[Prognostic factors for walking in childhood Guillain-Barré syndrome]

Abstract

Aims: The purpose of this study was to evaluate the clinical and electrophysiological variables that are linked to prognosis in Guillain Barre syndrome (GBS) in children.

Patients and methods: A retrospective cohort study was conducted on 99 children admitted to hospital after being diagnosed as suffering from GBS over a 3 year period. The time before reaching functional grade III on the Hughes scale was taken into account for the outcome, and the following factors were considered to be prediction variables: the electrical excitability of the motor nerves, the need for assisted ventilation, the presence of dysautonomia, age, the degree of maximum weakness on day 10 after the onset of the disease, cranial nerve involvement and origin (town or country).

Results: Patients with an excitable pattern, i.e. the presence of an electrical response in at least one of the three motor nerves, at the onset of the disease reached functional grade III on Hughes scale 3.55 times (CI 95% 1.5 6.0) quicker than individuals with a non excitable pattern after adjusting the variable with the strength of the quadriceps and a electromyography study that revealed signs of denervation in the anterior tibial muscle. The clinical variable associated with a favourable prognosis was the presence of any kind of muscular activity in the quadriceps (muscular strength between 1 and 5), regardless of different degrees of strength. Thus, patients with some muscular activity in the quadriceps on day 10 after the onset of the disease reached functional grade III 3.6 times (CI 95% 1.8 7.1) quicker than those who did not present any activity (muscular strength= 0). No differences were found in the time the two physiopathological types, acute axonal neuropathy and demyelinating polyneuropathy, required to reach Hughes grade III.

Conclusion: The absence of electrical excitability in the motor nerves and the absence of muscular activity in the quadriceps on day 10 of the disease are factors that are independently related to a prolonged recovery time in children with GBS.