Guillain-Barré Syndrome in a Level II Hospital: Pre and Post Protocol

Background: Guillain-Barré Syndrome (GBS) is a heterogeneous group of acute immune-mediated polyneuropathies. Incidence is lower in children than in adults and there is usually complete recovery. In 2011 the Portuguese Neuropediatric Society issued a diagnosis and management protocol for GBS that allows a more systematic orientation of patients and earlier treatment (when criteria are met), avoiding possible complications.

Aim: Characterize GBS pediatric patients in a level II hospital; compare the approach before and after the protocol.

Methods: Retrospective analysis of the epidemiological, laboratory, clinical, treatment and follow-up data of the cases admitted to our hospital with GBS between 2011-2018 (second group – post-protocol), and comparison with a previous study (2010) which included patients from 1997 to 2009 (first group – pre-protocol). Data was analyzed with Excel.

Results: The first study group had six patients, medium age 4,5 years, and the second, four patients, medium age 4,3 (total: seven masculine, three feminine). All had lower extremity weakness and areflexia. Other symptoms included: pain, paresthesia, cranial nerve involvement, and fever. Eight progressed to superior extremity weakness, and three had dysautonomic disfunction. One required mechanical respiratory support.

Most (9/10) had previous infection. All patients underwent lumbar puncture (LP), 8/10 had albuminocytologic dissociation. 9/10 had electromyography (EMG) compatible with peripheral polyneuropathy. Pre-protocol, 5/6 were treated with Immunoglobulin (Ig) and 2/6 with corticosteroids; Post-protocol, all patients were treated with Ig; Two repeated Ig, due to clinical worsening. 9/10 had complete recovery and one abandoned the follow-up, with partial areflexia after three months.

Conclusion: According to the protocol, corticosteroids are contraindicated and weren’t used on any patient from the second group. With atypical symptoms, LP and EMG can be helpful. Almost all patients had total recovery of the symptoms, which is frequent in children. The protocol permits a more uniformized approach to GBS.