Electrophysiological Patterns of Guillain Barre Syndrome in Iraqi Children...A Hospital Based Study

Abstract

ABSTRACT:BACKGROUND:Guillain-Barre syndrome (GBS) is an acute idiopathic progressive ascending weakness and considered the most common cause of acute flaccid paralysis in healthy infants and children. It is now known to be a heterogeneous syndrome with several variant forms. In addition to the demyelinating form, which is the most common type, axonal forms of GBS are now well recognized.OBJECTIVE:To estimate frequency, demographics, clinical characteristics and complications of GBS subtypes from nerve conductive study (NCS) and electromyography (EMG) in patients were admitted to Children Welfare Teaching Hospital.PATIENTS& METHODS:Fifty three children with GBS admitted to Children Welfare Teaching Hospital Medical City-Baghdad from January 2009 till August 2010 was enrolled in this study. Clinical data were obtained; electrophysiological studies (NCS, EMG) were performed to determine GBS subtypes.RESULT:Out of 53 children studied, eleven patients (20.6%) were diagnosed as axonal subtype and 42 (79.4%) were of demyelinating subtype.Axonal subtype was more frequent in rural than urban (8/11 patients 72.7% and 3/11 patients 27.3% respectively), where as demyelinating subtype was more frequent in urban residency compared to rural area (33/42 patients 78.6% and 9/42 patients 21.4% respectively) with a P value=0.0025.Although gastroenteritis was higher in axonal subtype (3/11 patients 27.3%) compared to only (5/42 patients, 11.9%) in demyelinating subtype, it did not reach the statistical significant. History of upper respiratory tract infection was reported more in demyelinating compared to axonal subtype (25/42 patients 59.6% and 3/11 patients 27.7% respectively).Cranial nerve involvement was found in 8 patients (72.7%) of the axonal subtype while it was found in 24 patients (57.1%) of demyelinating subtype.Respiratory failure was reported as complication in 4 patients (36.4%) of axonal subtype, compared to 7 patients (16.7%) of demyelinating subtype. Ventilator support was recorded in 3 patients (27.3%) of axonal, compared to only 1 patient (2.4%) in demyelinating subtype (p value=0.024).CONCLUSION:The demyelinating subtype was the predominant type of GBS followed by the axonal. Gastroenteritis was the predominant recorded antecedent event in axonal subtype and more frequent in rural residency. Cranial nerves involvement was reported more frequently in axonal subtype and has been a significant factor for future assisted ventilation..