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Clinical, electrophysiological subtypes and antiganglioside antibodies in childhood Guillain-Barré syndrome
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Clinical, electrophysiological subtypes and antiganglioside antibodies in childhood Guillain-Barré syndrome
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Journal Article
Clinical, electrophysiological subtypes and antiganglioside antibodies in childhood Guillain-Barré syndrome
2012
Overview
Background: Guillain-Barré syndrome (GBS) has been the most common
cause of flaccid paralysis in children after the decline in the
incidence of poliomyelitis. There are not any published data from the
Indian subcontinent documenting electrophysiological patterns and
antiganglioside antibodies in pediatric GBS. Materials and Methods: The
study population included children with GBS referred for
electrodiagnostic evaluation and also children with GBS admitted to our
institute between August 2006 and July 2007. Nerve conduction studies
were done to determine GBS subtypes and serum antiganglioside
antibodies were measured using enzyme-linked immunosorbent assay
(ELISA). Clinical and electrophysiological features were correlated
with antiganglioside antibody results. Results: Of the 43 (male to
female ratio = 2.1:1) children studied, 97.6% had motor weakness, 76.7%
had cranial nerve palsies, 13.9% had autonomic disturbances and
respiratory paralysis was found in 9.3% children. Antecedent illness
was recorded in 69.8% children. The GBS subtype distribution was as
follows: acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
in 21 (48.8%), acute motor axonal neuropathy (AMAN) in 19 (44.2%), and
3 (6.9%) children were unclassified. The severity of illness was
similar in both AMAN and AIDP subtypes and the recovery in both the
subtypes was complete without any significant difference in the
duration of recovery. Preceding diarrheal illness was more common in
AMAN subtype as compared to AIDP subtype (57.9% vs. 4.7%, P = 0.007).
Sensory symptoms were more common in AIDP subtype than in AMAN subtype
(66.6% vs. 21%, P = 0.03}. The commonest ganglioside antibody was IgM
GM2. Anti GM3 antibodies were exclusively seen in children with AMAN
and IgG GD1b was significantly associated with (36.7 vs. 4%; P = 0.007)
AMAN subtype. IgG GT1b was identified in 50% of patients with AIDP as
compared to 22.7% in patients with AMAN. Conclusion: In this study,
AMAN subtype accounted for a significant proportion of pediatric GBS.
AMAN was associated with diarrhea and specific antiganglioside
antibodies. Recovery in children with GBS was complete, irrespective of
the subtype.
Publisher
Medknow Publications on behalf of the Neurological Society of India
