Guillain Barre Syndrome: Major Cause of Acute Flaccid Paralysis in Children and Adolescents of Nepal

Abstract

Introduction. Guillain Barre Syndrome (GBS) is a post infectious polyneuropathy involving mainly motor but sometimes sensory and autonomic nerves. It is an acquired disease of the peripheral nerves that is characterized by rapidly progressing paralysis, areflexia and albumino-cytological dissociation in CSF. Methodology: Prospective, descriptive, observational, hospital based study was carried out to find out the clinico-epidemiological features of GBS including existing treatment modalities and its outcome. All cases fulfilled the criteria for AFP (Acute flaccid Paralysis) surveillance was included. Cases were reviewed for full medical history and examinations. To confirm the diagnosis, necessary investigations were carried out and combined with clinical symptoms. Results: Thirty patients were included in the study during study period. Among them 90% were diagnosed as GBS, 7.4% patients of GBS were associated with hypokalemic paralysis, 7.4% diagnosed as transverse myelitis and 3.7% diagnosed as idiopathic neuropathy. Different types of GBS were classified as AIDP (Acute inflammatory demyelinating polyneuropathy) 62.96%, AMAN (Acute motor axonal neuropathy) -25.52%, AMASAN (Acute motor and sensory axonal neuropathy) -3.3% and MFS (Miller fisher's syndrome) -6.6% according to NCV result. Male female ratio is 1.7:1.0. There was 14.8% patients had relapse within 5 year. Associated diseases were URTI, pneumonia, sore throat and diarrhea. Facial Nerve palsy was commonest cranial nerve involvement.Sixty percentage of patients presented with sensory symptoms. There was transient bowel and bladder involvement in 20% of the cases. 69.2% patients became bed ridden at the nadir. There was albumin-cytological dissociation in 80% case. Majority of patients improved with supportive treatment alone, 19.5% patient required ventilator support among them 40% died. 7.4% of cases expired during treatment. Half of the patients fully recovered within 3 months. Conclusion: GBS is the commonest cause of AFP, AIDP being commonest subtype in our setting. We have to improve our existing treatment facilities and extend to different centers to detect and treat GBS. Most of the patients improve with supportive treatment alone. Ventilator support indicates grave prognosis.

Clinico-Epidemiological Study of Acute Flaccid Paralysis at a Tertiary Centre

“…Among the children with GBS, preceeding viral illness was found in 75% children in form of diarrhea and respiratory tract infec on similar to the study of Sharma KS et al 14 . Complica ons of GBS were no ced in 50% children in the form of respiratory failure (50%) and autonomic failure (25%) with improvement seen in 25%, which is comparable to studies by Sharma KS et al The mean Glasgow Coma Scale in our study was 9.53±4.27.…”

“…2011) showed GBS as the major leading cause of AFP in children 8,12,13,14 . In this study, we had a total of only 4(9.3%) children with GBS while in a similar clinico-epidemiological study done at BPKIHS by Sharma KS et al, 90% were GBS 14 . Studies by McKhann GM et al and Morris M et al also had GBS as the most common cause 12,15 .…”

An epidemiological analysis of acute flaccid paralysis in Khuzestan Province, southwest Iran, from 2006 to 2010

“…The annual global incidence rate of GBS is one to four cases per 100,000 people. GBS is a post-infectious polyneuropathy that mainly affects the motor nerve branches [ 6 ].…”

Study of acute flaccid paralysis surveillance system in Kerman (Iran) for one decade

“…Majority of patients improved with supportive treatment alone, in this study after 60 days follow up more than 75% cases full recovered or have only mild disability, the 18% cases have moderate to severe disability, and 4% of patients with GBS have died ( Table 5). In a study the rate recovery after 3 months reported 50% and the rate of death was 7.4% [32]. The differences may be due to low age of our patients that were 15 years old or smaller.…”