Use of immunoglobulin in severe childhood Guillain-Barre syndrome

Objectives- To compare the clinical results in children with Guillain-Barre syndrome (GBS) admitted to the intensive care unit. Patients treated with intravenous immunoglobulin (IVIg) were compared with patients admitted before the immunoglobulin treatment was introduced. Design- Study of historical cohorts. Methods- The outcome of the children who did not receive IVIg before 1993 was compared with those children who received immunoglobulin treatment from this year until 2002. The days of ventilatory support and the time it took to reach state III on the GBS disability scale were used as measures of outcome. Age, muscular strength, cranial nerve palsy and the electrophysiological classification were the independent variables. Results- In all, 48 of 96 children were classified - 18 patients as axonal motor acute neuropathy (AMAN) and 30 patients as axonal inflammatory demyelinating polyneuropathy (AIDP). For both groups the analysis showed similar results behavior when comparing the outcome of patients with or without immunoglobulin treatment. A high proportion of patients with unexcitable nerves was found in the group with immunoglobulin treatment. Quadriplegia and the presence of unexcitable motor nerves were associated with a longer period of recovery. Conclusions- Immunoglobulin did not change the history of the illness as far as the time of ventilatory support in AMAN and AIDP groups is concerned and the time to reach state III on the GBS disability scale.