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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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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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Haridy NA, Shehab MM, Khedr EM. Long-term outcomes of plasma exchange versus intravenous immunoglobulin for the treatment of Guillain-Barré Syndrome: A double-blind, randomized clinical trial. Restor Neurol Neurosci 2023; 41:203-217. [PMID: 38217554 DOI: 10.3233/rnn-231369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
Background Most previous studies comparing the effectiveness of Plasma Exchange (PE) or intravenous immunoglobulin (IVIG) in treating Guillain-Barre syndrome (GBS) have focused on the short-term outcome at around 1 month. Objective To compare the long-term efficacy of PE and IVIG at one year in adult patients with GBS. Methods Eighty-one adult patients with acute GBS were randomized into two groups with a ratio of 2 : 1: PE (N = 54) and IVIG (N = 27). Patients were assessed with the Medical Research Council sum score (MRC sum score), GBS Disability Scale (GDS), and Functional assessment of acute inflammatory neuropathy (FAAIN) at baseline, ten days, one month, three months, and one year. Neurophysiological examinations were performed at baseline and three months following treatment. Results There were no significant differences between groups in demographic, clinical, and laboratory data. Both treatments produced a significant improvement in all clinical rating scales in both groups that continued up to one year. There were significant differences in the time course of recovery in the MRC and FAAIN scales, with significantly more improvement in the IVIG group at 1 and 3 months, although there was no significant difference in outcome at one year. However the effect size showed measurable differences between the PE and IVIG groups across the different measures at one-year. Electrophysiological studies showed equal improvement in most measures in both groups at three months, with a slightly greater effect in the IVIG group. Conclusion long term outcomes of IVIG and PE were equivalent. However the effect size showed measurable differences between the PE and IVIG groups across the different measures at one-year follow-up that indicate the superiorty of IVIG. There was also a tendency for improvement to be slightly faster in the IVIG group.
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Affiliation(s)
- Nourelhoda A Haridy
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed M Shehab
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Eman M Khedr
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt
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Kalita J, Misra UK, Chaudhary SK, Das M, Mishra A, Ranjan A, Kumar M. The outcome of Guillain-Barré syndrome following intravenous immunoglobulin compared to the natural course. Eur J Neurol 2022; 29:3071-3080. [PMID: 35837807 DOI: 10.1111/ene.15500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intravenous immunoglobulin (IVIg) is recommended in Guillain-Barré syndrome (GBS), but its efficacy may vary in different subtypes. We report the outcomes of patients with GBS following IVIg treatment compared to the natural course (NC). We also compare the effect of IVIg treatment in different subtypes of GBS. METHODS From a cohort of 528 GBS, we have extracted 189 patients who received IVIg and compared their outcomes with 199 age and peak disability matched patients who did not receive IVIg, plasmapheresis, or corticosteroid. Disability was assessed using the 0-6 GBS Disability Scale (GBSDS). Clinical and neurophysiological subtypes were recorded. The primary outcome was functional disability at 6-months and was categorized as complete (GBSDS ≤ 1), partial (GBSDS 2-3), and poor (GBSDS > 3). The secondary outcomes were in-hospital death, and duration of hospitalization, and mechanical ventilation (MV). RESULTS In-hospital death (2.6% vs 2%; p = 0.74) and 3-months poor recovery (20.7% vs 18%) were similar in the IVIg and NC group. At 6-months, however, a lesser proportion of patients in IVIg group had poor recovery (2.2% vs 8.3%; p = 0.026). The outcomes of IVIg and NC were compared in 72 AMAN and 256 AIDP patients. IVIg therapy did not alter the outcome in AMAN but resulted in a lesser proportion of poor recovery at 6-months in AIDP (0.8% vs. 6.6%; p = 0.03). CONCLUSION Intravenous immunoglobulin is beneficial in AIDP variants of GBS but not in the AMAN subtype. A customized treatment may be cost-effective till a randomized controlled trial is conducted in AMAN.
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow
| | - Usha K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.,Department of Neurology, Apollomedics Super Specialty Hospitals, Lucknow, Uttar Pradesh, India
| | - Sarvesh K Chaudhary
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow
| | - Moromi Das
- Department of Neurology, Guwahati Medical College, Assam, India
| | - Anadi Mishra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow
| | - Abhay Ranjan
- Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, India
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Randhawa MS, Iyer R, Bansal A, Mukund B, Angurana SK, Nallasamy K, Jayashree M, Singhi SC, Singhi P, Baranwal AK, Sankhyan N. Clinical Features Associated With Need for Mechanical Ventilation in Children With Guillain-Barré Syndrome: Retrospective Cohort From India. Pediatr Crit Care Med 2022; 23:378-382. [PMID: 35220343 DOI: 10.1097/pcc.0000000000002930] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the clinical features associated with the need for mechanical ventilation (MV) in children with Guillain-Barré syndrome (GBS). DESIGN Retrospective cohort study, 2010-2019. SETTING PICU. PATIENTS All children, 1 month to 12 years old, diagnosed with GBS in our single-center PICU. INTERVENTION Retrospective chart and data review. MEASUREMENTS AND MAIN RESULTS Out of 189 children identified with a diagnosis of GBS, 130 were boys (69%). The median (interquartile range [IQR]) age was 6 years (3-9 yr). At admission, the Hughes disability score was 5 (4-5), and cranial nerve palsies were present in 81 children (42%). Autonomic instability subsequently occurred in a total of 97 children (51%). In the 159 children with nerve conduction studies, the axonal variant of GBS (102/159; 64%) predominated, followed by the demyelinating variant (38/189; 24%). All children received IV immunoglobulins as first-line therapy at the time of admission. The median (IQR) length of PICU stay was 12 days (3-30.5 d). Ninety-nine children (52%) underwent invasive MV, and median duration of MV was 25 days (19-37 d). At admission, upper limb power less than or equal to 3 (p = 0.037; odds ratio (OR), 3.5 [1.1-11.5]), lower limb power less than or equal to 2 (p = 0.008; OR, 3.5 [1.4-8.9]), and cranial nerve palsy (p = 0.001; OR, 3.2 [1.6-6.1]) were associated with subsequent need for MV. Prolonged (> 21 d) MV was associated with more severe examination findings at admission: upper limb power less than or equal to 2 (p < 0.0001; OR, 4.2 [2.5-6.9]) and lower limb power less than or equal to 1 (p < 0.0001; OR, 4.5 [2.6-7.9]). CONCLUSIONS In children with GBS, referred to our center in North India, severe neuromuscular weakness at admission was associated with the need for MV. Furthermore, greater severity of this examination was associated with need for prolonged (> 21 d) MV. Identification of these signs may help in prioritizing critical care needs and early PICU transfer.
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Affiliation(s)
- Manjinder Singh Randhawa
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajalakshmi Iyer
- Pediatric Intensive Care Unit, Birmingham Children's Hospital and Charity, Birmingham, United Kingdom
| | - Arun Bansal
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bal Mukund
- Pediatrics and Intensive Care, Indian Naval Hospital Ship Asvini, Mumbai, India
| | - Suresh Kumar Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunit C Singhi
- Department of Pediatrics, Medanta Medicity, Gurugram, India
| | | | - Arun Kumar Baranwal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Division of Pediatric Neurology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kalita J, Kumar M, Misra U. Prognostic Significance of Serial Nerve Conduction in GB Syndrome. Neurol India 2022; 70:1995-2002. [DOI: 10.4103/0028-3886.359245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Shang P, Zhu M, Wang Y, Zheng X, Wu X, Zhu J, Feng J, Zhang HL. Axonal variants of Guillain-Barré syndrome: an update. J Neurol 2020; 268:2402-2419. [PMID: 32140865 DOI: 10.1007/s00415-020-09742-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
Axonal variants of Guillain-Barré syndrome (GBS) mainly include acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, and pharyngeal-cervical-brachial weakness. Molecular mimicry of human gangliosides by a pathogen's lipooligosaccharides is a well-established mechanism for Campylobacter jejuni-associated GBS. New triggers of the axonal variants of GBS (axonal GBS), such as Zika virus, hepatitis viruses, intravenous administration of ganglioside, vaccination, and surgery, are being identified. However, the pathogenetic mechanisms of axonal GBS related to antecedent bacterial or viral infections other than Campylobacter jejuni remain unknown. Currently, autoantibody classification and serial electrophysiology are cardinal approaches to differentiate axonal GBS from the prototype of GBS, acute inflammatory demyelinating polyneuropathy. Newly developed technologies, including metabolite analysis, peripheral nerve ultrasound, and feature selection via artificial intelligence are facilitating more accurate diagnosis of axonal GBS. Nevertheless, some key issues, such as genetic susceptibilities, remain unanswered and moreover, current therapies bear limitations. Although several therapies have shown considerable benefits to experimental animals, randomized controlled trials are still needed to validate their efficacy.
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Mingqin Zhu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Ying Wang
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xiangyu Zheng
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xiujuan Wu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jie Zhu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Shuangqing Road 83#, Beijing, 100085, China.
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The authors reply. Pediatr Crit Care Med 2019; 20:1002-1003. [PMID: 31580282 DOI: 10.1097/pcc.0000000000002075] [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: 11/26/2022]
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Is It Possible That IV Immunoglobulin Does Not Improve Outcome in Children With Guillain-Barré Syndrome? Answer: Yes. Pediatr Crit Care Med 2019; 20:681-682. [PMID: 31274796 DOI: 10.1097/pcc.0000000000001965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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