Abstract

Objective: To assess retrospectively the clinical profile, nerve conduction velocity studies and outcome of Guillian Barre Syndrome (GBS) in children.

Materials and Methods: The clinical and electrophysiological data of 184 children, who attended Kalawati Saran Children Hospital from Jan 2001 to Sept 2005 and were diagnosed as GBS based on Asbury-Cornblath criteria, were analyzed in the study. Severity of weakness was graded according to Hughes staging. Outcome was determined according to the functional recovery and independent ambulation. It was assessed in follow up at 1 month, 3 months and 6 months after the onset.

Results: A total of 184 patients were diagnosed as GBS during the study period, with an age range from 1-to15 yrs. (Mean-4.99_+ 2.95). Of this 37.4 % of cases were less than 3 years of age. There was a male preponderance with 71.7% of them being males. Seasonal preponderance was evident in more than 50% cases, developing the disease in summer season (May to Aug). Acute respiratory infections in 39/101 (38.61%) were the most common antecedent event followed by diarrhoea in 16/101(15.84%) and others (1-Tuberculosis, 1-measles, 2-skin infection). The most common symptom at the time of presentation was limb weakness, which was seen in all patients, followed by pain/paraesthesia in 31% and respiratory symptoms in 10% of the patients. Bulbar weakness was the most common type of cranial nerve involvement seen in 13%of them. Majority of the patients 140/184(76.08%) presented in stage IV {a-57 (40.71%), b-83 (59.28%)} followed by 29/184(15.76%) in stage III. Respiratory system involvement in the form of respiratory distress with potential respiratory failure was present in 33/184(18.08%), of which 19 (10.32%) patients required ventilator support. Cerebrospinal fluid (CSF) studies could be conducted in 31% of the patients who were admitted in the hospital and 70% of them showed some elevation of protein and cells in the CSF. Nerve conduction study (NCV) could be done only in 94/184(51.09%) patients and demyelination was the commonest finding in 51/94(54.26%). There were total 14(18.42%) deaths among the 76 patients who were admitted in the hospital and the commonest cause for death was respiratory failure. Seventy- nine cases were examined at 1 month out of which 51.89% were ambulatory with/ without support, 65% patients were seen at 3 month of which 50.42% recovered completely and 26.05% were ambulatory with minimum deficit. At 6 months follow-up, only 26 patients reported back, of which 15 (57.70%) had full recovery and rest of them were in the favorable group (100%) i.e. in stage III or less.

Conclusion: The most common symptom at the time of presentation was limb weakness. Respiratory system involvement was seen in only 18 % of the patients and only 10% of them required ventilator support. Seventy percent of the patients in whom CSF study was done showed elevation of proteins. Demylination was the commonest finding in nerve conduction study.  Outcome is good with general supportive care.