Abstract
Acute Flaccid Paralysis (AFP) is a complex clinical syndrome with broad array of potential etiologies and clinical features. The incidence of polio acute flaccidparalysis (AFP) has decreased in India but the non-polio AFP (NPAFP) rate has increased since 2000.It is useful to distinguish the possible causes of AFP in children using a neuro-anatomical approach. The accurate and early diagnosis of the cause is very important while managing the cases of AFP. This study is prospective and retrospective observational study. The objectives of our study were to study clinical features and etiology of AFP cases in children under 15 years age group.50 children under 15 years age group admitted in the tertiary care hospital from 2014 to 2018 with acute onset focal neurological weakness or paralysis were included in this study. Most common age group affected was 3 to 8 years (44%). Guillain-Barré syndrome (GBS) was the most frequent final diagnosis (78%) followed by Bell’s palsy (8%), Transverse Myelitis (6%), Traumatic Neuritis (4%) and others (4%). NCV studies revealed Acute Inflammatory Demyelinating Polyneuropathy (AIDP) as most common variant (38%) of GBS followed by Acute Motor Axonal Neuropathy (AMAN-31%) and Acute Motor Sensory Axonal Neuropathy(AMSAN-10%).51% cases of GBS had history of antecedent infection while 54% cases had cranial nerveinvolvement.CSF cytoalbumino dissociation was seen in only in 11% cases of GBS. This study concluded that GBS was the most common cause of AFP and AIDP was the most common variant of GBS.
References
- Saraswathy TS, Zahrin HN, Apandi MY, Kurup D, Rohani J, Zainah S, Khairullah NS. Acute flaccid paralysis surveillance: looking beyond the global poliomyelitise-radication initiative. Southeast Asian J Trop Med Public Health. 2008 Nov1;39(6):1033-9
- Vashisht N, Puliyel J, Sreenivas V. Trends in nonpolio acute flaccid paralysis incidence in India 2000 to 2013. Pediatrics. 2015 Feb 1;135(Supplement1): S16-7
- Ahmad A, Rehman A. one year surveillance data of acute flaccid paralysis at Bahawal Victoria Hospital Bahawalpur. PAKISTAN JOURNAL OF MEDICAL SCIENCES. 2007 Apr 1;23(3):308
- Jones Jr HR. Topical Review: Childhood Guillain-Barré Syndrome: Clinical Presentation, Diagnosis, and Therapy. Journal of Child Neurology. 1996 Jan;11(1):4-12.
- Hughes RA, Rees JH. Clinical and epidemiologic features of Guillain-Barré syndrome. Journal of Infectious Diseases. 1997 Dec 1;176(Supplement_2):S928.
- Andrus JK, De Quadros C, Olivé JM, Hull HF. Screening of cases of acute flaccid paralysis for poliomyelitis eradication: ways to improve specificity. Bulletin of the World Health Organization. 1992;70(5):591.
- Olivé JM, Castillo C, Castro RG, de Quadros CA. Epidemiologic study of Guillain-Barré syndrome in children< 15 years of age in Latin America. The Journal of infectious diseases. 1997 Feb 1;175(Supplement_1):S160-4
- Hızarcıoğlu M, Gülez P, Ünalp A, Gülhan T, Uran N. Early-onset acute partialtransverse myelitis: case report. İzmir Dr.Behçet Uz ÇocukHastanesi Dergisi.2013;3(2):133-7.
- Anis-ur-Rehman IM, Elahi M, Jamshed AA. Guillain Barre syndrome: Theleading cause of acute flaccid paralysis in Hazara division. J Ayub Med CollAbbottabad. 2007;19(1):1.
- Atassi MZ, Casali P, Atassi MZ, Casali P. Molecular mechanisms of autoimmunity. Autoimmunity. 2008 Jan 1; 41(2):123-32.
- Tekgul H, Serdaroglu G, Tutuncuoglu S. Outcome of axonal and demyelinating forms of Guillain-Barré syndrome in children. Pediatric neurology. 2003 Apr1;28(4):295-9.
- Nomani AZ, Iqbal M, Majeed H, Badshah M, Nabi S, Jan Z, Jamil U. Albuminocytological dissociation in different electrophysiological gbs variants. Pakistan Journal of Neurological Sciences (PJNS). 2015;10(4):32-6.
- Yadegari S, Nafissi S, Kazemi N. Comparison of electrophysiological findingsin axonal and demyelinating Guillain-Barre syndrome. Iranian journal ofneurology. 2014 Jul 4;13(3):138.
- Sharma KS, Singh R, Shah GS. Guillain Barre Syndrome: Major Cause of Acute Flaccid Paralysis in Children and Adolescents of Nepal. Journal of Nepal Paediatric Society. 2011 May 1;31(2).
- Löffel NB, Rossi LN, Mumenthaler M, Lütschg J, Ludin HP. The Landry Guillain-Barré syndrome: Complications, prognosis and natural history in 123 cases. Journal of the neurological Sciences. 1977 Aug 1;33(1):71-9.
- Dhadke SV, Dhadke VN, Bangar SS, Korade MB. Clinical profile of Guillain Barre syndrome. J Asso Physicians India. 2013 Mar;61:168-72.
- Alshekhlee A, Hussain Z, Sultan B, Katirji B. Guillain–Barré syndrome: incidence and mortality rates in US hospitals. Neurology. 2008 Apr29;70(18):1608-13.
- Taly AB, Gupta SK, Vasanth A, Suresh TG, Rao U, Nagaraja D, Swamy HS,Rao S, Subbakrishna DK. Critically ill Guillain Barre syndrome. The Journal ofthe Association of Physicians of India. 1994 Nov;42(11):871-4.
- Nomani AZ, Iqbal M, Majeed H, Badshah M, Nabi S, Jan Z, Jamil U. Albuminocytological dissociation in different electrophysiological gbs variants. Pakistan Journal of Neurological Sciences (PJNS). 2015;10(4):32-6.
- Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain‐Barré syndrome. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 1990;27(S1): S21-4.
Corresponding Author
Dr Tejasi L. Sawant
Resident Doctor, Grant Govt Medical College& Sir JJ Group of hospitals, Mumbai
DOI: https://dx.doi.org/10.18535/jmscr/v7i7.173
