Factors affecting prognosis in childhood Guillain-Barre syndrome

Introduction. Guillain-Barre syndrome (GBS) is the most frequent cause of acute flaccid paralysis in children. The factors that come to bear on its prognosis have not been properly determined in Latin America. Aims. Our aim was to establish the clinical and electrophysiological indicators of GBS in a group of paediatric patients attended in a tertiary care hospital. Patients and methods. We conducted a prospective study involving 67 patients who were hospitalised in the Instituto de Ortopedia Infantil Roosevelt between 1999 and 2002 after having been diagnosed as suffering from GBS. The clinical and electrophysiological characteristics were evaluated during the first month of illness and a clinical follow-up was carried out until the patients reached stage III on Hughes' functional disability scale. Results. Initially, it was observed that the protracted plateau time, the quadriplegia on day 10 of the disease and the electrical non-excitability demonstrated by means of neuroconduction studies were variables linked to a protracted recovery time. Patients with a protracted recovery time required respiratory assistance more often, but this association was not statistically significant. In the Kaplan-Meier survival analysis and the Cox analysis employed to determine the effects of covariance, the presence of quadriplegia associated to electrical non-excitability were identified as significant variables in nine patients who required a longer time to reach Hughes stage III (mean: 172.7 days, 95% confidence intervals: 143.51-202.05). Patients with excitable motor nerves and without quadriplegia reached functional stage III more quickly (mean: 39.51 days, 95% confidence intervals: 25.79-53.24). Conclusions. Children with GBS who display non-excitable motor nerves and quadriplegia on day 10 of the illness are the group with the poorest prognosis and have a very long motor recovery time.