Prognostic factors for the sequelae and severity of Guillain‐Barré syndrome in children

Abstract

Introduction Guillain‐Barré syndrome (GBS) is an inflammatory polyradiculoneuritis. Our aim in this study was to describe the clinical characteristics and the long‐term sequelae of GBS in a French pediatric population. Methods In this multicenter, retrospective study we evaluated clinical signs, radiological examinations, laboratory tests, treatments, and outcomes. Results One hundred ten children were included in this investigation. These children presented with walking difficulties, muscle weakness, and cranial nerve impairment. Electrodiagnostic testing revealed 70% with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and 16% with acute motor axonal neuropathy (AMAN). One hundred children received immunoglobulins. At follow‐up, 77% were cured, whereas 9% had sequelae, associated with an axonal form (P < .01) and a short interval between symptom onset and hospitalization (P < .01). The need for intubation was correlated with peripheral facial paralysis (P < .01) and dysautonomia (P < .01). Discussion Although AIDP and AMAN present in a similar way, the axonal form is associated with a worse outcome.

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“…Under the category of AFP, GBS, AFM, and TM present with substantial weakness and potentially respiratory depression. 53,54 Despite the consistency of weakness at onset, reported outcomes reveal a great deal of variability in long-term motor strength and function for all three pathologies.…”

“…However, one-fourth of the children report adverse effects on schoolwork and quality of life. 54 Followup studies of adults who had GBS during childhood have shown that many patients experience residual pain, unsteadiness, and fatigue in their daily lives. 55 A recent review of pediatric TM discusses the variability in reported outcomes.…”

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“…The presence of sequelae was correlated with the short duration between symptom onset and hospitalization and with the axonal form of GBS (AMSAN or AMAN), with 29% of children with the axonal form having sequelae compared to 5% of those with AIDP. We should mention that, in our French colleagues' study, most children received IVIg, unlike our patient who underwent four courses of TPE (24). Other studies report that the axonal forms (AMAN and AMSAN) are correlated with a higher risk of long-term sequelae (38,39), and other authors consider that although the axonal form of GBS has a longer recovery period compared to the demyelinating forms, there are no long-term differences between them (40,41).…”

“…AMAN is more common in China, but there are also percentage differences between northern and southern China (21)(22)(23). In a study on the pediatric population, also conducted in China, 22% of patients with GBS had AMAN (21), while another study conducted in two centers in France (Toulouse and Montpellier) that included children showed that AMAN was present in 17 of the total 110 patients included in the study (24). In North America and Europe, the AIDP subtype is the most common, and only 5% are axonal subtypes of GBS (25), where the incidence of AMAN subtype is 1-3% (6,7).…”

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“…In the case of Guillain-Barré syndrome (GBS), a rapidly evolving immune-mediated demyelinating polyradiculoneuropathy, axonal involvement is a well-known indicator of poor prognosis [82]. In line with this, CSF NF-L was not only elevated in the acute phase and correlated with disability [2] but was also a strong predictor of persistent disability [12].…”