Ujjal Kr Sarkar1, Lalita Menon1, Debabrata Sarbapalli1, Ranabir Pal2, Forhad Akhtar Zaman2, Sumit Kar2, Jyoti Singh3, Mohan Mondal4, Soma Mukherjee5
1Department of Anesthesiology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
2Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences and Central Referral Hospital (CRH), Gangtok, Sikkim, India.
3Department of Emergency Medicine, Caboolture Hospital, Caboolture, Queensland, Australia.
4Department of Anesthesiology, North Bengal Medical College and Hospital, Darjeeling, India.
5Department of Anesthesiology, RG Kar Medical College, Kolkata, India.
Objective: In childhood Guillain-Barré syndrome (GBS), the clinical profiles using intravenous immunoglobulin (IVIg) in addition to supportive care were studied. Materials and Methods: This was a retrospective analysis of 139 children with severe GBS admitted to our respiratory care unit managed with the IVIg as an adjunct intervention to conventional supportive and respiratory care. Results: In our case series of 139 cases, motor weakness was the most common presenting feature. Antecedent illness was found in 66.7% of cases in the preceding two weeks, which included nonspecific illness, acute respiratory infection, diarrhea, and chickenpox. At onset, sensory symptoms (pain and paresthesia) were noted in 59% of the cases and limb weakness in 77%. On admission, a majority (61.54%) were in Hughes neurological disability grading stage V; all had limb weakness at the peak deficit, autonomic disturbance was seen in 35.8%, and bulbar palsy in 52%. Duration of illness was less than three weeks in 67% of cases. The mean duration of ventilation was 21.5 days (range, 5-60 days). Conclusions: Male preponderance and motor weakness was the most common presenting illness and a majority achieved full recovery in our series. Although IVIg may be useful in the treatment of GBS, the key issue is excellent intensive care unit management.
Keywords: Guillain-Barré syndrome, intravenous immunoglobulin, supportive care.