Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Guillain-Barre Syndrome Medication

  • Author: Marc P DiFazio, MD; Chief Editor: Amy Kao, MD  more...
 
Updated: Dec 11, 2014
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Intravenous immunoglobulin (IVIG) is the predominant choice in childhood Guillain-Barré syndrome (GBS). DVT prophylaxis should be initiated and stress gastritis prophylaxis with H2 blockers (eg, ranitidine) may be beneficial. A bowel routine should also be instituted, as gastroparesis secondary to autonomic dysfunction and/or extended bed rest is not uncommon.

Next

Blood products

Class Summary

IVIG is an effective treatment of autoimmune neuropathies in general. It can reduce duration of hospitalization as well as need or duration for mechanical ventilation.

IVIG (Gammagard, Gamimune)

 

Features relevant to efficacy may include neutralization of circulating myelin antibodies through anti-idiotypic antibodies; down-regulation of proinflammatory cytokines, including interferon-gamma; blockade of Fc receptors on macrophages; suppression of inducer T and B cells and augmentation of suppressor T cells; blockade of complement cascade; promotion of remyelination; and a 10% increase in CSF IgG.

Previous
Next

Histamine2-Receptor Antagonists

Class Summary

H2-receptor antagonists are reversible competitive blockers of histamines at the H2 receptors, particularly those in the gastric parietal cells, where they inhibit acid secretion. The H2 antagonists are highly selective, do not affect the H1 receptors, and are not anticholinergic agents.

Cimetidine (Tagamet)

 

Cimetidine inhibits histamine at H2 receptors of gastric parietal cells, which results in reduced gastric acid secretion, gastric volume, and hydrogen concentrations.

Ranitidine (Zantac)

 

Ranitidine inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn, reduces gastric acid secretion, gastric volume, and hydrogen ion concentrations.

Famotidine (Pepcid)

 

Famotidine competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and hydrogen ion concentrations.

Nizatidine (Axid)

 

Nizatidine competitively inhibits histamine at the H2 receptor of the gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and reduced hydrogen concentrations.

Previous
 
Contributor Information and Disclosures
Author

Marc P DiFazio, MD Associate Professor, Department of Neurology, Uniformed Services University of the Health Sciences; Director, Pediatric Subspecialty Services, Shady Grove Adventist Hospital for Children

Marc P DiFazio, MD is a member of the following medical societies: Alpha Omega Alpha, International Parkinson and Movement Disorder Society, American Academy of Cerebral Palsy and Developmental Medicine, American Academy of Neurology, Child Neurology Society

Disclosure: Nothing to disclose.

Coauthor(s)

Nitin C Patel, MD, MPH, FAAN Professor of Clinical Pediatrics and Neurology, Southern Illinois University School of Medicine; Private Practice, Columbia Center for Child Neurology

Nitin C Patel, MD, MPH, FAAN is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, Child Neurology Society

Disclosure: Nothing to disclose.

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.

Sameer Chhibber, MD, FRCPC Neuromuscular Fellow, Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School

Disclosure: Nothing to disclose.

Mita N Patel University of Missouri-Columbia School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Child Neurology Society

Disclosure: Have stock from Cellectar Biosciences; have stock from Varian medical systems; have stock from Express Scripts.

Acknowledgements

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.

Jennifer A Markowitz, MD Attending Physician, Department of Neurology, Children's Hospital Boston

Jennifer A Markowitz, MD is a member of the following medical societies: Child Neurology Society

Disclosure: Nothing to disclose.

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 School of Medicine; 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.

Sarah Sheikh, MBBCh, MSc, MRCP Neuromuscular Fellow, Department of Neurology, Brigham and Women's Hospital

Sarah Sheikh, MBBCh, MSc, MRCP is a member of the following medical societies: American Academy of Neurology, Massachusetts Medical Society, and Royal College of Physicians of the UK

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. Kuwabara S. Guillain-Barré syndrome: epidemiology, pathophysiology and management. Drugs. 2004. 64(6):597-610. [Medline].

  2. Lee JH, Sung IY, Rew IS. Clinical presentation and prognosis of childhood Guillain-Barré syndrome. J Paediatr Child Health. 2008 Jul-Aug. 44(7-8):449-54. [Medline].

  3. Seneviratne U. Guillain-Barré syndrome. Postgrad Med J. 2000 Dec. 76(902):774-82. [Medline]. [Full Text].

  4. Kimoto K, Koga M, Odaka M, Hirata K, Takahashi M, Li J, et al. Relationship of bacterial strains to clinical syndromes of Campylobacter-associated neuropathies. Neurology. 2006 Nov 28. 67(10):1837-43. [Medline].

  5. Souayah N, Nasar A, Suri MF, Qureshi AI. Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). J Clin Neuromuscul Dis. 2009 Sep. 11(1):1-6. [Medline].

  6. CDC. Estimating Deaths from Seasonal Influenza in the United States. [Full Text].

  7. Preliminary results: surveillance for Guillain-Barré syndrome after receipt of influenza A (H1N1) 2009 monovalent vaccine - United States, 2009-2010. MMWR Morb Mortal Wkly Rep. 2010 Jun 4. 59(21):657-61. [Medline].

  8. World Health Organization. Programmes and Projects - Global Alert and Response (GAR). Pandemic (H1N1) 2009 briefing notes. World Health Organization. Available at http://www.who.int/csr/disease/swineflu/notes/briefing_20091119/en/. Accessed: January 8, 2012.

  9. Tremblay ME, Closon A, D'Anjou G, Bussières JF. Guillain-Barré syndrome following H1N1 immunization in a pediatric patient. Ann Pharmacother. 2010 Jul-Aug. 44(7-8):1330-3. [Medline].

  10. da Silveira CM, Salisbury DM, de Quadros CA. Measles vaccination and Guillain-Barré syndrome. Lancet. 1997 Jan 4. 349(9044):14-6. [Medline].

  11. Slade BA, Leidel L, Vellozzi C, Woo EJ, Hua W, Sutherland A, et al. Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine. JAMA. 2009 Aug 19. 302(7):750-7. [Medline].

  12. Smith MJ. Meningococcal tetravalent conjugate vaccine. Expert Opin Biol Ther. 2008 Dec. 8(12):1941-6. [Medline].

  13. Landaverde JM, Danovaro-Holliday MC, Trumbo SP, Pacis-Tirso CL, Ruiz-Matus C. Guillain-Barré syndrome in children aged 1111111111111111J Infect Dis</i>. 2010 Mar. 201(5):746-50. [Medline].

  14. Griffin JW, Li CY, Ho TW, Tian M, Gao CY, Xue P, et al. Pathology of the motor-sensory axonal Guillain-Barré syndrome. Ann Neurol. 1996 Jan. 39(1):17-28. [Medline].

  15. Griffin JW, Li CY, Ho TW, Xue P, Macko C, Gao CY, et al. Guillain-Barré syndrome in northern China. The spectrum of neuropathological changes in clinically defined cases. Brain. 1995 Jun. 118 ( Pt 3):577-95. [Medline].

  16. Nachamkin I, Arzarte Barbosa P, Ung H, Lobato C, Gonzalez Rivera A, Rodriguez P, et al. Patterns of Guillain-Barre syndrome in children: results from a Mexican population. Neurology. 2007 Oct 23. 69(17):1665-71. [Medline].

  17. Kalra V, Chaudhry R, Dua T, Dhawan B, Sahu JK, Mridula B. Association of Campylobacter jejuni infection with childhood Guillain-Barré syndrome: a case-control study. J Child Neurol. 2009 Jun. 24(6):664-8. [Medline].

  18. Barzegar M, Alizadeh A, Toopchizadeh V, Dastgiri S, Majidi J. Association of Campylobacter jejuni infection and GuillainBarré syndrome: a cohort study in the northwest of Iran. Turk J Pediatr. 2008 Sep-Oct. 50(5):443-8. [Medline].

  19. Islam Z, Jacobs BC, Islam MB, Mohammad QD, Diorditsa S, Endtz HP. High incidence of Guillain-Barre syndrome in children, Bangladesh. Emerg Infect Dis. 2011 Jul. 17(7):1317-8. [Medline].

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

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

  22. Kalra V, Sankhyan N, Sharma S, Gulati S, Choudhry R, Dhawan B. Outcome in childhood Guillain-Barré syndrome. Indian J Pediatr. 2009 Aug. 76(8):795-9. [Medline].

  23. Roodbol J, de Wit MC, Walgaard C, de Hoog M, Catsman-Berrevoets CE, Jacobs BC. Recognizing Guillain-Barre syndrome in preschool children. Neurology. 2011 Mar 1. 76(9):807-10. [Medline].

  24. al-Qudah AA, Shahar E, Logan WJ, Murphy EG. Neonatal Guillain-Barré syndrome. Pediatr Neurol. 1988 Jul-Aug. 4(4):255-6. [Medline].

  25. Kieseier BC, Kiefer R, Gold R, Hemmer B, Willison HJ, Hartung HP. Advances in understanding and treatment of immune-mediated disorders of the peripheral nervous system. Muscle Nerve. 2004 Aug. 30(2):131-56. [Medline].

  26. Hughes RA. The concept and classification of Guillain-Barré syndrome and related disorders. Rev Neurol (Paris). 1995 May. 151(5):291-4. [Medline].

  27. Schwerer B. Antibodies against gangliosides: a link between preceding infection and immunopathogenesis of Guillain-Barré syndrome. Microbes Infect. 2002 Mar. 4(3):373-84. [Medline].

  28. Inaloo S, Katibeh P. Guillain-barre syndrome presenting with bilateral facial nerve palsy. Iran J Child Neurol. 2014 Winter. 8(1):70-2. [Medline]. [Full Text].

  29. Ilyas M, Tolaymat A. Minimal change nephrotic syndrome with Guillain-Barré syndrome. Pediatr Nephrol. 2004 Jan. 19(1):105-6. [Medline].

  30. Heiner JD, Ball VL. A child with benign acute childhood myositis after influenza. J Emerg Med. 2010 Sep. 39(3):316-9. [Medline].

  31. Lacroix LE, Galetto A, Haenggeli CA, Gervaix A. Delayed recognition of Guillain-Barré syndrome in a child: a misleading respiratory distress. J Emerg Med. 2010 Jun. 38(5):e59-61. [Medline].

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

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

  34. 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. 2007 Jan. 92(1):48-52. [Medline]. [Full Text].

  35. Roodbol J, de Wit MC, Aarsen FK, Catsman-Berrevoets CE, Jacobs BC. Long-term outcome of Guillain-Barré syndrome in children. J Peripher Nerv Syst. 2014 Jun. 19(2):121-6. [Medline].

  36. Hughes RA, Wijdicks EF, Barohn R, Benson E, Cornblath DR, Hahn AF, et al. Practice parameter: immunotherapy for Guillain-Barré syndrome: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2003 Sep 23. 61(6):736-40. [Medline].

  37. Yata J, Nihei K, Ohya T, Hirano Y, Momoi M, Maekawa K, et al. High-dose immunoglobulin therapy for Guillain-Barré syndrome in Japanese children. Pediatr Int. 2003 Oct. 45(5):543-9. [Medline].

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

  39. Baranwal AK, Ravi RN, Singh R. Exchange transfusion: a low-cost alternative for severe childhood Guillain-Barré syndrome. J Child Neurol. 2006 Nov. 21(11):960-5. [Medline].

  40. Shahar E. Current therapeutic options in severe Guillain-Barré syndrome. Clin Neuropharmacol. 2006 Jan-Feb. 29(1):45-51. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.