Ten-Year Prospective Study (Clinical Spectrum) of Childhood Guillain-Barré Syndrome in the Arabian Peninsula: Comparison of Outcome in Patients in the Pre— and Post—Intravenous Immunoglobulin Eras

Abstract

A prospective study of Guillain-Barré syndrome from January 1992 to December 2001 was undertaken. Intravenous immunoglobulins were used in all patients. All patients were followed up until complete recovery. Various parameters, such as onset of weakness, duration of hospital stay, ventilation requirement, residual deficit, and mortality, were recorded. Acute relapses and fluctuations were also noted. The pattern of this group was compared with patients before 1992, who were not given intravenous immunoglobulins in the Sultanate of Oman. Our data were compared with a few studies prior to 1992 from the medical literature. Our study revealed a definite benefit with intravenous immunoglobulins. The disease course and hospital stay were shortened. Fewer patients needed ventilation. There was no mortality, and the residual deficit was less than 5%. Occasional relapses at a later stage in the course of illness have been noted in acute Guillain-Barré syndrome. However, acute relapse, a new phenomenon that was not seen in the pre-intravenous immunoglobulin era, stood at 11.9%. Intravenous immunoglobulins have made a significant difference in the outcome of Guillain-Barré syndrome, but one has to be aware of acute relapses, which usually occur in the first 2 to 3 weeks after administration.

Prospective study of children with Guillain-Barre syndrome

“…16 At the same time the mean hospital stay in the IVIG group was markedly reduced, though the range was not different. Complete recovery was also faster in terms of both mean time and longest time in the IVIG group.…”

“…11,12,13 However, there are few reports with an unfavorable response to IVIG. 14,15,16 Plasmapheresis was done in two of our patients who failed to respond to IVIG and needed ventilation. Although some authors advocate that plasmapheresis is superior to IVIG in severe cases, 15 many studies favour IVIG, 11,12,13 based on the fact that the group who underwent plasmapheresis had higher relapse rate as compared to the IVIG group.…”

Clinical features and prognosis with Guillain-Barré syndrome

“…[7] Since the first report of GBS in childhood by Mannier-Vinard in 1925, showing an incidence of 0.24–1.26 per 100,000 children under 15 years of age,[9] the age-specific incidence was 1.26 in 100,000 in the 1–4 years age group and 0.24 in 100,000 in the 5–9 years age group. [12] GBS has a worldwide distribution and affects all races and all ages, including the newborn.…”

“…The diagnosis of acute GBS was based on the following criteria: An acute progressive symmetric weakness of the extremities with areflexia or hyporeflexia, CSF showing albuminocytological dissociation and electrophysiology revealing features of demyelinating/axonal neuropathy. [9] Albuminocytological dissociation was defined as CSF with raised protein and total cell count of ≤10/mm 3 .…”

Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms

“…Pediatric studies of IVIG (2 g/kg divided over 2 or 5 days) are limited but suggest benefit [25]. One multicenter randomized study from Western Europe found that early treatment with IVIG was associated with earlier motor recovery [31]. Other studies show that IVIG was no better than supportive care, although the time from symptom onset to maximum symptom severity was shorter in patients who received IVIG within 10 days than patients who did not receive IVIG [32].…”