GUILLAIN-BARRÉ SYNDROME

AUTONOMIC DISTURBANCES IN CHILDREN

Abstract

Objectives: To determine the outcome of autonomic disturbances in children
with Guillain Barre Syndrome. Study Design: Case series study. Setting: Pediatric ICU and
Neurology ward of Nishtar Medical University/hospital Multan. Period: 9th June 2014 to 8th June
2015. Methods: 48 children having age less than 18 years. Clinical examination of central
nervous system was conducted by single examiner to see presence of acute flaccid paralysis
and to detect autonomic dysfunction. Cerebrospinal fluid analysis for albumino-cytologic
dissociation, electromyography and nerve conduction studies was done in every patient of
Guillain Barre Syndrome. Outcome was noted as expired, discharged or LAMA. Results: Mean
age was 5.4 years and male female ratio was 1.2:1. Total 34 children were found to have clinical
evidence of autonomic instability. Among 48 children, 17 children (35.4%) received no therapy,
28 children (58.3%) received Intravenous immunoglobulin (IVIG) therapy, and 3 children (6.3%)
received plasmapheresis. In children with autonomic disturbance, 24 children (70.6%) were
discharged, 8 children (23.5%) expired and 2 children (5.9%) LAMA. Of the total 14 children
without autonomic disturbance, 11 children (78.6%) were discharged, 3 children (21.4%)
expired and no child LAMA (p-value >0.05). Mean duration of stay for patients with autonomic
instability was 130 days versus 63 days in patients without autonomic instability (p-value
<0.005). Demyelination variety was seen in 35 children (72.9%) and axonal degeneration
in 13 children (27.1%). Mortality was high in children who had axonal degeneration but with
insignificant p-value of >0.05. Conclusions: Autonomic instability is common in patients of
GBS and is associated with increased risk of morbidity. Prompt recognition and treatment of
autonomic instability can improve the outcomes of children with GBS.