Clinical profile, electrophysiological pattern and predictors of short-term outcome of Guillain-Barré syndrome in children

Abstract

Background: Guillain-Barré syndrome (GBS) is a rare but potentially life-threatening immune-mediated disorder affecting peripheral nerves, causing acute flaccid paralysis with variable clinical severity. Its diverse presentation and disease course make diagnosis, management, and prognostication difficult, particularly in children. This study aimed to assess the clinical profile, electrophysiological pattern, and predictors of short-term outcomes in pediatric GBS. Methods: This observational study was conducted at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh, from September 2018 to August 2019. A total of 93 children diagnosed with GBS were enrolled by consecutive sampling. Clinical characteristics, electrophysiological findings, treatment modalities, and short-term functional outcomes were analyzed. Outcome was assessed after 3 months of follow-up. Results: Children aged 5-10 years were most commonly affected, with a male-to-female ratio of 1.7:1. Quadriparesis was the predominant presentation (87.1%), while 19.4% required mechanical ventilation. Electrophysiological studies showed acute motor axonal neuropathy (AMAN) in 65.6%, acute inflammatory demyelinating polyneuropathy (AIDP) in 31.2%, and acute motor-sensory axonal neuropathy (AMSAN) in 3.2% of cases. Patients receiving intravenous immunoglobulin with supportive care had shorter hospital stays than those receiving supportive care alone. At 3 months, 41.9% achieved favorable functional recovery (GBS disability grade 0-2), with no mortality recorded. Poor outcome was significantly associated with quadriplegia, bulbar involvement, neck flexor weakness, low baseline Medical Research Council score, and need for mechanical ventilation. Conclusions: Quadriplegia, bulbar involvement, neck flexor weakness, poor baseline muscle strength, and mechanical ventilation requirement are significant predictors of poor short-term functional outcomes in pediatric GBS.