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Bhagwat AP, Sharath HV, Warghat PA. Effect of Paediatric Rehabilitation in Children With Guillain-Barré Syndrome: A Case Series. Cureus 2024; 16:e59815. [PMID: 38846247 PMCID: PMC11154077 DOI: 10.7759/cureus.59815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare autoimmune disorder impacting the peripheral nervous system, particularly severe in children. This case series assesses the efficacy of paediatric rehabilitation on functional outcomes in paediatric GBS patients. The interventions focused on balance training, strength enhancement, and activities of daily living (ADLs). Four paediatric GBS patients were enrolled, presenting primarily with weakness and fever. Post-rehabilitation, significant enhancements were noted in motor function, ADLs, and quality of life (QoL). This series underscores the favourable impact of paediatric rehabilitation on GBS, advocating for early initiation to improve recovery and enhance QoL. GBS poses significant challenges, particularly in paediatric populations, necessitating comprehensive management strategies. While the syndrome's acute phase is managed medically, rehabilitation plays a pivotal role in optimizing long-term outcomes. This study aims to evaluate the effect of paediatric rehabilitation interventions on functional outcomes in children diagnosed with GBS. The four paediatric patients diagnosed with GBS underwent paediatric rehabilitation, comprising balance training, strength enhancement, and ADL exercises. Functional outcomes, including motor function, ADLs, and QoL, were assessed pre- and post-rehabilitation using standardized measures. The most common presenting symptoms in the paediatric GBS patients were weakness and fever. Following paediatric rehabilitation, significant improvements were observed in specific functional outcomes, including motor function, ADLs, and QoL. These improvements underscore the efficacy of paediatric rehabilitation in enhancing functional recovery and overall well-being in these patients. The findings of this case series emphasize the crucial role of paediatric rehabilitation in managing GBS in children. Early initiation of rehabilitation interventions may facilitate better recovery trajectories and improve long-term outcomes. Comprehensive rehabilitation strategies addressing motor function, ADLs, and QoL are essential components of holistic GBS management in pediatric patients. Pediatric rehabilitation interventions, encompassing balance training, strength enhancement, and ADL exercises, demonstrate significant benefits in improving functional outcomes in children with GBS. Early initiation of rehabilitation interventions is pivotal for enhancing the recovery process and optimizing the QoL in pediatric GBS patients. Further research is warranted to validate these findings and refine rehabilitation protocols for optimal outcomes.
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Affiliation(s)
- Anushka P Bhagwat
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - H V Sharath
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratiksha A Warghat
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Sharma P, Surve RM, Pendharkar HS, Kulkarni GB, Naik SS. Mimics of Guillain-Barré Syndrome in Pediatric Patients Admitted to the Neuro-Intensive Care Unit of a Tertiary Care Hospital-A Case Series. Neurol India 2024; 72:379-383. [PMID: 38817174 DOI: 10.4103/ni.ni_881_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/24/2023] [Indexed: 06/01/2024]
Abstract
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis in children, but several diseases mimic GBS. We aimed to identify and report the clinical pointers and battery of tests required to differentiate Guillain-Barré syndrome from its observed mimics in the pediatric population admitted to our neuro-critical care unit. We conducted a retrospective record analysis of all pediatric patients admitted over ten years from 2008-2018, whose initial presentation was compatible with a clinical diagnosis of GBS. Eighty-three patients were at first treated as GBS, of which seven (8.4%) were found to have an alternate diagnosis-three cases of paralytic rabies, one case each of acute disseminated encephalomyelitis, cervical myeloradiculopathy, neuromyelitis optica, and a case of community-acquired Staphylococcus aureus pneumonia associated sepsis. Neurophysiological and neuro-virological testing, central nervous system imaging, and sepsis screening helped to confirm the alternate diagnosis. Our case series provides knowledge of subtle clinical differences along with the mindful use of diagnostic testing to facilitate the accurate diagnosis of GBS mimics.
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Affiliation(s)
- Prachi Sharma
- Department of Neruroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rohini M Surve
- Department of Neruroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hima S Pendharkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shweta S Naik
- Department of Neruroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Kobayashi Takahashi Y, Hayakawa I, Abe Y. Diagnostic odyssey of Guillain-Barré syndrome in children. Brain Dev 2024; 46:108-113. [PMID: 37914621 DOI: 10.1016/j.braindev.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/04/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND OBJECTIVES A gap exists between difficulty in diagnosis and importance of early recognition and intervention in pediatric Guillain-Barré syndrome (GBS). Therefore, this study aimed to establish a diagnostic odyssey plot that allows "at-a-glance" overview of the diagnostic odyssey of GBS in children, including overall diagnostic delay, physician-related and patient-related diagnostic delays, and length and frequency of diagnostic errors. METHODS In this single-center retrospective cohort study, standardized data were obtained from children with GBS from 2003 to 2020. Overall diagnostic delay (time between symptom onset and diagnosis), physician-related diagnostic delay (time between the first medical visit and diagnosis), and patient-related diagnostic delay (time between symptom onset and the first medical visit) were analyzed. RESULTS The study examined a total of 21 patients (11 men, median age 4.5 years). Overall, there were 40 misdiagnoses among 17 patients, while four were diagnosed correctly at the first visit. The overall diagnostic delay was 9 days [interquartile range (IQR), 6-17 days]. Physician-related diagnostic delay, but not patient-related diagnostic delay, was correlated with the overall diagnostic delay. Patients in the late-diagnosed group were more frequently misdiagnosed during their diagnostic odyssey than patients in the other groups. Risk factors associated with diagnostic delay included delayed onset of weakness and sensory deficits, absence of swallowing problems, and misdiagnosis as orthopedic disorders or viral infections. DISCUSSION A unique diagnostic odyssey exists in pedaitric GBS. Several clinical risk factors were associated with the diagnostic delay.
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Affiliation(s)
- Yoko Kobayashi Takahashi
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan; Department of Child Neurology, National Center for Neurology and Psychiatry, Tokyo, Japan
| | - Itaru Hayakawa
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, University of Tokyo, Tokyo, Japan.
| | - Yuichi Abe
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
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Estublier B, Colineaux H, Arnaud C, Cintas P, Baudou E, Chaix Y, Rivier F, Biotteau M, Meyer P, Cheuret E. Long-term outcomes of paediatric Guillain-Barré syndrome. Dev Med Child Neurol 2024; 66:176-186. [PMID: 37501281 DOI: 10.1111/dmcn.15693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023]
Abstract
AIM To study long-term sequelae in children with Guillain-Barré syndrome (GBS). METHOD This was a prospective observational study with children from two French tertiary centres. Data were from clinical and several standardized scales or questionnaires. RESULTS Fifty-one patients were included with a median follow-up of 6 years 4 months (range 3-20 years) after the acute phase. The sequelae rate was 67% (95% confidence interval [CI] 53-78) and did not vary with time. Most children had minor sequelae (Guillain-Barré Syndrome Disability Score [GBSDS] = 1); only one was unable to run (GBSDS = 2). The most frequent complaints were paraesthesia (43%), pain (35%), and fatigue (31%). The neurological examination was abnormal in 18% of children, autonomy was compromised in 14%, and symptoms of depression occurred in 34%. The factors associated with late-onset sequelae were correlated with severity during the initial phase (i.e. initial GBSDS >4, odds ratio 6.6, 95% CI 1.8-33; p = 0.009). The predictive factors of more severe late-onset conditions were initial severity (p = 0.002) and sex (female patients; p = 0.01). INTERPRETATION Two-thirds of children with GBS had late-onset sequelae following an episode, often minor, but sometimes with continuing effects on their everyday lives. Particularly affected were those who had severe GBS during the acute phase and who lost the ability to walk. WHAT THIS PAPER ADDS Two-thirds of children with Guillain-Barré syndrome (GBS) had persistent sequelae. Sequelae were often minor, but daily repercussions of them were sometimes serious. Sequelae were significantly associated with severe GBS during the acute phase.
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Affiliation(s)
- Bastien Estublier
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
| | - Hélène Colineaux
- Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
- CERPOP, Centre for Epidemiology and Research in POPulation Health, UMR 1295, INSERM, Toulouse III University, Toulouse, France
| | - Catherine Arnaud
- Clinical Epidemiology Unit, Toulouse University Hospital, Toulouse, France
- CERPOP, Centre for Epidemiology and Research in POPulation Health, UMR 1295, INSERM, Toulouse III University, Toulouse, France
| | - Pascal Cintas
- Neurophysiological Exploration Department, Toulouse-Purpan University Hospital, Toulouse, France
| | - Eloise Baudou
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Yves Chaix
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - François Rivier
- Department of Pediatric Neurology, CHU Montpellier, PhyMedExp, University of Montpellier, Inserm, CNRS, Montpellier, France
| | - Maelle Biotteau
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Pierre Meyer
- Department of Pediatric Neurology, CHU Montpellier, PhyMedExp, University of Montpellier, Inserm, CNRS, Montpellier, France
| | - Emmanuel Cheuret
- Neuropediatric Department, Toulouse-Purpan University Hospital, Toulouse, France
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Javankiani S, Nasrollahizadeh A, Gharib B, Heidari M, Memarian S. The characteristics of Guillain-Barre syndrome in children in pre-COVID-19 and during the COVID-19 pandemic: A cross-sectional study. Health Sci Rep 2023; 6:e1782. [PMID: 38143455 PMCID: PMC10739064 DOI: 10.1002/hsr2.1782] [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] [Received: 08/22/2023] [Revised: 10/29/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023] Open
Abstract
Background and Aims In the pathophysiology of Guillain-Barre syndrome (GBS), inflammation and immunity are believed to play a key role. The neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) have been recently identified as potential markers of inflammation or immunity. This study aimed to investigate whether NLR, MLR, and PLR are associated with GBS characteristics in children. We also assessed the impact of the COVID-19 pandemic on the characteristics of GBS in Iran. Methods In this retrospective cross-sectional study, we reviewed the records of all 150 children diagnosed with GBS in the Children's Medical Center hospital affiliated with Tehran University of Medical Sciences (TUMS) from March 2017 until March 2022. The TUMS research ethics committee approved the study (Ethics code: IR.TUMS.CHMC.REC.1399.125). Patients' data including gender, age, clinical symptoms, laboratory findings, and electrodiagnostic study results were collected and analyzed. Results This study involved 150 children, comprising 93 boys and 57 girls, with an average age of 7.53 ± 3.75 years. The analysis demonstrated that the number of hospitalization days increased with an increase in NLR (p = 0.025). Moreover, patients with abnormal electrodiagnostic study patterns had a higher risk of intensive care unit (ICU) admission (p: 0.027), although according to binary logistic regression, respiratory failure at admission time was the only significant factor increasing the risk of ICU admission (p = 0.035). The study also found that the pandemic has resulted in a shift from acute inflammatory demyelinating polyneuropathy to acute motor axonal neuropathy as the most common EMG-NCV pattern in our patients (p < 0.001). Conclusion We found that higher NLR was associated with a longer hospitalization duration and could potentially distinguish between severe and mild cases of GBS. We have also shown that the COVID-19 pandemic has changed our patients' most frequent electromyography and nerve conduction velocity (EMG-NCV) patterns.
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Affiliation(s)
- Sepide Javankiani
- Children's Medical CenterTehran University of Medical SciencesTehranIran
| | | | - Behdad Gharib
- Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Morteza Heidari
- Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Sara Memarian
- Children's Medical CenterTehran University of Medical SciencesTehranIran
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Pan M, Sun T, Zhu W, Liu H, Dong H. Guillain Barré syndrome after combined diphtheria, tetanus, and acellular pertussis (DTaP) vaccine: A rare pediatric case report and review of literature. Hum Vaccin Immunother 2023; 19:2261199. [PMID: 37753771 PMCID: PMC10538447 DOI: 10.1080/21645515.2023.2261199] [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: 05/23/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
A 20-month-old girl was diagnosed with Guillain - Barré syndrome (GBS) based on progressive muscle weakness, areflexia, and albuminocytologic dissociation of the cerebrospinal fluid. Despite timely and systematic treatment, she eventually became paralyzed. There is a temporal correlation between the girl's GBS and the DTaP vaccination, but the exact causal relationship between the two is still debatable. Furthermore, we summarized clinical features of other 45 published GBS cases after DTP vaccines (or vaccine substances containing tetanus) through a systematic review. The mean onset age, sex distribution, onset time after vaccination, detection of antiganglioside antibodies, and other basic clinical features of GBS after DTP vaccination (or vaccine substances containing tetanus) were analyzed. The temporal pattern of GBS after vaccination was similar to that of GBS after infection. Herein, we report this rare case of presumptive pediatric GBS after DTaP vaccination and review similar cases to draw the attention of medical personnel to similar events after vaccination. An association between DTP vaccines and GBS has been proposed, and the causal relationship between these two incidents are worthy further exploration. Moreover, surveillance and vigilance for GBS after vaccination are highly recommended.
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Affiliation(s)
- Meichen Pan
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tianying Sun
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weiwei Zhu
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huine Liu
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - HongMei Dong
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
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Devi AK, Randhawa MS, Bansal A, Angurana SK, Malhi P, Nallasamy K, Jayashree M. Long-Term Neurological, Behavioral, Functional, Quality of Life, and School Performance Outcomes in Children With Guillain-Barré Syndrome Admitted to PICU. Pediatr Neurol 2023; 140:18-24. [PMID: 36587490 DOI: 10.1016/j.pediatrneurol.2022.11.002] [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: 05/14/2022] [Revised: 09/24/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Most children with Guillain-Barré syndrome (GBS) recover but may suffer from long-term sequelae, interfering with development and quality of life. Owing to the lack of published data, we aimed to assess the long-term neurological, behavioral, functional, quality of life, and school performance outcomes them. METHODS Design: Cross-sectional observational. SETTING Pediatric intensive care unit. PATIENTS Children, aged one to 12 years, with GBS admitted over five years (July 2012 to June 2017) were enrolled during one year (July 2017 to June 2018). These children were assessed for the following outcomes: neurological (Hughes disability score, Pediatric Cerebral Performance Category [PCPC], Pediatric Overall Performance Category [POPC], and Glasgow Outcome Scale-Extended Pediatric version [GOS-E Peds] scales), behavioral (Childhood Psychopathology Measurement Schedule [CPMS]), functional (Vineland Social Maturity Scale [VSMS]-Indian Adaptation), quality of life (Pediatric Quality of Life [PedsQL]), and school performance (Parent-Directed Questionnaire). RESULTS Eighty children were enrolled after a median of 3.0 (1.3-4.2) years from discharge. The majority (95%) had favorable neurological recovery (Hughes disability score 0 to 1). Favorable outcome was noted in 95% of children on PCPC, 87.5% on POPC, 60% on GOS-E Peds, 86.2% on CPMS, 92.5% on VSMS, and 98% on PedsQL. The majority (97.5%) of childre were attending schools, and 57.7% had satisfactory school performance. The presence of quadriparesis at admission, mechanical ventilation, tracheostomy requirement, poor ambulatory status at discharge, and longer pediatric intensive care unit and hospital stay predicted unfavorable neurological outcome on different tools. Absence of quadriparesis at admission and no requirement of mechanical ventilation predicted a favorable result on all outcome measures. CONCLUSIONS On long-term follow-up, most children with severe GBS showed favorable neurological, behavioral, functional, and quality of life outcomes. Severe clinical presentation and prolonged intensive care unit stay predict poor long-term outcome.
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Affiliation(s)
- Angom Kiran Devi
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manjinder Singh Randhawa
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Bansal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Suresh Kumar Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Prahbhjot Malhi
- Pediatric Psychology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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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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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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Anti-GM1 IgM antibody positive axonal variant of Guillain-Barre-syndrome in a pediatric patient with dengue fever. J Neuroimmunol 2021; 355:577572. [PMID: 33862418 DOI: 10.1016/j.jneuroim.2021.577572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION While children of all ages may be affected by Guillain-Barre-Syndrome (GBS), there are no reports of Dengue Fever (DF) as the preceding or concurrent infection in this age group. In addition, the presence of anti-GM1 IgM antibody, commonly seen in Multifocal Motor Neuropathy, is rarely encountered in both axonal and demyelinating variants of GBS. Moreover, only few neuromuscular ultrasound findings of the axonal variant in children were reported in the literature. CASE Here we present a nine-year-old female who developed the classic signs, symptoms and neurophysiologic findings of axonal type of GBS during DF. She had elevated anti-GM1 IgM antibody atypical of this variant and diffusely enlarged nerves via neuromuscular ultrasound. CONCLUSION In a pediatric patient with DF and acute flaccid paralysis, GBS should always be one of the considerations. Although rare, anti-ganglioside GM1 IgM antibody can still be found in axonal variant of GBS.
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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: 240] [Impact Index Per Article: 80.0] [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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12
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Liu SC, Poon JT, Candee MS. Clinical Reasoning: A Teenager With Shortness of Breath and Difficulty Walking. Neurology 2021; 96:e2346-e2350. [PMID: 33504640 DOI: 10.1212/wnl.0000000000011544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Suzanne C Liu
- From the Division of Pediatric Neurology (S.C.L., M.S.C.), Department of Pediatrics, University of Utah/Primary Children's Hospital; and Department of Neurology (J.T.P.), University of Utah, Salt Lake City.
| | - Jason T Poon
- From the Division of Pediatric Neurology (S.C.L., M.S.C.), Department of Pediatrics, University of Utah/Primary Children's Hospital; and Department of Neurology (J.T.P.), University of Utah, Salt Lake City
| | - Meghan S Candee
- From the Division of Pediatric Neurology (S.C.L., M.S.C.), Department of Pediatrics, University of Utah/Primary Children's Hospital; and Department of Neurology (J.T.P.), University of Utah, Salt Lake City
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13
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A Case Report of Pediatric Paraneoplastic Dysautonomia. Pediatr Emerg Care 2020; 36:e742-e744. [PMID: 30045352 DOI: 10.1097/pec.0000000000001558] [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: 11/25/2022]
Abstract
We present the case of a 16-year-old girl who presented with severe refractory orthostatic hypotension secondary to pandysautonomia. Initially, she was treated for Guillain-Barré syndrome given clinical symptoms and increased protein on cerebrospinal fluid, but the severity of symptoms and lack of response to intravenous immunoglobulin prompted further evaluation for an autoimmune etiology. She was ultimately diagnosed with paraneoplastic neuropathy secondary to Hodgkin lymphoma. Paraneoplastic neurologic phenomena are rare, occurring in just 0.01% of cancers, and prompt recognition is crucial for initiating appropriate therapy. Rapid progression of severe disabling symptoms should raise suspicion for an underlying malignancy. The patient had limited response to splanchnic vasoconstrictors in addition to α-agonists, anticholinergics, and mineralocorticoids until initiation of modified Hodgkin lymphoma directed chemotherapy plus rituximab.
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14
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Ipe TS, Meyer EK, Sanford KW, Joshi SK, Wong ECC, Raval JS. Use of therapeutic plasma exchange for pediatric neurological diseases. J Clin Apher 2020; 36:161-176. [PMID: 33063869 DOI: 10.1002/jca.21850] [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: 06/19/2020] [Revised: 09/10/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Abstract
Therapeutic plasma exchange is used to treat neurological diseases in the pediatric population. Since its first use in pediatric patients with hepatic coma in the form of manual whole blood exchange, therapeutic plasma exchange has been increasingly used to treat these disorders of the nervous system. This expansion is a result of improved techniques and apheresis instruments suitable for small children, as well as the recognition of its applicability to many diseases in the pediatric population. This review provides a historical overview of the use of therapeutic apheresis in children and highlights the most common applications for therapeutic plasma exchange to treat neurological disorders in children.
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Affiliation(s)
- Tina S Ipe
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Erin K Meyer
- American Red Cross, Columbus, Ohio, USA.,Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kimberly W Sanford
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarita K Joshi
- Department of Hematology/Oncology and Bone Marrow Transplant, University of Washington, Seattle, Washington, USA
| | - Edward C C Wong
- Department of Pediatrics and Pathology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA.,Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jay S Raval
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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15
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Luo H, Hong S, Li M, Wang L, Jiang L. Risk factors for mechanical ventilation in children with Guillain-Barré syndrome. Muscle Nerve 2020; 62:214-218. [PMID: 32367533 DOI: 10.1002/mus.26905] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND We assessed clinical predictors of mechanical ventilation in children with Guillain-Barré syndrome (GBS) to help identify patients who require mechanical ventilation. METHODS We retrospectively collected the clinical, laboratory, and electrophysiological data of 103 children with GBS. Patients were categorized into two groups based on the requirement for mechanical ventilation. Variables that were significantly different between the two groups in univariate analysis were analyzed by multivariate logistic regression models. RESULTS Time from symptom onset to admission (P = .002), facial or bulbar weakness (P = .001), and axonal type (P = .005) were associated with mechanical ventilation in univariate analysis. In multivariate analysis, facial or bulbar weakness (odds ratio [OR], 7.936; P = .013) and axonal type (OR, 4.582; P = .022) were independent predictors for mechanical ventilation. CONCLUSIONS Facial or bulbar weakness and axonal type were associated with increased risk for mechanical ventilation in children with GBS.
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Affiliation(s)
- Hanyu Luo
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Mei Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Li Wang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, P.R. China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
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16
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Levison LS, Thomsen RW, Markvardsen LK, Christensen DH, Sindrup SH, Andersen H. Pediatric Guillain-Barré Syndrome in a 30-Year Nationwide Cohort. Pediatr Neurol 2020; 107:57-63. [PMID: 32192820 DOI: 10.1016/j.pediatrneurol.2020.01.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Guillain-Barré syndrome is the most common cause of acute flaccid paresis in childhood. Few validated large-scale population-based data are available concerning pediatric Guillain-Barré syndrome, including incidence, risk factors, and initial clinical characteristics. METHODS In the Danish National Patient Registry, we identified all children aged below 16 years (N = 212) diagnosed with Guillain-Barré syndrome and admitted to any Danish department of pediatrics between 1987 and 2016. A total of 145 (68%) medical files could be retrieved and reviewed, enabling classification of patients with true Guillain-Barré syndrome. The nationwide Guillain-Barré syndrome incidence rate was calculated and stratified by age, gender, time periods, and season. Risk factors and initial Guillain-Barré syndrome characteristics were assessed by medical record review. RESULTS The positive predictive value of Guillain-Barré syndrome diagnosis codes was 86%. The crude Guillain-Barré syndrome incidence rate was 0.69 per 100,000 person years and peaked at two years of age. The incidence rate was higher among men (0.80) than women (0.58) and was relatively stable over the 30-year period. No seasonal difference of the incidence rate was found. Of the 125 Guillain-Barré syndrome cases, 63% were preceded by infection, whereas none were preceded by surgery or malignant disease. Medically treated pain was documented in 70%, mainly confined to the lower extremities. CONCLUSIONS Pediatric Guillain-Barré syndrome diagnoses in the Danish National Patient Registry have high validity, the incidence peaks at age two years, and is preceded by infection in two-thirds of children. Lower extremity pain is a common clinical presentation in the acute setting.
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Affiliation(s)
| | | | | | | | | | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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17
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Leung E, Javaid S, Pelshaw CB, Erlandson E. Superimposed Guillain-Barré Syndrome (GBS) in pediatric hypoxic brain injury. J Pediatr Rehabil Med 2020; 13:63-69. [PMID: 32176662 DOI: 10.3233/prm-180562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hypoxic brain injury results in severe disabilities that require extensive acute inpatient and outpatient rehabilitation to promote maximal functional and cognitive recovery. Brain hypoxemia can result from a multitude of causes, including but not limited to cardiac arrest, drug overdose, and/or shock. While recovery from a hypoxic brain injury alone can be challenging, dealing with concurrent debilitative diagnoses such as Guillain Barré Syndrome (GBS) further complicates the recovery and rehabilitation course. CASE REPORT The current case study highlights the acute inpatient rehabilitation course of a 16 year old male who presented with cerebral hypoxia secondary to strangulation and subsequently developed GBS. Physical examination of the patient upon rehabilitation consult was inconsistent with a purely hypoxic brain injury, including the absence of rectal tone. This prompted further potential spinal cord injury evaluation and work up, with diagnostic testing confirmatory of GBS. RELEVANCE This case is important as, to our knowledge from literature review, the first known documented instance of hypoxic brain injury complicated by GBS. Moreover, it highlights the importance of identifying all potential causes of functional disability, particularly when presented with physical exam findings inconsistent with chief diagnosis, in order to maximize functional recovery and rehabilitative gains during acute inpatient rehabilitation.
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Affiliation(s)
- Enoch Leung
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit Medical Center/Rehabilitation Institute of Michigan, Detroit, MI, USA
| | - Simra Javaid
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit Medical Center/Rehabilitation Institute of Michigan, Detroit, MI, USA
| | - Charles B Pelshaw
- Department of Pediatric Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
| | - Erika Erlandson
- Department of Pediatric Physical Medicine and Rehabilitation, Children's Hospital of Michigan, Detroit, MI, USA
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18
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Müller-Felber W. Periphere Neuropathien im Kindesalter. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Yosha-Orpaz N, Aharoni S, Rabie M, Nevo Y. Atypical Clinical Presentations of Pediatric Acute Immune-Mediated Polyneuropathy. J Child Neurol 2019; 34:268-276. [PMID: 30674221 DOI: 10.1177/0883073818825213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in children. During the acute phase, the disorder can be life-threatening by involving the respiratory muscles and the autonomic nervous system. Nevertheless, the prognosis is good, and most children achieve full recovery. The aim of this study was to characterize the clinical and electrophysiologic findings in children with Guillain-Barré syndrome referred to a tertiary center in Israel. A retrospective database review from 2009 to 2015 identified 39 children. Data on clinical presentation, respiratory complications, and long-term neurologic outcomes were collected. Atypical clinical findings at admission included asymmetric weakness in 23%, nonascending weakness in 30%, and normal deep tendon reflexes in 28%. Eight children were later diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Electrophysiologic findings, available in 12 patients with Guillain-Barré syndrome, revealed acute inflammatory demyelinating polyradiculoneuropathy (AIDP) in 4 (33.5%), AIDP with secondary axonal changes in 3 (25%), and acute motor axonal neuropathy (AMAN) subtype in 4 (33.5%); 8% had no abnormal findings. On follow-up, 71% of the children with Guillain-Barré syndrome fully recovered compared to 14% of the children with CIDP. Corresponding rates of neurologic sequelae were 29% and 86%. Clinicians should be alert to the atypical presenting symptoms of Guillain-Barré syndrome, which occur in a significant proportion of children.
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Affiliation(s)
- Naama Yosha-Orpaz
- 1 Pediatric Neurology Unit, Edith Wolfson Medical Center, Holon, Israel
| | - Sharon Aharoni
- 2 Institute of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Malcolm Rabie
- 2 Institute of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yoram Nevo
- 2 Institute of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Sharma K, Tengsupakul S, Sanchez O, Phaltas R, Maertens P. Guillain-Barré syndrome with unilateral peripheral facial and bulbar palsy in a child: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19838750. [PMID: 30915222 PMCID: PMC6429638 DOI: 10.1177/2050313x19838750] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022] Open
Abstract
Guillain-Barré syndrome is characterized by progressive motor weakness, sensory changes, dysautonomia, and areflexia. Cranial nerve palsies are frequent in Guillain-Barré syndrome. Among cranial nerve palsies in Guillain-Barré syndrome, facial nerve palsy is the most common affecting around half of the cases. Facial palsy in Guillain-Barré syndrome is usually bilateral. We describe a pediatric Guillain-Barré syndrome variant presenting with unilateral peripheral facial palsy and dysphagia. A 5-year-old boy had progressive lower extremity weakness and pain 3 days prior to onset of unilateral peripheral facial palsy. On presentation, diagnosis of Guillain-Barré syndrome was supported by areflexia and albuminocytologic dissociation. His condition deteriorated with a decline in his respiratory effort and inability to handle secretions. He was given non-invasive ventilation to prevent worsening of his acute respiratory failure. Brain and spine magnetic resonance imaging scans showed enhancement of the left bulbar nerve complex and anterior and posterior cervical nerve roots with gadolinium. Treatment with intravenous immunoglobulin led to an uneventful clinical course with partial recovery within 2 weeks. In summary, Guillain-Barré syndrome should be considered as a possible cause of unilateral peripheral facial palsy. Guillain-Barré syndrome patients with facial nerve and bulbar palsy require close monitoring as they are at risk of developing acute respiratory failure. Early intervention with intravenous immunoglobulin may benefit these patients. Magnetic resonance imaging findings may lend support to early intervention.
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Affiliation(s)
- Kamal Sharma
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Supatida Tengsupakul
- Division of Pediatric Infectious Disease and Pediatric Hospitalist Service, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Omar Sanchez
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Rozaleen Phaltas
- Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Paul Maertens
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, USA
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21
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Vander-Plas S, Eboh NI. Case 2: A 2-year-old Girl with Difficulty Bearing Weight. Pediatr Rev 2019; 40:40-41. [PMID: 30600278 DOI: 10.1542/pir.2017-0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Ngozi I Eboh
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX
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22
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Karalok ZS, Taskin BD, Yanginlar ZB, Gurkas E, Guven A, Degerliyurt A, Unlu E, Kose G. Guillain-Barré syndrome in children: subtypes and outcome. Childs Nerv Syst 2018; 34:2291-2297. [PMID: 29948140 DOI: 10.1007/s00381-018-3856-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study reviews the clinical features, subtypes, and outcomes of childhood Guillain-Barré syndrome (GBS). METHODS Fifty-four children who attended a tertiary care training and research hospital in Turkey were enrolled in the study. RESULTS The mean age was 6.5 ± 4.2 years and 32 patients (59.5%) were male. The most common subtype of GBS was acute inflammatory demyelinating polyneuropathy (AIDP), which was seen in 27 patients (50%). Having antecedent history, especially upper respiratory tract infection was significantly more common in AIDP (P = 0.028). Sensorial symptoms were significantly more frequent in axonal type GBS (P = 0.001). When we compare the demyelinating and axonal forms, all of the groups had favorable outcome. CONCLUSION The diagnosis of pediatric GBS can be delayed because of its variable presentation. Early admission to hospital and early treatment are important for decreasing the need for respiratory support and improving the outcome.
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Affiliation(s)
- Zeynep Selen Karalok
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey.
| | - Birce Dilge Taskin
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Zeliha Brohi Yanginlar
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Esra Gurkas
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Alev Guven
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Aydan Degerliyurt
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Ece Unlu
- Department of Physical Medicine and Rehabilitation, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Gulsen Kose
- Department of Pediatric Neurology, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
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23
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Orhan EK, Kiraç LB, DİKmen PY, Matur Z, Ertaş M, Öge AE, Deymeer F, Yazici J, Baslo MB. Electromyography in Pediatric Population. NORO PSIKIYATRI ARSIVI 2018; 55:36-39. [PMID: 30042639 DOI: 10.5152/npa.17023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/14/2016] [Indexed: 11/22/2022]
Abstract
Introduction Electrodiagnostic evaluation provides an important extension to the neurological examination for the evaluation of pediatric neuromuscular disease. Many pediatric neuromuscular diseases are analogous to those seen in the adult. However, the relative frequency of these illnesses varies greatly when different age populations are compared. The purpose of the present study is to provide a retrospective analysis of children referred to our electromyography (EMG) laboratory for electrophysiological examinations. Methods We retrospectively reviewed electrodiagnostic records of patients aged between 0-15 years, from January 2004 to June 2013. Patients were classified as having plexopathy, nerve root lesions, polyneuropathy, myopathy, mononeuropathy, anterior horn cell disease, neuromuscular transmission disorder, facial nerve palsy, and other rare disorders. Results We reviewed totally 5563 pediatric records, which was on the average 578 studies per year. It was about 14% of the all EMG examinations performed in our laboratory. When we looked at all the procedures, 3271 of the records included needle EMGs, 170 of them were single fiber EMGs, 100 of them were repetitive nerve stimulations, and 52 of them were evoked potentials. The results were normal in 55% of the cases. As a result of electrophysiological examinations, the common diagnoses were: plexopathy (28.6%), polyneuropathy (7.4%), and myopathy (6.6%) in patients aged 0-5 years (41.2% of all records); myopathy (9.4%), PNP (8.5%), mononeuropathy (6.4%), and plexopathy (5.9%) in 6-10 years (28.2% of all records); PNP (11.3%), myopathy (6.6%), and mononeuropathy (5.6%) in 11-15 years (30.6% of all records). Conclusion Infants and toddlers mostly suffered from brachial plexopathy which can be prevented by proper obstetrical management. Nerve conduction studies and EMG yielded diagnostic importance for demyelinating neuropathy and myopathy in patients older than 6 years of age.
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Affiliation(s)
- Elif Kocasoy Orhan
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Leyla Baysal Kiraç
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Pınar Yalinay DİKmen
- Department of Neurology, Acıbadem University Faculty of Medicine, İstanbul, Turkey
| | - Zeliha Matur
- Department of Neurology, Istanbul Bilim University Faculty of Medicine, İstanbul, Turkey
| | - Mustafa Ertaş
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - A Emre Öge
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Feza Deymeer
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - Jale Yazici
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
| | - M Barş Baslo
- Department of Neurology, Istanbul University Faculty of Medicine, İstanbul, Turkey
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24
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van der Pijl J, Wilmshurst JM, van Dijk M, Argent A, Booth J, Zampoli M. Acute flaccid paralysis in South African children: Causes, respiratory complications and neurological outcome. J Paediatr Child Health 2018; 54:247-253. [PMID: 28960591 DOI: 10.1111/jpc.13709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/02/2017] [Accepted: 08/21/2017] [Indexed: 11/26/2022]
Abstract
AIM To describe the causes, clinical presentation and neurological outcome of acute flaccid paralysis in children. METHODS A retrospective study in a tertiary paediatric hospital in South Africa. Data on clinical presentation, respiratory complications and long-term neurological outcomes of children presenting with acute flaccid paralysis were collected. Logistic regression analysis was applied to determine predictors for the need of mechanical ventilation. RESULTS The study included 119 patients, 99 of whom had Guillain-Barré syndrome (GBS); 47 patients (39.5%) required mechanical ventilation. Backward logistic regression analysis revealed that bulbar dysfunction (P < 0.001), autonomic dysfunction (P = 0.003) and upper limb paralysis (P = 0.038) significantly predicted the need for mechanical ventilation. EuroQol-5D scores of self-care problems and usual activities after discharge significantly declined over time. CONCLUSIONS In this large series from Africa, GBS was the main cause of acute flaccid paralysis in children and was associated with significant morbidity. Other causes of acute flaccid paralysis mimicking GBS were not uncommon and should be excluded in this setting.
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Affiliation(s)
- Jolanda van der Pijl
- Department of Paediatric Surgery and Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jo M Wilmshurst
- Division of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Monique van Dijk
- Department of Paediatric Surgery and Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Andrew Argent
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Division of Paediatric Critical Care, Children's Heart Disease and Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Jane Booth
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Division of Paediatric Pulmonology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Marco Zampoli
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,Division of Paediatric Pulmonology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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25
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Vasconcelos MM, Vasconcelos LG, Brito AR. Assessment of acute motor deficit in the pediatric emergency room. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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26
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Vasconcelos MM, Vasconcelos LGA, Brito AR. Assessment of acute motor deficit in the pediatric emergency room. J Pediatr (Rio J) 2017; 93 Suppl 1:26-35. [PMID: 28756061 DOI: 10.1016/j.jped.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/28/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This review article aimed to present a clinical approach, emphasizing the diagnostic investigation, to children and adolescents who present in the emergency room with acute-onset muscle weakness. SOURCES A systematic search was performed in PubMed database during April and May 2017, using the following search terms in various combinations: "acute," "weakness," "motor deficit," "flaccid paralysis," "child," "pediatric," and "emergency". The articles chosen for this review were published over the past ten years, from 1997 through 2017. This study assessed the pediatric age range, from 0 to 18 years. SUMMARY OF THE DATA Acute motor deficit is a fairly common presentation in the pediatric emergency room. Patients may be categorized as having localized or diffuse motor impairment, and a precise description of clinical features is essential in order to allow a complete differential diagnosis. The two most common causes of acute flaccid paralysis in the pediatric emergency room are Guillain-Barré syndrome and transverse myelitis; notwithstanding, other etiologies should be considered, such as acute disseminated encephalomyelitis, infectious myelitis, myasthenia gravis, stroke, alternating hemiplegia of childhood, periodic paralyses, brainstem encephalitis, and functional muscle weakness. Algorithms for acute localized or diffuse weakness investigation in the emergency setting are also presented. CONCLUSIONS The clinical skills to obtain a complete history and to perform a detailed physical examination are emphasized. An organized, logical, and stepwise diagnostic and therapeutic management is essential to eventually restore patient's well-being and full health.
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Affiliation(s)
- Marcio Moacyr Vasconcelos
- Universidade Federal Fluminense (UFF), Hospital Universitário Antônio Pedro, Departamento Materno Infantil, Niterói, RJ, Brazil.
| | - Luciana G A Vasconcelos
- Associação Brasileira Beneficente de Reabilitação (ABBR), Divisão de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Adriana Rocha Brito
- Universidade Federal Fluminense (UFF), Hospital Universitário Antônio Pedro, Departamento Materno Infantil, Niterói, RJ, Brazil
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27
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Panosyan FB. Bilateral Ptosis due to Sympathetic Dysfunction as a Feature of Guillain-Barre Syndrome. J Clin Neuromuscul Dis 2017; 19:38-42. [PMID: 28827488 DOI: 10.1097/cnd.0000000000000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This case-control study demonstrates that bilateral ptosis due to ocular sympathetic dysfunction is a characteristic feature of Guillain-Barre syndrome (GBS) and apraclonidine can be helpful in unmasking this clinical feature. Five patients with GBS and 9 healthy controls were assessed for ocular sympathetic dysfunction through application of topical apraclonidine to 1 eye. Changes resulting from reversal of ptosis or miosis due to apraclonidine were compared with the eye on the other side with no apraclonidine using photographs. Ocular sympathetic dysfunction in the form of mild bilateral ptosis was found in all 5 patients with GBS recruited in this study. Consistent with previous reports, healthy subjects had no significant response to apraclonidine. Although there was evidence of concomitant pupillary dysfunction in the form of bilateral Horner syndrome in 2 of the patients with GBS with more severe GBS phenotype, this study did not have the statistical power to reach conclusions regarding pupillary dysfunction and disease severity in GBS.
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Affiliation(s)
- Francis B Panosyan
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
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28
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Miranda S, Chaignot C, Collin C, Dray-Spira R, Weill A, Zureik M. Human papillomavirus vaccination and risk of autoimmune diseases: A large cohort study of over 2million young girls in France. Vaccine 2017; 35:4761-4768. [PMID: 28750853 DOI: 10.1016/j.vaccine.2017.06.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/01/2017] [Accepted: 06/09/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Whether human papillomavirus (HPV) vaccination could induce or trigger autoimmune diseases (AID) has been questioned, and potentially contributes to low immunization coverage in France. This study evaluated the association between HPV vaccination and the risk of AID using routinely collected data sources. METHODS All girls aged 13-16years between 2008 and 2012, covered by the general health insurance scheme and without history of HPV vaccination or AID, were included and followed using French nationwide databases. Fourteen neurological, rheumatological, haematological, gastrointestinal or endocrine AID, were identified from ICD-10 codes allocated to hospital stays and long-term illnesses or by marker drugs. Their incidence was compared between girls exposed and non-exposed to HPV vaccination, using a Cox model adjusted for inclusion year, geographic area, socio-economic indicators, healthcare use level and other immunizations. RESULTS Among 2,252,716 girls, 37% received HPV vaccine and 4,096 AID occurred during a mean follow-up time of 33months. The incidence of AID was not increased after exposure to HPV vaccination, except for Guillain-Barré syndrome (GBS) (incidence rate of 1.4 among exposed [20 cases] versus 0.4 per 100,000 PY among unexposed [23 cases]; adjusted HR: 3.78 [1.79-7.98]). This association persisted across numerous sensitivity analyses and was particularly marked in the first months following vaccination. Under the hypothesis of a causal relationship, this would result in 1-2 GBS cases attributable to HPV vaccine per 100,000 girls vaccinated. CONCLUSIONS Our study provides reassuring results regarding the risk of AID after HPV vaccination, but an apparently increased risk of GBS was detected. Further studies are warranted to confirm this finding.
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Affiliation(s)
- Sara Miranda
- Agence Nationale de Sécurité des Médicaments et des Produits de Santé (ANSM) [French National Agency for Medicines and Health Products Safety], Saint-Denis, France
| | - Christophe Chaignot
- Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés (CNAMTS) [French National Health Insurance Fund for Salaried Workers], Paris, France
| | - Cédric Collin
- Agence Nationale de Sécurité des Médicaments et des Produits de Santé (ANSM) [French National Agency for Medicines and Health Products Safety], Saint-Denis, France
| | - Rosemary Dray-Spira
- Agence Nationale de Sécurité des Médicaments et des Produits de Santé (ANSM) [French National Agency for Medicines and Health Products Safety], Saint-Denis, France
| | - Alain Weill
- Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés (CNAMTS) [French National Health Insurance Fund for Salaried Workers], Paris, France
| | - Mahmoud Zureik
- Agence Nationale de Sécurité des Médicaments et des Produits de Santé (ANSM) [French National Agency for Medicines and Health Products Safety], Saint-Denis, France.
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29
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Rossi A, Martinetti C, Morana G, Severino M, Tortora D. Diagnostic Approach to Pediatric Spine Disorders. Magn Reson Imaging Clin N Am 2017; 24:621-44. [PMID: 27417404 DOI: 10.1016/j.mric.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Understanding the developmental features of the pediatric spine and spinal cord, including embryologic steps and subsequent growth of the osteocartilaginous spine and contents is necessary for interpretation of the pathologic events that may affect the pediatric spine. MR imaging plays a crucial role in the diagnostic evaluation of patients suspected of harboring spinal abnormalities, whereas computed tomography and ultrasonography play a more limited, complementary role. This article discusses the embryologic and developmental anatomy features of the spine and spinal cord, together with some technical points and pitfalls, and the most common indications for pediatric spinal MR imaging.
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Affiliation(s)
- Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy.
| | - Carola Martinetti
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Mariasavina Severino
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Domenico Tortora
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
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30
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Esposito S, Longo MR. Guillain–Barré syndrome. Autoimmun Rev 2017; 16:96-101. [DOI: 10.1016/j.autrev.2016.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
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31
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Yeshokumar AK, Sun LR, Klein JL, Baranano KW, Pardo CA. Gait Disturbance as the Presenting Symptom in Young Children With Anti-NMDA Receptor Encephalitis. Pediatrics 2016; 138:peds.2016-0901. [PMID: 27531146 DOI: 10.1542/peds.2016-0901] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 11/24/2022] Open
Abstract
This case series demonstrates a novel clinical phenotype of gait disturbance as an initial symptom in children <3 years old with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Anti-NMDAR encephalitis is one of the most common causes of encephalitis in children, more common than any of the viral encephalitides and the second most common autoimmune cause after acute disseminated encephalomyelitis. Anti-NMDAR encephalitis in children often presents with disrupted speech and sleep patterns followed by progression to motor dysfunction, dyskinesias, and seizures. Because this condition can present initially with vague symptoms, diagnosis and treatment of anti-NMDAR encephalitis are often delayed. Although nearly 40% of all reported patients are <18 years old, few infants and toddlers have been reported with this disease. Four children <3 years old were diagnosed with anti-NMDAR encephalitis at our institution. Interestingly, each child presented initially with the chief concern of gait disturbance. One child presented with unsteady walking and slurred speech, suggestive of cerebellar ataxia, and 3 had inability to bear weight on a unilateral lower extremity, resulting in unsteady gait. Two of these children had seizures at the time of hospital presentation. All developed classic behavioral changes, insomnia, dyskinesias, or decreased speech immediately before or during hospitalization. When seen in the setting of other neurologic abnormalities, gait disturbance should raise the concern for anti-NMDAR encephalitis in young children. The differential diagnosis for gait disturbance in toddlers and key features suggestive of anti-NMDAR encephalitis are reviewed.
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Affiliation(s)
| | | | - Jessica L Klein
- Division of Pediatric Neurology, and Department of Pediatrics, The Medical University of South Carolina, Charleston, South Carolina
| | | | - Carlos A Pardo
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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32
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Meyer Sauteur PM, Roodbol J, Hackenberg A, de Wit MCY, Vink C, Berger C, Jacobs E, van Rossum AMC, Jacobs BC. Severe childhood Guillain-Barré syndrome associated with Mycoplasma pneumoniae infection: a case series. J Peripher Nerv Syst 2016; 20:72-8. [PMID: 26115201 DOI: 10.1111/jns.12121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/28/2015] [Accepted: 06/10/2015] [Indexed: 01/09/2023]
Abstract
We report seven children with recent Mycoplasma pneumoniae infection and severe Guillain-Barré syndrome (GBS) that presented to two European medical centres from 1992 to 2012. Severe GBS was defined as the occurrence of respiratory failure, central nervous system (CNS) involvement, or death. Five children had GBS, one Bickerstaff brain stem encephalitis (BBE), and one acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP). The five patients with severe GBS were derived from an original cohort of 66 children with GBS. In this cohort, 17 children (26%) had a severe form of GBS and 47% of patients with M. pneumoniae infection presented with severe GBS. Of the seven patients in this case series, five were mechanically ventilated and four had CNS involvement (two were comatose). Most patients presented with non-specific clinical symptoms (nuchal rigidity and ataxia) and showed a rapidly progressive disease course (71%). Antibodies against M. pneumoniae were detected in all patients and were found to be intrathecally synthesised in two cases (GBS and BBE), which proves intrathecal infection. One patient died and only two patients recovered completely. These cases illustrate that M. pneumoniae infection in children can be followed by severe and complicated forms of GBS. Non-specific clinical features of GBS in such patients may predispose a potentially life-threatening delay in diagnosis.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Laboratory of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich, Switzerland
| | - Joyce Roodbol
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Annette Hackenberg
- Division of Neurology, and Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich, Switzerland
| | - Marie-Claire Y de Wit
- Department of Pediatrics, Division of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Cornelis Vink
- Laboratory of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Erasmus University College, Erasmus University, Rotterdam, The Netherlands
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich, Switzerland
| | - Enno Jacobs
- TU Dresden, Medical Faculty Carl Gustav Carus, Institute of Medical Microbiology and Hygiene, Dresden, Germany
| | - Annemarie M C van Rossum
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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33
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Chang PT, Yang E, Swenson DW, Lee EY. Pediatric Emergency Magnetic Resonance Imaging: Current Indications, Techniques, and Clinical Applications. Magn Reson Imaging Clin N Am 2016; 24:449-80. [PMID: 27150329 DOI: 10.1016/j.mric.2015.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
MR imaging plays an important role in the detection and characterization of several pediatric disease entities that can occur in the emergent setting because of its cross-sectional imaging capability, lack of ionizing radiation exposure, and superior soft tissue contrast. In the age of as low as reasonably achievable, these advantages have made MR imaging an increasingly preferred modality for diagnostic evaluations even in time-sensitive settings. In this article, the authors discuss the current indications, techniques, and clinical applications of MR imaging in the evaluation of pediatric emergencies.
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Affiliation(s)
- Patricia T Chang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David W Swenson
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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34
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Živković S. Intravenous immunoglobulin in the treatment of neurologic disorders. Acta Neurol Scand 2016; 133:84-96. [PMID: 25997034 DOI: 10.1111/ane.12444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2015] [Indexed: 12/17/2022]
Abstract
Intravenous immunoglobulins (IVIGs) are often used in the treatment of autoimmune disorders and immunodeficiencies, and it has been estimated that neurologic indications can account for up to 43% of IVIG used in clinical practice. In neurologic clinical practice, IVIG is used for acute therapy of newly diagnosed autoimmune disorders or exacerbations of pre-existing conditions, or as long-term maintenance treatment for chronic disorders. IVIG exerts its effects on humoral and cell-based immunity through multiple pathways, without a single dominant mechanism. Clinical use of IVIG has been supported by guidelines from American Academy of Neurology and European Federation of Neurologic Societies. IVIG is generally recommended for the treatment of Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy in adults, multifocal motor neuropathy and myasthenia gravis, and should be considered as a treatment option for dermatomyositis in adults and Lambert-Eaton myasthenic syndrome. Additional potential indications include stiff person syndrome, multiple sclerosis during pregnancy or while breastfeeding, refractory autoimmune epilepsy, and paraneoplastic disorders. Clinical use of IVIG is mostly safe but few adverse effects may still occur with potentially severe complications, including aseptic meningitis and thromboembolism. In addition to intravenous route (IVIG), subcutaneous immunoglobulins have been used as an alternative treatment option, especially in patients with limited intravenous access. Treatment with IVIG is effective in various autoimmune diseases, but its broader use is constrained by limited supply. This review evaluates the use of immunoglobulins in treatment of neurologic diseases.
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Affiliation(s)
- S. Živković
- Department of Neurology; University of Pittsburgh Medical Center; Pittsburgh PA USA
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35
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Pons L, Manel V, Ville D, Javouhey E, Bordet F. A New Observation of an Atypical and Severe Variant of the Guillain-Barre Syndrome in a Child: Remaining Challenges for Diagnosis, Nosologic Classification, and Therapeutic Course. Child Neurol Open 2015; 2:2329048X15609053. [PMID: 28503595 PMCID: PMC5417028 DOI: 10.1177/2329048x15609053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 06/19/2015] [Accepted: 07/06/2015] [Indexed: 11/16/2022] Open
Abstract
Guillain-Barré syndrome is a rare acute polyradiculoneuropathy. Several variants and unusual presentations have been described, particularly in pediatrics. In most cases, making an early diagnosis is challenging due to the treatments that consist in the rapid administration of intravenous immunoglobulin or plasma exchange. The authors present the case of a 7-year-old boy with an atypical and severe axonal Guillain-Barré syndrome, associated with Mycoplasma pneumonia. When he was admitted, febrile respiratory failure was the main focus, and then he presented signs of acute polyneuropathy with cranial nerve palsy and brief hyperreflexia. Mechanical ventilation was required for 48 days as well as 2 cycles of intravenous immunoglobulin. The authors describe all the medical challenges that the authors encountered. This case highlights the fact that respiratory distress can be the main clinical symptom in children. This delays the establishment of a correct diagnosis, even more so when neurological manifestations are abundant and unusual.
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Affiliation(s)
- Linda Pons
- Service de réanimation pédiatrique, Hôpital Femme Mère Enfant, HCL, Lyon, France.,Service d'explorations fonctionnelles neuropédiatriques, HFME, HCL, Lyon, France.,Service de neurologie pédiatrique, Hôpital Femme Mère Enfant, HCL, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Véronique Manel
- Service d'explorations fonctionnelles neuropédiatriques, HFME, HCL, Lyon, France
| | - Dorothée Ville
- Service de neurologie pédiatrique, Hôpital Femme Mère Enfant, HCL, Lyon, France
| | - Etienne Javouhey
- Service de réanimation pédiatrique, Hôpital Femme Mère Enfant, HCL, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Fabienne Bordet
- Service de réanimation pédiatrique, Hôpital Femme Mère Enfant, HCL, Lyon, France
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36
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Sim GY, Kim WS. Clinical variants of Guillain-Barré syndrome in children. J Biomed Res 2014. [DOI: 10.12729/jbr.2014.15.3.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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37
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Tasker RC, Darras BT. Neuromuscular disorders: from diagnosis to translational research, drug development and clinical trials. Curr Opin Pediatr 2013; 25:674-5. [PMID: 24240286 PMCID: PMC4008827 DOI: 10.1097/mop.0b013e328365de49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric neuromuscular disorders are a heterogeneous group of conditions that form four distinct groupings: (1) motor neuron diseases, (2) neuropathies, (3) disorders of the neuromuscular junction, and (4) myopathies.
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Affiliation(s)
- Robert C Tasker
- aDepartment of Neurology bDepartment of Anaesthesia (Pediatrics), Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
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