Clinical profile, electrophysiological pattern and predictors of short-term outcome of Guillain-Barré syndrome in children

Sufia Khatun Sumi; Farzana Binta Rashid; M. Samsun Nahar Sumi; Nusrat Shams; Tahsina Jasmin; Bithi Debnath; Narayan Saha

doi:10.18203/2349-3291.ijcp20263293

Authors

Sufia Khatun Sumi Department of Paediatric Neurology, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh
Farzana Binta Rashid Department of Paediatric Neurology, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh
M. Samsun Nahar Sumi Department of Paediatric Neurology, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh
Nusrat Shams Department of Paediatric Neurology, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh
Tahsina Jasmin Department of Paediatric Neurology, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh
Bithi Debnath Department of Paediatric Neurology, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh
Narayan Saha Department of Paediatric Neurology, National Institute of Neuro Sciences and Hospital, Dhaka, Bangladesh Received: 11 June 2026

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263293

Keywords:

Neurological presentation, Guillain-Barre syndrome, Children, Quadriplegia, Paraplegia

Abstract

Background: Guillain-Barré syndrome (GBS) is a rare but potentially life-threatening immune-mediated disorder affecting peripheral nerves, causing acute flaccid paralysis with variable clinical severity. Its diverse presentation and disease course make diagnosis, management, and prognostication difficult, particularly in children. This study aimed to assess the clinical profile, electrophysiological pattern, and predictors of short-term outcomes in pediatric GBS.

Methods: This observational study was conducted at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh, from September 2018 to August 2019. A total of 93 children diagnosed with GBS were enrolled by consecutive sampling. Clinical characteristics, electrophysiological findings, treatment modalities, and short-term functional outcomes were analyzed. Outcome was assessed after 3 months of follow-up.

Results: Children aged 5-10 years were most commonly affected, with a male-to-female ratio of 1.7:1. Quadriparesis was the predominant presentation (87.1%), while 19.4% required mechanical ventilation. Electrophysiological studies showed acute motor axonal neuropathy (AMAN) in 65.6%, acute inflammatory demyelinating polyneuropathy (AIDP) in 31.2%, and acute motor-sensory axonal neuropathy (AMSAN) in 3.2% of cases. Patients receiving intravenous immunoglobulin with supportive care had shorter hospital stays than those receiving supportive care alone. At 3 months, 41.9% achieved favorable functional recovery (GBS disability grade 0-2), with no mortality recorded. Poor outcome was significantly associated with quadriplegia, bulbar involvement, neck flexor weakness, low baseline Medical Research Council score, and need for mechanical ventilation.

Conclusions: Quadriplegia, bulbar involvement, neck flexor weakness, poor baseline muscle strength, and mechanical ventilation requirement are significant predictors of poor short-term functional outcomes in pediatric GBS.

Metrics

Metrics Loading ...

References

Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med. 2012;366(24):2294-304. DOI: https://doi.org/10.1056/NEJMra1114525

Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology. 2011;36(2):123-33. DOI: https://doi.org/10.1159/000324710

Berzegar M, Davari F S, Dastagiri S, Malekian A, Toopchizadeh V. Childhood Guillian Barre Syndrome in the Iran’s east Azerbhaijan province: 2001-2005. Iran J Child Neurol. 2008;2(4):25-30.

Mohammad B, Saeed D, Mohammad HK, Ali V. Childhood Guillan-Barre syndrome in the North-West of Iran. BMC Neurol. 2007;7:22. DOI: https://doi.org/10.1186/1471-2377-7-22

Ansar V, Valadi N. Guillain-Barré syndrome. Prim Care. 2015;42(2):189-93. DOI: https://doi.org/10.1016/j.pop.2015.01.001

Dash S, Pai AR, Kamath U, Rao P. Pathophysiology and diagnosis of Guillain-Barré syndrome-challenges and needs. Int J Neurosci. 2015;125(4):235-40. DOI: https://doi.org/10.3109/00207454.2014.913588

Fujimura H. The Guillain-Barré syndrome. Handb Clin Neurol. 2013;115:383-402. DOI: https://doi.org/10.1016/B978-0-444-52902-2.00021-7

Arcila-Londono X, Lewis RA. Guillain-Barré syndrome. Semin Neurol. 2012;32(3):179-86. DOI: https://doi.org/10.1055/s-0032-1329196

Korinthenberg R, Schessl J, Kirschner J. Clinical presentation and course of childhood Guillain-Barré syndrome: a prospective multicenter study. Neuropediatrics. 2007;38(1):10-7. DOI: https://doi.org/10.1055/s-2007-981686

Roodbol J, de Wit MC, Walgaard C, de Hoog M, Catsman-Berrevoets CE, Jacobs BC. Recognizing Guillain-Barre syndrome in preschool children. Neurology. 2011;76(9):807-10. DOI: https://doi.org/10.1212/WNL.0b013e31820e7b62

National Institute of Neurological and Communications Disorders and Stroke. Criteria for diagnosis of Guillain Barré syndrome. Ann Neurol. 1978;3(6):565-6.

Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol. 1990;27(4):21-4. DOI: https://doi.org/10.1002/ana.410270707

Mogale KD, Antony JH, Ryan MM. The pharyngeal-cervical-brachial form of Guillain-Barré syndrome in childhood. Pediatr Neurol. 2005;33(4):285-8. DOI: https://doi.org/10.1016/j.pediatrneurol.2005.04.012

Legido A, Tenembaum SN, Katsekos CD and Menkes J. Autoimmune and post-infectious diseases. En: Menkes J, Sarnat HB, María BL, editors. Child Neurology. 7th edition. Philadelphia; Lippincott Williams and Wilkins. 2006;557-657.

Kaul RL, Alfutaisi A. Prospective study of children with Guillain-Barre syndrome. Indian J Pediat. 2008;75(8):787-90. DOI: https://doi.org/10.1007/s12098-008-0099-1

Kumbhar SG, Kumbhar SK, Sale MS, Kawada R. Clinical Profile of childhood Guillian Barre Syndrome- A Retrospective study. Int J Healthcare Biomed Res. 2016;04(03):19-25.

Sarkar UK, Menon L, Sarbapalli D, Pal R, Kar S, Singh J, Mondal M. Spectrum of Guillian Barre Syndrome in tertiary care hospital at Kolkata. JNSBM. 2011;2(2):211-5. DOI: https://doi.org/10.4103/0976-9668.92320

Veena K, Naveen S, Suvasini S, Sheffali G, Rama C, Benu D. Outcome in Childhood Guillain-Barré Syndrome. Indian J Pediat. 2009;76(8):795-9. DOI: https://doi.org/10.1007/s12098-009-0125-y

Kundu NC. Electrophysiology in the Guillain-Barré syndrome: study of 30 cases. J Bangladesh College Physicians Surgeons. 2006;24:54-60. DOI: https://doi.org/10.3329/jbcps.v24i2.149

Islam Z, Jacobs BC, van Belkum A, Mohammad QD, Islam MB, et al. An axonal variant of Guillain-Barre´ syndrome associated with Campylobacter infection in Bangladesh. Neurology. 2010;74(7):581-7. DOI: https://doi.org/10.1212/WNL.0b013e3181cff735

Van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of Guillain-Barré syndrome. Lancet Neurol. 2008;7(10):939-50. DOI: https://doi.org/10.1016/S1474-4422(08)70215-1

Sandhya M, Snehalatha IBJ, Devender A, Balarami R, Narayana P. Guillain-Barré syndrome: Clinical profile and Consensus to revise Hughes grade 5. Int J Med Publ Health. 2016;6(4):193-9. DOI: https://doi.org/10.5530/ijmedph.2016.4.10

Ropper AH. Electrodiagnostic Abnormalities in 113 Consecutive Patients with Guillain-Barre Syndrome. Arch Neurol. 1990;47(8):881-7. DOI: https://doi.org/10.1001/archneur.1990.00530080065012

Ye Y, Wang K, Deng F, Xing Y. Electrophysiological subtypes and prognosis of Guillain-Barré syndrome in northeastern China. Muscle Nerve. 2013;47(1):68-71. DOI: https://doi.org/10.1002/mus.23477

Kalita J, Misra UK, Goyal G, Das M. Guillain-Barré syndrome: Subtypes and predictors of outcome from India. J Peripher Nerv Syst. 2014;19(1):36-43. DOI: https://doi.org/10.1111/jns5.12050

Haden RDM, Hughes RAC. Guillain-Barre Syndrome recent advances. Arch Neural. 2008;41:511-14. DOI: https://doi.org/10.1001/archneur.1984.04050170057018

Habib R, Saifuddin M, Islam R, Rahman A, Bhowmik NB, Haque MA. Clinical Profile of Guillain Barre’s Syndrome-Observations from a Tertiary Care Hospital of Bangladesh. BIRDEM Med J. 2017;7(1):38-42. DOI: https://doi.org/10.3329/birdem.v7i1.31270

Rees JH, Thompson RD, Smeeton NC, Hughes RAC. Epidemiological study of Guillain-Barré syndrome in southeast England. J Neurol Neurosurg Psychiat. 1998;64(1):74-7. DOI: https://doi.org/10.1136/jnnp.64.1.74

Paul BS, Bhatia R, Prasad K, Padma MV, Tripathi M, Singh MB. Clinical predictors of mechanical ventilation in Guillain-Barré syndrome. Neurol India. 2012;60:150-3. DOI: https://doi.org/10.4103/0028-3886.96383

Verma R, Chaudhari TS, Raut TP, Garg RK. Clinico-electrophysiological profile and predictors of functional outcome in Guillain–Barre syndrome (GBS). J Neurological Sci. 2013;335:105-11. DOI: https://doi.org/10.1016/j.jns.2013.09.002

Gupta P K, Sankhyan N, Singhi S and Singhi P. A Comparison of Clinical Profile and Short-term Outcome of Demyelinating and Axonal Subtypes of Guillain-Barré Syndrome in Children. EC Paediat. 2019;8(10):1064-73.

Sadek AA, Taleb AA, Ali WA. Outcome of Guillain-Barré Syndrome in Children: A prospective cohort study in a tertiary hospital in Upper Egypt. Electronic Physician. 2016;8(12):3318-24. DOI: https://doi.org/10.19082/3318

Koul R, Chacko A, Ahmed R. Ten-year prospective study (Clinical Spectrum) of childhood Guillain-Barré Syndrome in the Arabian Peninsula: Comparison of outcome in patients in pre- and post-intravenous immunoglobulin eras. J Child Neurol. 2003;18(11):767-71. DOI: https://doi.org/10.1177/08830738030180110501