Guillain Barre Syndrome: A clinical observational study in Indian paediatric patients

Background: Guillain Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis (AFP) after nationwide poliomyelitis eradication measures in India. AFP surveillance has increased the detection of cases. New modalities of management such as artificial ventilation and intravenous immunoglobulin (IVIG) are expected to increase survival of GBS patients.

Objective: To study the clinical presentation, prognostic factors and outcome in GBS patients admitted to a tertiary care centre in Gujarat, India.

Method: A prospective observational study was carried out in a tertiary care centre in Gujarat, India. All paediatric patients with symmetrical onset of weakness, flaccid paralysis and hyporeflexia, admitted to the centre from March to October 2013, were included in the study. Patients with asymmetric weakness, isolated cranial nerve involvement and upper motor signs were excluded. A detailed clinical history was taken and a systemic examination was done. Nerve conduction velocity (NCV) study was carried out. All patients received IVIG and other supportive measures. Accumulated data were compared to other similar studies.

Results: Eighteen paediatric GBS patients were enrolled during the study period. An equal incidence of the disease was seen in all age groups. Males were more commonly affected. Antecedent infection was seen in 38%. Upper respiratory tract infection and fever were the most common. Most (66.7%) patients presented with weakness in both upper and lower limbs. Mortality in our study was 22%. Some prognostic factors such as demyelination NCV study was seen in half of the expired patients. The greater the age the poorer was the prognosis. Patients with involvement of both upper and lower limbs at the time of admission had a poorer prognosis than those with involvement of only lower limbs.

Conclusions: In our study antecedent infection was seen in 38% of patients. There was a 22% mortality and demyelination NCV study was seen in 50% of the expired patients. The prognosis was poorer in the older age groups. Patients with quadriparesis had a poorer prognosis than those with paraparesis. 

Sri Lanka Journal of Child Health, 2017; 46(3): 238-242