Guillain Barre Syndrome: Major Cause of Acute Flaccid Paralysis in Children and Adolescents of Nepal.
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Date
2011-05
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Abstract
Introduction. Guillain Barre Syndrome (GBS) is a post infectious polyneuropathy involving mainly motor
but sometimes sensory and autonomic nerves. It is an acquired disease of the peripheral nerves that is
characterized by rapidly progressing paralysis, areflexia and albumino-cytological dissociation in CSF.
Methodology: Prospective, descriptive, observational, hospital based study was carried out to find out
the clinico-epidemiological features of GBS including existing treatment modalities and its outcome.
All cases fulfilled the criteria for AFP (Acute flaccid Paralysis) surveillance was included. Cases were
reviewed for full medical history and examinations. To confirm the diagnosis, necessary investigations
were carried out and combined with clinical symptoms. Results: Thirty patients were included in the
study during study period. Among them 90% were diagnosed as GBS, 7.4% patients of GBS were
associated with hypokalemic paralysis, 7.4% diagnosed as transverse myelitis and 3.7% diagnosed as
idiopathic neuropathy. Different types of GBS were classified as AIDP (Acute inflammatory demyelinating
polyneuropathy) 62.96%, AMAN (Acute motor axonal neuropathy) - 25.52%, AMASAN (Acute motor and
sensory axonal neuropathy) - 3.3% and MFS (Miller fisher’s syndrome) - 6.6% according to NCV result.
Male female ratio is 1.7:1.0. There was 14.8% patients had relapse within 5 year. Associated diseases
were URTI, pneumonia, sore throat and diarrhea. Facial Nerve palsy was commonest cranial nerve
involvement.Sixty percentage of patients presented with sensory symptoms. There was transient bowel
and bladder involvement in 20% of the cases. 69.2% patients became bed ridden at the nadir. There was
albumin-cytological dissociation in 80% case. Majority of patients improved with supportive treatment
alone, 19.5% patient required ventilator support among them 40% died. 7.4% of cases expired during
treatment. Half of the patients fully recovered within 3 months. Conclusion: GBS is the commonest cause
of AFP, AIDP being commonest subtype in our setting. We have to improve our existing treatment facilities
and extend to different centers to detect and treat GBS. Most of the patients improve with supportive
treatment alone. Ventilator support indicates grave prognosis.
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Keywords
GBS (Gullein Barre Syndrome), AFP (Acute flaccid Paralysis), AIDP (Acute inflammatory demyelinating polyneuropathy, AMAN (Acute motor axonal neuropathy), AMASAN (Acute motor and sensory axonal neuropathy),, MFS (Miller fisher’s syndrome)
Citation
Sharma K S, Singh R, Shah G S. Guillain Barre Syndrome: Major Cause of Acute Flaccid Paralysis in Children and Adolescents of Nepal. Journal of Nepal Paediatric Society. 2011 May-Aug; 31(2): 93-97.