Guillain–Barré syndrome in children: clinical and diagnostic features

Introduction. In 2025, we will commemorate the 100^th anniversary of the first pediatric case of Guillain–Barré Syndrome (GBS), initially documented by M. Monnier-Vinard. This significant milestone invites a reevaluation of our contemporary understanding of GBS in children. While the original description of GBS was thorough, the categorization has expanded over time to include a wider array of conditions, resulting in the term applied to various acute demyelinating polyneuropathies. The atypical forms of GBS present notable diagnostic challenges for healthcare providers.

Objective. To analyze the demographic and clinical characteristics, treatment methods, and prognosis of GBS in children in Russia.

Materials and methods. The study included fifty 6 months – 15 years patients with typical and atypical forms of Guillain-Barré syndrome (GBS). Neurological status was assessed using the Medical Research Council sum score and the Hughes disability scale. Additionally, data from cerebrospinal fluid analysis, nerve conduction study, magnetic resonance imaging of the spine, and peripheral nerves ultrasound was evaluated.

Results. The classic ascending subtype of GBS was diagnosed in 30 (60%) patients, while atypical manifestations were observed in 17 (34%). Three (6%) patients had an overlap syndrome: GBS with acute myelitis. The median age of the patients was 7 [5.0; 11.0] years. Two peaks of GBS incidence associated with respiratory and gastrointestinal infections were identified. The most common initial symptoms were pain (80%), weakness in the legs (64%), and difficulty walking (54%). All 26 (100%) GBS patients were followed for 12 months from the onset of the disease regained the ability to walk.

Conclusion. Both typical and atypical forms of GBS can occur in children. Overlap syndrome (GBS with acute myelitis) is a rare complication following COVID-19 and may go undiagnosed. With appropriate therapy the prognosis for both typical and atypical forms of GBS is generally favourable.

Compliance with ethical standards. The study was conducted as part of the research project “Dysimmune Polyneuropathies in Children: Clinical and Diagnostic Features and Prognosis,” approved by the Ethics Committee (Protocol No. 192 dated January 27, 2020) of the Pirogov Russian National Research Medical University.

Contribution:
Kozyreva A.A. — concept, research design, research coordination, material collection and data processing, review of publications on the topic, text writing, article editing;
Bembeeva R.Ts. — concept, research design, text writing, article editing;
Druzhinina E.S. — text writing, article editing, peripheral nerve ultrasound and nerve conduction studies;
Shakaryan А.К. — material collection, article editing;
Guseva G.D. — material collection, article editing;
Besedin S.G. — material collection, article editing;
Zavadenko N.N. — concept, research design, research coordination, article editing.
All co-authors are responsible for the integrity of all parts of the manuscript and approval of its final version.

Acknowledgements. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 1, 2024
Accepted: November 11, 2024
Published: January 31, 2025

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