eMedicine Specialties > Neurology > Pediatric Neurology

Guillain-Barre Syndrome in Childhood: Follow-up

Author: Brian S Tseng, MD, PhD, Assistant Professor, Department of Neurology, Division of Pediatric Neurology, Harvard Medical School, Massachusetts General Hospital
Coauthor(s): Jennifer A Markowitz, MD, Fellow in Neuromuscular Disease, Massachusetts General Hospital and Brigham and Women's Hospital
Contributor Information and Disclosures

Updated: Sep 18, 2008

Follow-up

Further Inpatient Care

  • Careful attention should be paid to multiple issues that may require intervention and specialist consultation. Among the concerns of Guillain-Barré syndrome (GBS) comorbidities are cardiorespiratory function, nutrition, urinary retention, decubitus ulcers, constipation, gastritis, dysesthesias/pain, mood and anxiety issues, iatrogenic infectious complications, and contractures in patients who are severely ill or who have a particularly prolonged course.
  • In the long term, physical therapy may provide benefit to patients during the recovery phase of the illness.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Respiratory compromise is the most concerning and life-threatening aspect of GBS in childhood. Recognition of early respiratory distress signs is absolutely vital. In the absence of respiratory distress signs in an outpatient scenario, giving appropriate instructions to patient families for "return criteria" to the emergency department is paramount.
  • The challenge of GBS is the potential for progression from mild gait disturbance to the need for intubation for respiratory support. Many cases of childhood GBS will not require intubation but one cannot be certain without close observation and time. There are not clear early markers to stratify a child's risk of respiratory failure.
  • As an inpatient, care should be to taken to monitor respiratory and cardiac function, especially in the acute, progressive stage of the disease.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Kenneth J Mack, MD, PhD, to the development and writing of this article.



More on Guillain-Barre Syndrome in Childhood

Overview: Guillain-Barre Syndrome in Childhood
Differential Diagnoses & Workup: Guillain-Barre Syndrome in Childhood
Treatment & Medication: Guillain-Barre Syndrome in Childhood
Follow-up: Guillain-Barre Syndrome in Childhood
References
[ CLOSE WINDOW ]

References

  1. Nachamkin I, Barbosa PA, Ung H, Lobato C, Rivera AG, Rodriguez P. Patterns of Guillain-Barre syndrome in children: results from a Mexican population. Neurology. Oct 23 2007;69(17):1665-71. [Medline].

  2. Korinthenberg R, Schessl J, Kirschner J. Clinical presentation and course of childhood Guillain-Barré syndrome: a prospective multicentre study. Neuropediatrics. Feb 2007;38(1):10-7. [Medline].

  3. Shafqat S, Khealani BA, Awan F, Abedin SE. Guillain-Barré syndrome in Pakistan: similarity of demyelinating and axonal variants. Eur J Neurol. Jun 2006;13(6):662-5. [Medline].

  4. Nishimoto Y, Susuki K, Yuki N. Serologic marker of acute motor axonal neuropathy in childhood. Pediatr Neurol. Jul 2008;39(1):67-70. [Medline].

  5. Schessl J, Koga M, Funakoshi K, Kirschner J, Muellges W, Weishaupt A, et al. Prospective study on anti-ganglioside antibodies in childhood Guillain-Barré syndrome. Arch Dis Child. Jan 2007;92(1):48-52. [Medline].

  6. Abd-Allah SA, Jansen PW, Ashwal S, Perkin RM. Intravenous immunoglobulin as therapy for pediatric Guillain-Barre syndrome. J Child Neurol. Sep 1997;12(6):376-80. [Medline].

  7. Bradshaw DY, Jones HR. Guillain-Barre syndrome in children: clinical course, electrodiagnosis, and prognosis. Muscle Nerve. Apr 1992;15(4):500-6. [Medline].

  8. Bril V, Ilse WK, Pearce R, et al. Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain-Barre syndrome. Neurology. Jan 1996;46(1):100-3. [Medline].

  9. Delanoe C, Sebire G, Landrieu P, et al. Acute inflammatory demyelinating polyradiculopathy in children: clinical and electrodiagnostic studies. Ann Neurol. Sep 1998;44(3):350-6. [Medline].

  10. DiMario FJ. Intravenous immunoglobulin in the treatment of childhood Guillain-Barre syndrome: a randomized trial. Pediatrics. Jul 2005;116(1):226-8. [Medline].

  11. England JD. Guillain-Barré syndrome. Annu Rev Med. 1990;41:1-6. [Medline].

  12. Epstein MA, Sladky JT. The role of plasmapheresis in childhood Guillain-Barre syndrome. Ann Neurol. Jul 1990;28(1):65-9. [Medline].

  13. Gorson KC, Ropper AH, Muriello MA, Blair R. Prospective evaluation of MRI lumbosacral nerve root enhancement in acute Guillain-Barre syndrome. Neurology. Sep 1996;47(3):813-7. [Medline].

  14. Griffin JW, Li CY, Ho TW, et al. Guillain-Barre syndrome in northern China. The spectrum of neuropathological changes in clinically defined cases. Brain. Jun 1995;118 (Pt 3):577-95. [Medline].

  15. Griffin JW, Li CY, Ho TW, et al. Pathology of the motor-sensory axonal Guillain-Barre syndrome. Ann Neurol. Jan 1996;39(1):17-28. [Medline].

  16. Ho TW, Li CY, Cornblath DR. Patterns of recovery in the Guillain-Barre syndromes. Neurology. 1997;48:695-700. [Medline].

  17. Ho TW, Mishu B, Li CY. Guillain-Barre syndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain. Jun 1995;118 (Pt 3):597-605. [Medline].

  18. Hughes RA. Ineffectiveness of high-dose intravenous methylprednisolone in Guillain-Barre syndrome. Lancet. Nov 2 1991;338(8775):1142. [Medline].

  19. Hughes RA, Rees JH. Clinical and epidemiological features of Guillain-Barre syndrome. J Infect Dis. 1997;176:S92-8. [Medline].

  20. Hung PL, Chang WN, Huang LT, et al. A clinical and electrophysiologic survey of childhood Guillain-Barre syndrome. Pediatr Neurol. Feb 2004;30(2):86-91. [Medline].

  21. Jones HR. Childhood Guillain-Barre syndrome: clinical presentation, diagnosis and therapy. J Child Neurol. 1996;11:4-12. [Medline].

  22. Korinthenberg R, Monting JS. Natural history and treatment effects in Guillain-Barre syndrome: a multicentre study. Arch Dis Child. Apr 1996;74(4):281-7. [Medline].

  23. Korinthenberg R, Schessl J, Kirschner J, Monting JS. Intravenously administered immunoglobulin in the treatment of childhood Guillain-Barre syndrome: a randomized trial. Pediatrics. Jul 2005;116(1):8-14. [Medline].

  24. Koul R, Chacko A, Ahmed R, et al. Ten-year prospective study (clinical spectrum) of childhood Guillain-Barre syndrome in the Arabian peninsula: comparison of outcome in patients in the pre- and post-intravenous immunoglobulin eras. J Child Neurol. Nov 2003;18(11):767-71. [Medline].

  25. Lamont PJ, Johnston HM, Berdoukas VA. Plasmapheresis in children with Guillain-Barre syndrome. Neurology. Dec 1991;41(12):1928-31. [Medline].

  26. Marks HG, Augustyn P, Allen RJ. Fisher's syndrome in children. Pediatrics. Nov 1977;60(5):726-9. [Medline].

  27. McCarthy N, Andersson Y, Jormanainen V. The risk of Guillain-Barre syndrome following infection with Campylobacter jejuni. Epidemiol Infect. Feb 1999;122(1):15-7. [Medline].

  28. Nagasawa K, Kuwabara S, Misawa S, et al. Electrophysiological subtypes and prognosis of childhood Guillain-Barre syndrome in Japan. Muscle Nerve. Feb 27 2006;[Medline].

  29. Prevots DR, Sutter RW. Assessment of Guillain-Barre syndrome mortality and morbidity in the United States: implications for acute flaccid paralysis surveillance. J Infect Dis. Feb 1997;175 Suppl 1:S151-5. [Medline].

  30. Ropper AH. The Guillain-Barre syndrome. N Engl J Med. Apr 23 1992;326(17):1130-6. [Medline].

  31. Ropper AH, Kehne SM. Guillain-Barre syndrome: management of respiratory failure. Neurology. 1985;35:1662-5. [Medline].

  32. Rostami AM. Pathogenesis of immune-mediated neuropathies. Pediatr Res. Jan 1993;33(1 Suppl):S90-4. [Medline].

  33. Ryan MM. Guillain-Barre syndrome in childhood. J Paediatr Child Health. May-Jun 2005;41(5-6):237-41. [Medline].

  34. Shanbag P, Amirtharaj C, Pathak A. Intravenous immunoglobulins in severe Guillian-Barre syndrome in childhood. Indian J Pediatr. 2003;70(7):541-3. [Medline].

  35. Sladky JT. Guillain-Barre syndrome in children. J Child Neurol. Mar 2004;19(3):191-200. [Medline].

  36. Stratton KR, Howe CJ, Johnston RB. Adverse events associated with childhood vaccines other than pertussis and rubella. Summary of a report from the Institute of Medicine. JAMA. May 25 1994;271(20):1602-5. [Medline].

  37. van der Meche FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barre syndrome. Dutch Guillain-Barre Study Group. N Engl J Med. Apr 23 1992;326(17):1123-9. [Medline].

  38. Zafeiriou DI, Kontopoulos EE, Katzos GS, et al. Single dose immunoglobulin therapy for childhood Guillain-Barre syndrome. Brain Dev. Jul 1997;19(5):323-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Guillain-Barre syndrome in children, Guillain-Barre syndrome, Guillain-Barré-Strohl syndrome, acute inflammatory demyelinating polyneuropathy, acute inflammatory demyelinating polyradiculopathy, AIDP, acute febrile polyneuritis, GBS, acute motor axonal neuropathy, AMAN

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Brian S Tseng, MD, PhD, Assistant Professor, Department of Neurology, Division of Pediatric Neurology, Harvard Medical School, Massachusetts General Hospital
Brian S Tseng, MD, PhD is a member of the following medical societies: Child Neurology Society
Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer A Markowitz, MD, Fellow in Neuromuscular Disease, Massachusetts General Hospital and Brigham and Women's Hospital
Jennifer A Markowitz, MD is a member of the following medical societies: Child Neurology Society
Disclosure: Nothing to disclose.

Medical Editor

Robert Stanley Rust Jr, MD, MA, Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia; Chair-Elect, Child Neurology Section, American Academy of Neurology
Robert Stanley Rust Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Neil A Busis, MD, Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside
Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Neurology, Department of Pediatrics, Division of Pediatrics, Oregon Health and Science University; Consulting Staff, Shriners Hospital
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.