Factors affecting the outcome of Guillain-Barre syndrome among pediatric patients in Tikur Anbessa Specialized Hospital
Keywords:GBS, factors and treatment outcomes, pediatric patients.
Background: Guillain-BarrÃ© syndrome is an acute immune-mediated polyradiculoneuropathy characterized by progressive weakness and areflexia with a highly variable clinical presentation, course, and outcome. The factors that determine the clinical variation and outcome of GBS are poorly understood and not studied in our setup which complicates the care and treatment.
Objectives: Assessed the factors affecting the outcomes of Guillain-BarrÃ© syndrome (GBS) among children <15 years in Tikur Anbesa Specialized Hospital.
Methods: Institution based analytical cross-sectional study was done among 91 patients with GBS on follow-up identified by chart tracing and reviewed at Tikur Anbesa specialized hospital from October 1/2012 to January 30/2019. Required data were collected using a checklist. The data were entered into a computer using Ep-info and exported to Statistical Package for Social Sciences Version 23 for analysis.
Results: There were 91 patients with a male to female ratio of 1.1:1 and 80 % of them are between 2-10 years of age. Cranial nerve involvement was found in 24/91(26.4 %) and 36/91(39.6%) had dysautonomia. The commonest sub-type was AMAN, 67/91 (73%). Functional independence was achieved by 47/91(52%) at 3 months and 80/91(88%) at 6 months. Poor functional outcome of GBS was significantly associated with the presence of sensory symptoms, dysautonomia, and the need for mechanical ventilation, P < 0.05.
Conclusion: The severity of motor weakness at nadir is associated with a lower likely hood of functional independence and patients with longer hospital stays require a longer time for functional independence.
Min Zhong, Fang-Cheng Cai.Current perspectives on Guillain-BarrÃ© syndrome. World J Pediatr. 2007;3(3);187-194
Hughes RA, Swan AV, Raphael JC, Annane D, van Koningsveld R, van Doorn PA. Immunotherapy for Guillain-Barre syndrome a systematic review. a journal of neurology. 2007; 130(Pt 9):2245â€“57.
Hughes RA, Pritchard J, Hadden RD. Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain-Barre syndrome. The Cochrane database of systematic reviews. 2013; 2
WitschJ, Galldiks N, Bender A, Kollmar R, BÃ¶sel J, Hobohm C, et al. Long-term outcome in patients with Guillain-BarrÃ© syndrome requiring mechanical ventilation. Journal of neurology. 2013; 260 (5):1367â€“7)
Kuwabara S. Guillain-Barre syndrome: epidemiology, pathophysiology and management. Drugs 2004; 64: 597-610.
Sharma B, Paul M. Guillainâ€”Barre Syndrome in 2016: The Centenary Advances Int. J. Med. Public Health, 2016; 6(2):111-2.
TigistBacha, WondemagegneGezahegn, AshenafiTazebew. The clinical presentation, epidemiology, and short term outcome of guillain-barre syndrome in tikuranbessa hospital a 6 year retrospective study. Ethiop Med J, 2018;56
Schmidt-Ott R, Schmidt H, Feldmann S, Brass F, Krone B.Gross U. Improved serological diagnosis stresses the major role of Campylobacter jejuni in triggering Guillain-Barre syndrome. Clin Vaccine Immunol 2006;13:779-783
Ang CW, Jacobs BC, Brandenburg AH, Laman JD, van der Meche FG, Osterhaus AD, et al. Cross-reactive antibodies against GM2 and CMV-infected fibroblasts in Guillain-Barre syndrome. Neurology 2000; 54:1453-1458.
Kieseier BC, Kiefer R, Gold R, Hemmer B, Willison HJ, Hartung HP. Advances in understanding and treatment of immune-mediated disorders of the peripheral nervous system. Muscle Nerve 2004; 30: 131-156.
Hughes RA.The concept and classification of Guillain-Barre syndrome and related disorders. Rev Neurol 1995; 151: 291-294.
Zhang G, Li Q, Zhang R, Wei X, Wang J, Qin X . Subtypes and Prognosis of Guillain- BarrÃ© Syndrome in Southwest China. PL0S ONE. 2015; 10 (7)
WalgaardC, Lingsma H F, Ruts L et al. Early recognition of poor prognosis in Guillin-Barre syndrome. Neurology. 2011; 36(2):123-33.
AkbayamSinan, Dogan Murat, AkgonCihangiret al. Clinical features and prognosis with Guillin-Barre syndrome. Annals of Indian Academy of Neurology Official Journal of Indian Academy of Neurology. 2011;14(2):98-102
Fokke Christian, Berg Ven den Bianca, Drenthen Judith et al. Diagnosis of Guillin-Barre syndrome and validation of brighton criteria. The Oxford University Press A Journal of Neurology. 2014; 137: 33-43.
Jacobs, B. C. et al. International Guillain-BarrÃ© Syndrome Outcome Study (IGOS): protocol of a prospective observational cohort study on clinical and biological predictors of disease course and outcome in Guillain- BarrÃ© syndrome. Journal of the Peripheral Nervous System. 2017; 22(2): 68- 76.
Van Koningsveld R, Steyerberg EW, Hughes RAC, et al. A clinical prognostic scoring system for Guillain-Barre syndrome. Lancet Neurol 2007; 6:589-94.
Walgaard C, Lingsma HF, Ruts L, et al. Prediction of respiratory insufficiency in Guillain-Barre syndrome. Ann Neurol, 2010; 67(6):781-7.
Walgaard C, Lingsma HF, Ruts L, et al. Early recognition of poor prognosis in Guillain-Barre syndrome. Neurology 2011; 76(11):968-75.
Jolanda Van der pijl et al. Acute flaccid paralysis in South African children:causes, respiratory complications and neurological outcome. Journal of pediatrics and childhealth.2017;54(3)
Mahmoud Reza Ashrafi et al. Clinical Short-Term Outcome of GuillainBarrÃ©Syndrome in Children. Iran J pediatr,2008;18(1):11-19
Saroj Kumar Bhagat et al. Clinical Profile, Functional Outcome, and Mortality of Guillain-Barre Syndrome A Five-Year Tertiary Care Experiencefrom Nepal.Neurology Research International,2019; vol 2019(2)
A. Alshekhlee, Z. Hussain, B. Sultan, and B. Katirji. Guillain BarrÂ´e syndrome Incidence and mortality rates in US hospitals. Neurology, 2008; 70(18):1608â€“1613
Asiri S, Altwaijri WA, Ba-Armah D, Al Rumayyan A, Alrifai MT, salam M, Almutairi AF. Prevalence and outcomes of Guillain-BarrÃ© syndrome among pediatrics in Saudi Arabia: a 10-year retrospective study. Neuropsychiatric disease and treatment, 2019;15:627-635