-day mortality was statistically similar in both treatment groups (plasmapheresis or immunoglobulin), we found a trend toward lower mortality in the plasmapheresis group (OR 0.78; 95% CI 0.62-0.97; p=0.062). We found no differences in terms of disability at discharge in GBS patients treated with plasmapheresis or immunoglobulin. CONCLUSION Mortality and functional outcome were statistically similar between patients treated with immunoglobulin or plasmatic exchange. However, there was a trend toward lower mortality in patients treated with plasmapheresis.
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Tacke M, Müller-Felber W. Klinische Neurophysiologie auf der pädiatrischen Intensivstation. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1532-8135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungAuf pädiatrischen Intensivstationen kommt es häufig zum Einsatz neurophysiologischer Untersuchungsmethoden. Bei akuten Enzephalopathien oder in Situationen, in denen ein hohes Risiko für epileptische Anfälle besteht, werden verschiedene Varianten des EEGs verwendet. Bei Hinweisen auf neuromuskuläre Erkrankungen sind die Neurographie, die evozierten Potentiale, und die Elektromyographie die entscheidenden diagnostischen Methoden. Im Falle erworbener Hirnschädigungen wie z. B. nach Reanimationsereignissen oder bei Schädel-Hirn-Traumata können sowohl das EEG, als auch die evozierten Potentiale zur Prognoseabschätzung verwendet werden. Die Umstände auf der Intensivstation erschweren bei all diesen Methoden die Durchführung und die Interpretation. Viele Patienten werden mit Medikamenten behandelt, die die Untersuchungsergebnisse beeinflussen (insbesondere Sedativa und Muskelrelaxantien). Elektronische Geräte, z. B. für die Beatmung der Patienten, können zum Auftreten deutlicher Artefakte bei den neurophysiologischen Untersuchungen führen. Im vorliegenden Artikel werden die Einsatzbereiche neurophysiologischer Methoden auf pädiatrischen Intensivstationen beschrieben und auf Details bei der Anwendung eingegangen.
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Affiliation(s)
- Moritz Tacke
- Dr. von Haunersches Kinderspital, LMU Klinikum München, München
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Luo HY, Li XJ, Cheng M, Wang J, Xie LL, Yao ZX, Jiang L. Clinical characteristics of children with Guillain-Barré syndrome and factors associated with disease severity. J Clin Neurosci 2021; 92:120-125. [PMID: 34509238 DOI: 10.1016/j.jocn.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/20/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
Guillain-Barré syndrome (GBS) is the leading cause of pediatric acute flaccid paralysis. This study aimed to summarize the clinical features of children with GBS and to explore factors associated with the severity of weakness. One hundred and twenty-two children with GBS (73 males and 49 females) were retrospectively analysed. The median age (IQR) at diagnosis was 4.0 years (2.9-7.2 years), and 26.2% of patients were at the age of 2-3 years. Of the 122 cases, 71 (58.2%) had an antecedent infection, 58 (47.5%) had cranial nerve involvement, 36 (29.1%) had dysautonomia, 77 (63.1%) had sensory symptoms, 28 (23.0%) had difficulty in breathing of which 15 (12.3%) patients required mechanical ventilation, and 8 (6.6%) had normal tendon reflex or hyperreflexia. Cytoalbuminologic dissociation of the cerebrospinal fluid was observed in 97 cases (82.9%). Further, 120 patients underwent nerve conduction studies: 76 (63.3%) exhibited demyelinating features whereas 36 (30.0%) had axonal type of CBS. 70.2% of patients could walk independently at 12 weeks. Fourteen (11.5%) patients were classified into the mild group [GBS disability score (GBS-DS) < 3] and 108 (88.5%) were classified into the severe group (GBS-DS ≥ 3). The incidence of cranial involvement (P = 0.038) and decreased tendon reflexes (P = 0.048) were significantly different between the two groups. These findings suggested that cranial nerve involvement is associated with severe muscle weakness in children with GBS.
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Affiliation(s)
- Han-Yu Luo
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Xiu-Juan Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Min Cheng
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Juan Wang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Ling-Ling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Zheng-Xiong Yao
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China.
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Korinthenberg R, Trollmann R, Plecko B, Stettner GM, Blankenburg M, Weis J, Schoser B, Müller-Felber W, Lochbuehler N, Hahn G, Rudnik-Schöneborn S. Differential Diagnosis of Acquired and Hereditary Neuropathies in Children and Adolescents-Consensus-Based Practice Guidelines. CHILDREN-BASEL 2021; 8:children8080687. [PMID: 34438578 PMCID: PMC8392610 DOI: 10.3390/children8080687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/21/2022]
Abstract
Disorders of the peripheral nerves can be caused by a broad spectrum of acquired or hereditary aetiologies. The objective of these practice guidelines is to provide the reader with information about the differential diagnostic workup for a target-oriented diagnosis. Following an initiative of the German-speaking Society of Neuropaediatrics, delegates from 10 German societies dedicated to neuroscience worked in close co-operation to write this guideline. Applying the Delphi methodology, the authors carried out a formal consensus process to develop practice recommendations. These covered the important diagnostic steps both for acquired neuropathies (traumatic, infectious, inflammatory) and the spectrum of hereditary Charcot-Marie-Tooth (CMT) diseases. Some of our most important recommendations are that: (i) The indication for further diagnostics must be based on the patient's history and clinical findings; (ii) Potential toxic neuropathy also has to be considered; (iii) For focal and regional neuropathies of unknown aetiology, nerve sonography and MRI should be performed; and (iv) For demyelinated hereditary neuropathy, genetic diagnostics should first address PMP22 gene deletion: once that has been excluded, massive parallel sequencing including an analysis of relevant CMT-genes should be performed. This article contains a short version of the guidelines. The full-length text (in German) can be found at the Website of the "Arbeitsgemeinschaft der Wissenschftlichen Medizinischen Fachgesellschaften e.V. (AWMF), Germany.
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Affiliation(s)
- Rudolf Korinthenberg
- Division of Neuropaediatrics and Muscular Disorders, Faculty of Medicine, University Medical Center (UMC), University of Freiburg, 79106 Freiburg, Germany
- Correspondence: ; Tel.: +49-761-46017
| | - Regina Trollmann
- Department of Pediatrics, Division of Neuropaediatrics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Barbara Plecko
- Department of Pediatrics and Adolescent Medicine, Medical University Graz, 8036 Graz, Austria;
| | - Georg M. Stettner
- Neuromuscular Center Zurich, Department of Pediatric Neurology, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - Markus Blankenburg
- Department of Pediatric Neurology, Klinikum Stuttgart, Olgahospital, 70174 Stuttgart, Germany;
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University Hospital, 52074 Aachen, Germany;
| | - Benedikt Schoser
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, Ziemssenstr. 1a, 80336 Munich, Germany;
| | | | - Nina Lochbuehler
- Pediatric Radiology, Institute of Radiology, Olgahospital, Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Gabriele Hahn
- Department of Radiological Diagnostics, UMC, University of Dresden, 01307 Dresden, Germany;
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Mastrangelo M, Baglioni V. Management of Neurological Emergencies in Children: An Updated Overview. Neuropediatrics 2021; 52:242-251. [PMID: 34192789 DOI: 10.1055/s-0041-1730936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Neurological emergencies account for about one-third of the highest severity codes attributed in emergency pediatric departments. About 75% of children with acute neurological symptoms presents with seizures, headache, or other paroxysmal events. Life-threatening conditions involve a minor proportion of patients (e.g., less than 15% of children with headache and less than 5% of children with febrile seizures). This review highlights updated insights about clinical features, diagnostic workup, and therapeutic management of pediatric neurological emergencies. Particularly, details will be provided about the most recent insights about headache, febrile seizures, status epilepticus, altered levels of consciousness, acute motor impairment, acute movement disorders, and functional disorders, as well as the role of diagnostic tools (e.g., neuroimaging, lumbar puncture, and electroencephalography), in the emergency setting. Moreover, the impact of the current novel coronavirus disease2019 (COVID-19) pandemic on the evaluation of pediatric neurologic emergencies will also be analyzed.
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Affiliation(s)
- Mario Mastrangelo
- Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza Università di Roma, Rome, Italy
| | - Valentina Baglioni
- Child Neurology and Infantile Psychiatry Unit, Department of Human Neuroscience, Sapienza Università di Roma, Rome, Italy
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33
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Luo J, Xia Z, Che Y, Zhou K. Characteristics, treatments, and prognosis of a critical illness polyneuromyopathy patient with positive anti-GM1 after severe traumatic brain injury: A case report. Clin Exp Pharmacol Physiol 2021; 48:831-836. [PMID: 33715175 DOI: 10.1111/1440-1681.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/01/2020] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
To investigate the clinical features, treatment and prognosis of critical illness polyneuromyopathy (CIPNM) in patients with severe traumatic brain injury (sTBI) who had positive anti-ganglioside GM1 (anti-GM1) antibody IgG. A case of CIPNM with positive anti-GM1 antibody IgG was retrospectively analysed and followed-up for 30 months. After 1 week of treatment with large dose of short-term glucocorticoid and human immunoglobulin, the muscle strength of both lower extremities was restored to grade 1. Three months later, the muscle strength and muscle tension of the patient's limbs returned to normal except for grade 3 of bilateral dorsal extensor muscle strength. In addition, the patient can walk alone with a waddling gait. After 30 months, there was no recurrence. The application of large dose of short-term glucocorticoid and human immunoglobulin to CIPNM that are positive for anti-GM1 antibodies may be an effective treatment.
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Affiliation(s)
- Jiemin Luo
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, China
| | - Zhiyuan Xia
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, China
| | - Yanjun Che
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, China
- Department of NSICU, Jingjiang People's Hospital, Jingjiang, China
| | - Ke Zhou
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, China
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34
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Heng KYC, Lee JH, Thomas T. Anti-N-Methyl-D-aspartate receptor encephalitis masquerading as fever of unknown origin. Clin Case Rep 2021; 9:2323-2327. [PMID: 33936687 PMCID: PMC8077294 DOI: 10.1002/ccr3.4025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/05/2020] [Accepted: 01/24/2021] [Indexed: 11/24/2022] Open
Abstract
Fever of unknown origin (FUO) is a diagnostic challenge. Anti-N-methyl-D-aspartate receptor encephalitis should be considered in children with FUO and new-onset neurological symptoms without significant encephalopathy.
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Affiliation(s)
- Katrina Yi Ching Heng
- Department of Child DevelopmentDepartment of Paediatric MedicineKK Women's and Children's HospitalSingapore CitySingapore
| | - Jan Hau Lee
- Department of Children's Intensive Care UnitDepartment of Paediatric SubspecialtiesKK Women's and Children's HospitalSingapore CitySingapore
| | - Terrence Thomas
- Paediatric Neurology ServiceDepartment of Paediatric MedicineKK Women's and Children's HospitalSingapore CitySingapore
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35
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Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet 2021; 397:1214-1228. [PMID: 33647239 DOI: 10.1016/s0140-6736(21)00517-1] [Citation(s) in RCA: 252] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/07/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis worldwide. Most patients present with an antecedent illness, most commonly upper respiratory tract infection, before the onset of progressive motor weakness. Several microorganisms have been associated with Guillain-Barré syndrome, most notably Campylobacter jejuni, Zika virus, and in 2020, the severe acute respiratory syndrome coronavirus 2. In C jejuni-related Guillain-Barré syndrome, there is good evidence to support an autoantibody-mediated immune process that is triggered by molecular mimicry between structural components of peripheral nerves and the microorganism. Making a diagnosis of so-called classical Guillain-Barré syndrome is straightforward; however, the existing diagnostic criteria have limitations and can result in some variants of the syndrome being missed. Most patients with Guillain-Barré syndrome do well with immunotherapy, but a substantial proportion are left with disability, and death can occur. Results from the International Guillain-Barré Syndrome Outcome Study suggest that geographical variations exist in Guillain-Barré syndrome, including insufficient access to immunotherapy in low-income countries. There is a need to provide improved access to treatment for all patients with Guillain-Barré syndrome, and to develop effective disease-modifying therapies that can limit the extent of nerve injury. Clinical trials are currently underway to investigate some of the potential therapeutic candidates, including complement inhibitors, which, together with emerging data from large international collaborative studies on the syndrome, will contribute substantially to understanding the many facets of this disease.
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Affiliation(s)
- Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Helmar C Lehmann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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36
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Brisca G, Mariani M, Pirlo D, Romanengo M, Pistorio A, Gaiero A, Panicucci C, Piccotti E, Bruno C. Management and outcome of benign acute childhood myositis in pediatric emergency department. Ital J Pediatr 2021; 47:57. [PMID: 33750449 PMCID: PMC7945053 DOI: 10.1186/s13052-021-01002-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benign acute childhood myositis (BACM) is a self-limited syndrome associated with viral infections characterized by symmetric lower extremity pain typically affecting school-aged children. Evolution in rhabdomyolysis and kidney damage is rarely reported. Despite this, the acute presentation commonly concerns both parents and health care providers, often leading to unnecessary workup. The aim of the study was to determine the features and outcome of a large series of children with BACM identifying a management pathway for pediatricians in Emergency Department (ED). METHODS We conducted a retrospective study of patients with BACM managed in 2 Italian pediatric ED during a period of 8 and a half years. Demographic data, clinical, and laboratory results were extracted from electronic medical records. Recurrence, complications, treatments, and outcomes were also recorded. Descriptive statistics were produced for first-episode patients and for those with recurrence of myositis. A comparison between groups was performed. RESULTS One hundred and thirteen patients with BACM were identified. Ninety-two children (65 males) had a single episode, while ten (nine males) had recurrence. The mean age at presentation was 6.0 years (range 2-13,2). All patients had normal neurological examination and no one developed myoglobinuria, or renal failure. At first evaluation median CK level was 1413 UI/l (normal values < 150 U/L). Median CK of "recurrent" patients was higher than "non-recurrent" (2330 vs 1150 U/L, p = 0.009). Viral studies were positive in 51/74 cases, with high prevalence of Influenza viruses. Ninety-six patients (85%) were hospitalized with a median of 4 days. No patients had any residual muscular impairment. CONCLUSIONS BACM has an excellent prognosis. Severe pathological conditions can be excluded with a complete history and clinical examination and simple blood and urine tests, avoiding unnecessary diagnostic investigations. Most patients may be discharged home from ED recommending hydration, rest, analgesics and careful follow-up.
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Affiliation(s)
- Giacomo Brisca
- Subintensive Care Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy.
| | - Marcello Mariani
- Infectious Disease Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela Pirlo
- Subintensive Care Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Marta Romanengo
- Subintensive Care Unit, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy
| | - Angela Pistorio
- Department of Epidemiology and Biostatistics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alberto Gaiero
- Pediatric and Neonatology Department, ASL2 Savonese, Savona, Italy
| | - Chiara Panicucci
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Emanuela Piccotti
- Pediatric Emergency Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Korinthenberg R, Eckenweiler M, Fuchs H. Severe Locked-In-Like Guillain-Barré's Syndrome: Dilemmas in Diagnosis and Treatment. Neuropediatrics 2021; 52:19-26. [PMID: 33111302 DOI: 10.1055/s-0040-1715480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Guillain-Barré's syndrome in childhood can follow an atypical course, increasing the challenges in diagnosis and decisions regarding immunomodulatory treatment. Here, we report the case of on a 13-year-old boy with acute onset Guillain-Barré's syndrome progressing over 40 days to a very severe, locked-in-like syndrome despite intensive immunomodulatory treatment. After a plateau phase lasting 3 months and characterized by fluctuating signs of ongoing inflammatory disease activity, we were prompted to perform repeated and maintenance immunomodulatory treatment, which resulted in a continuous and nearly complete recovery of function. Atypical features at disease onset, the severe "total" loss of all peripheral and cranial nerve function, and an apparent late response to treatment give rise to reviewing the dilemmas of diagnosis and treatment in such severe and protracted courses of Guillain-Barré syndrome.
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Affiliation(s)
- Rudolf Korinthenberg
- Department of Neuropediatrics and Muscular Disorders, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscular Disorders, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Hans Fuchs
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
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Neuropathic pain in children: Steps towards improved recognition and management. EBioMedicine 2020; 62:103124. [PMID: 33248373 PMCID: PMC7704400 DOI: 10.1016/j.ebiom.2020.103124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022] Open
Abstract
Neuropathic pain in children can be severe and persistent, difficult to recognise and manage, and associated with significant pain-related disability. Recognition based on clinical history and sensory descriptors is challenging in young children, and screening tools require further validation at older ages. Confirmatory tests can identify the disease or lesion of the somatosensory nervous system resulting in neuropathic pain, but feasibility and interpretation may be influenced by age- and sex-dependent changes throughout development. Quantitative sensory testing identifies specific mechanism-related sensory profiles; brain imaging is a potential biomarker of alterations in central processing and modulation of both sensory and affective components of pain; and genetic analysis can reveal known and new causes of neuropathic pain. Alongside existing patient- and parent-reported outcome measures, somatosensory system research methodologies and validation of mechanism-based standardised end-points may inform individualised therapy and stratification for clinical trials that will improve evidence-based management of neuropathic pain in children.
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Shang P, Zhu M, Baker M, Feng J, Zhou C, Zhang HL. Mechanical ventilation in Guillain-Barré syndrome. Expert Rev Clin Immunol 2020; 16:1053-1064. [PMID: 33112177 DOI: 10.1080/1744666x.2021.1840355] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Up to 30% of patients with Guillain-Barré syndrome (GBS) develop respiratory failure requiring intensive care unit (ICU) admission and mechanical ventilation. Progressive weakness of the respiratory muscles is the leading cause of acute respiratory distress and respiratory failure with hypoxia and/or hypercarbia. Bulbar weakness may compromise airway patency and predispose patients to aspiration pneumonia. Areas covered: Clinical questions related to the use of mechanical ventilation include but are not limited to: When to start? Invasive or noninvasive? When to wean from mechanical ventilation? When to perform tracheostomy? How to manage complications of GBS in the ICU including nosocomial infection, ventilator-associated pneumonia, and ICU-acquired weakness? In this narrative review, the authors summarize the up-to-date knowledge of the incidence, pathophysiology, evaluation, and general management of respiratory failure in GBS. Expert opinion: Respiratory failure in GBS merits more attention from caregivers. Emergency intubation may lead to life-threatening complications. Appropriate methods and time point of intubation and weaning, an early tracheostomy, and predictive prophylaxis of complications benefit patients' long-term prognosis.
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University , Changchun, China.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Mingqin Zhu
- Department of Neurology, First Hospital of Jilin University , Changchun, China.,Departments of Laboratory Medicine and Pathology, Neurology and Immunology, Mayo Clinic , Rochester, MN, USA
| | - Matthew Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University , Changchun, China
| | - Chunkui Zhou
- Department of Neurology, First Hospital of Jilin University , Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China , Beijing, China
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Korinthenberg R, Sejvar JJ. The Brighton Collaboration case definition: Comparison in a retrospective and prospective cohort of children with Guillain-Barré syndrome. J Peripher Nerv Syst 2020; 25:344-349. [PMID: 32869396 DOI: 10.1111/jns.12411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy frequently preceded by an infection with Campylobacter jejuni or nonspecific infections, and rarely by a vaccination. Due to a lack of a pathognomonic finding or biomarker, its diagnosis is based on a typical constellation of clinical and paraclinical symptoms and findings. The Brighton Collaboration GBS Working Group published in 2011 GBS case definitions and guidelines for diagnosis to improve the registration of GBS cases occurring in conjunction with vaccination programs worldwide. We applied these criteria to two historical studies on GBS in children and adolescents performed retrospectively from 1989 to 1994 and prospectively from 1998 to 2002. The clinical criteria were met in 91% of the retrospective and all of the prospective cases. CSF investigations were conducted in all patients and revealed cytoalbuminologic dissociation in 80% of the retrospective and 75% of the prospective cohort. Nerve conduction studies were performed in 61% and 69% of the cohorts, respectively, and were pathological in 92% each. The Brighton criteria are well suited to capture GBS in retro- and prospective studies. However, because they are designed to diagnose classical symmetric and ascending GBS and Fisher syndrome, very rare topographical variants of GBS such as the pharyngo-cervico-brachial variant and others could be missed.
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Affiliation(s)
- Rudolf Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany.,Present (private) address: Gutleutstr. 21, 79115, Freiburg, Germany
| | - James J Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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