Childhood Guillain-Barre syndrome: Clinical presentation, diagnosis, and therapy

A rapidly progressive, generally symmetric, ascending flaccid paraparesis or quadriparesis that develops in an infant or child constitutes an uncommon but important pediatric neurologic emergency that requires immediate evaluation and treatment. The differential diagnosis primarily includes acute neuropathies, most commonly the childhood Guillain-Barre syndrome and, rarely, acute transverse myelitis or infantile poliomyelitis. A clinical distinction may be difficult in the younger child in whom detailed sensory examination is not possible. Although most children with Guillain-Barre syndrome usually have a benign and relatively limited clinical illness, some become severely ill, requiring intubation and careful intensive monitoring. To date, no well-controlled multi-institutional studies of treatment with either plasmapheresis or intravenously administered immunoglobulin have been developed in children despite the success of these modalities in adults. A review of the data available using these therapies is included in this study.