Predictive factors for achieving independent walking in children with Guillain-Barre syndrome

Abstract

BackgroundTo determine the predictors of achieving independent walking at 2 and 6 months after onset of weakness in children with Guillain-Barre syndrome (GBS).MethodsChildren with GBS admitted to the Tabriz Children's Hospital were studied prospectively. All patients had frequent clinical evaluations until achieving independent walking. Unaided walking at 2 and 6 months and factors influencing these outcomes were determined using both univariate and multiple analyses.ResultsBetween 2003 and 2014, 324 children (mean age: 5.3±3.66 years) were admitted. The mean duration to independent walking was 2.97±3.02 months; 90.5% of patients could walk independently at 6 months. In the univariate analysis, disability score of >3 (P=0.03), autonomic nerve involvement (P=0.003), cranial nerve involvement (P=0.008), and absent compound muscle action potential (CMAP; P=0.048) were found to be significantly associated with poor walking outcome at 6 months. In the multivariate analysis, cranial nerve involvement (P=0.008) and absence of CMAP (P=0.022) were independently associated with poor functional outcome.ConclusionDisability score >3, cranial and autonomic nerve involvement, and absence of CMAP were predictors of independent walking in childhood GBS in this study; early rehabilitation program may prevent further impairments secondary to immobility in these patients.

<p>Prevalence and outcomes of Guillain-Barr&eacute; syndrome among pediatrics in Saudi Arabia: a 10-year retrospective study</p>

“…Residual paralysis at the second month post onset of disease was highly associated with patients of age 8–14 years (65.2%) in this setting, which is compatible with findings reported by a study conducted in Iraq 12. In addition, GBS cases with cranial and autonomic involvement had a poor functional outcome, which was a similar finding to this study, but with no statistically significant differences 42. Additionally, in studies where GBS and acute myelitis were concurrent, all cases suffered residual paralysis 35.…”

Child with Guillain-Barré Syndrome Responding to Plasmapheresis: A Case Report

“…Despite limited evidence, it seems that the prognosis is poorer for GBS patients in the following groups [13][14][15][16][17][18]: (a) those very young (<2 years); (b) those very weak at presentation; (c) those having cranial nerve involvement; (d) those quadriparetic on day 10; (e) those requiring ventilator support; and (f) those having inexcitable motor nerves on nerve conduction studies.…”

Clinical Characteristics and Prognostic Factors of Children with Guillain-Barré Syndrome

“…In another prospective study with 324 patients, the prognosis was better with 96% of patients achieving independent gait, but also showed 1.5% of mortality [25]. The proportion of patients who achieved independent gait but showed minor functional disability was not mentioned [25]. In this study, 73.7% of patients showed full recovery after 6 months, 15.8% did not achieve independent walking, and 10.5% achieved independent gait but showed minor functional disabilities after 6 months.…”

“…Higher age was also a poor prognostic factor in adults [26,27]. However, in children, younger age was associated with poor outcome regarding the achievement of independent gait [25]. In a study which compared the outcome of demyelinating and axonal forms of GBS in children, there was no difference among different subtypes [29].…”

“…In a prospective study of 95 children with GBS including two patients later diagnosed with chronic inflammatory demyelinating polyneuropathy, 75% of the children were symptom-free at last follow-up without any mortality (follow-up duration of 10 to 604 days, median 288 days) [24]. In another prospective study with 324 patients, the prognosis was better with 96% of patients achieving independent gait, but also showed 1.5% of mortality [25]. The proportion of patients who achieved independent gait but showed minor functional disability was not mentioned [25].…”