Rare Clinical Presentation in a Case of Pediatric Guillain-Barré Syndrome and Rehabilitation Outcome

Abstract

Nearly half of patients with Guillain-Barré syndrome (GBS) have cranial nerve involvement. Ocular muscle weakness or ophthalmoplegia occurs in ~10% of these patients. Patients presenting with bilateral ptosis, with or without ophthalmoplegia, is a rare finding. Anti-GQ1b antibody has been found in Miller Fisher syndrome and GBS with ophthalmoplegia variants. We report a case of GBS in a young boy presenting with rare presentation of tetraplegia, bilateral ptosis, and facial palsy, no ataxia but ophthalmoplegia with seronegative anti-GQ1b antibody. Patient showed recovery in cranial nerves involvement as well as with motor and functional recovery after 3 weeks of inpatient rehabilitation (Barthel Index score improved to 60/100 at the time of discharge from 20/100 at the time of admission). He was independent for most of the activity of daily livings including ambulation at the time of discharge from rehabilitation unit (p < 0.001).

Benefit of inpatient rehabilitation care in management of acute demyelinating syndrome in children

“…By the time of discharge, patient scored 20 on AM-PAC indicating 36% impairment, which was 41% improvement from admission. Sharma et al [35] reported a case report of 7 year old boy with normal birth and development associated with no prior illness presented with tetroplgia, facial palsy and opthamoplegia with posies and sernegative anti-GQ1b antibody was started on intravenous immunoglobulin showed inadequate response and referred for inpatient rehabilitation. Rehabilitation was focused with goal to prevent complication and maximize Functional ability.…”