Electrophysiologic Findings in Pediatric Guillain Barre Syndrome

Article Information

Title: Electrophysiologic Findings in Pediatric Guillain Barre Syndrome

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: Supplementary 1

Language: English

DOI: 10.51253/pafmj.v73iSUPPL-1.11036

Keywords: Acute inflammatory demyelinating polyradiculo neuropathyAcute motor axonal neuropathyGuillian Barre syndrome

Abstract

Objective: To describe electrophysiologic findings in the pediatric GuillianBarre syndrome (GBS).
Study design: Comparative prospective study.
Place and Duration of Study: Department of Neurology, The Children’s Hospital and Institute of Child Health, Lahore Pakistan, from Jun to Dec 2015.
Methodology: Children below 18 years of age, presenting in medical emergency/neurology OPD and fulfilling the clinical case definition of GBS were included for the study. Electrophysiologic studies were performed within 24 hours of admission in all patients.
Results: Out of 83 patients with GBS, 59% were male and 80% were between 3-12 years of age. According to the electrophysiological findings, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the most common subtype followed by acute motor axonal neuropathy (AMAN). Reduced CMAP and absent F-response were the most common electrophysiologic findingspresented in 70% and 57.8% of patients respectively. However, absent F-response was not specific for any subtype (p&gt;0.05). Prolonged motor DL, reduced NCV, temporal dispersion and abnormal F-wave latency were characteristicelectrophysiologic features of demyelination (p≤0.001). However, prolonged motor DL and absent F-wave occurred early in the course of disease while reduced NCV and temporal dispersion observed later.
Conclusion: Electrophysiologic studieswere useful in making the appropriate diagnosis to initiate immunotherapy, particularly during first week after onset of weakness when albuminocytologic dissociation may not be present.

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Research Objective

To describe electrophysiologic findings in pediatric Guillain-Barre syndrome (GBS).

Methodology

A comparative prospective study conducted in the Department of Neurology, The Children's Hospital and Institute of Child Health, Lahore, Pakistan, from June to December 2015. Children under 18 years old meeting the clinical case definition of GBS were included. Electrophysiologic studies (nerve conduction studies and needle electromyography) were performed within 24 hours of admission.

Methodology Flowchart

                        graph TD;
    A["Children < 18 years with GBS clinical definition"] --> B["Electrophysiologic Studies"NCS, EMG""];
    B --> C["Data Collection Sociodemographic, Electrophysiologic"];
    C --> D["Classification of GBS subtypes"];
    D --> E["Analysis of Electrophysiologic Findings"];
    E --> F["Conclusion"];

Discussion

AIDP was the predominant subtype of pediatric GBS in this study, aligning with findings in Pakistan and other Asian countries. Electrophysiologic studies were crucial for early diagnosis, especially when albuminocytologic dissociation was not yet present. Demyelination was characterized by prolonged motor DL, reduced NCV, temporal dispersion, and abnormal F-wave latency, with some features appearing earlier than others. Conduction blocks and absent F-waves, while more common in AIDP, were also observed in axonal GBS.

Key Findings

Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the most common subtype (48%), followed by acute motor axonal neuropathy (AMAN) (34%). Reduced Compound Muscle Action Potential (CMAP) amplitude (70%) and absent F-response (57.8%) were the most common electrophysiologic findings. Prolonged motor distal latency (DL), reduced nerve conduction velocity (NCV), temporal dispersion, and abnormal F-wave latency were characteristic of demyelination. Prolonged motor DL and absent F-wave occurred early, while reduced NCV and temporal dispersion were observed later.

Conclusion

Electrophysiologic studies are valuable for the early diagnosis of pediatric GBS, enabling timely initiation of immunotherapy. AIDP is the most common subtype. Demyelination is associated with specific electrophysiologic markers, some of which manifest earlier in the disease course than others.

Fact Check

* The study was conducted from June to December 2015.
* 83 patients with GBS were enrolled in the study.
* 59% of the patients were male.

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