Clinical, electrophysiological subtypes and antiganglioside antibodies in childhood Guillain-Barré syndrome.
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.


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.


CONCLUSIONS
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.
Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India. meenaak@hotmail.com
Meena A
MA
Kannan
Rathna Kishore
RK
Ch
S A
SA
Jabeen
K Rukmini
KR
Mridula
Pragnya
P
Rao
R
R
Borgohain
D000293:Adolescent; D001323:Autoantibodies / Q000097:blood*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography / Q000379:methods; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D005732:Gangliosides / Q000145:classification / Q000276:immunology*; D020275:Guillain-Barre Syndrome / Q000145:classification / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D009431:Neural Conduction / Q000502:physiology*; D012189:Retrospective Studies; D012621:Seasons; D012737:Sex Factors
D001323:Autoantibodies; D005732:Gangliosides