Prevalence and outcomes of Guillain-Barré syndrome among pediatrics in Saudi Arabia: a 10-year retrospective study

Asiri, Safiyyah; Altwaijri, Waleed A; Ba-Armah, Duaa; Al Rumayyan, Ahmed; Alrifai, Muhammad T; Salam, Mahmoud; Almutairi, Adel F

Rehabilitation in GBS patients is an expensive and lengthy procedure that should rapidly follow the cessation of progressive paralysis. One setting stated that 66% of their 407 GBS patients had a progression to maximum paralysis within 8 days. 34 Another study stated that the majority of cases with axonal variants of GBS were more likely to complain of rapid progression to maximum paralysis in comparison to AIDP patients. 35 Autonomic dysfunction and cranial nerve involvement were significantly associated with shorter time duration to maximum paralysis or nadir, 28 which was similar to figures observed in this setting. Although autonomic nervous dysfunction was a significant predictor of adverse clinical outcomes in the literature, 36 at early stages of the disease (within 7 days) has been proven to be a leading factor in shortening the duration to maximum paralysis. 37 In this setting, only four cases underwent plasmapheresis, all of whom were observed to endure maximum paralysis in ,2 weeks. Patients complaining of GBS often exhibit a full recovery, as most patients regain ambulation, but residual paralysis or disability remains in up to 10% of the cases. 38 In one regional study, residual paralysis was still observed in 64.7% and 29.4% of GBS patients after 3 to 6 months of the incident, respectively. 39 In this setting, after 2 months of nadir, the clinical outcomes were better, as 46.9% complained of residual paralysis. It was reported that by the third month, 47.1% of GBS patients are expected to have a complete recovery, while 24.3% will have poor recovery (wheelchair-bound). 40 One longitudinal study stated that the rates of GBS patients with complete recovery or minor limitations was 41% in the first month, 71% in the third, 86% in the sixth, and 92% in the twelfth. 41 Residual paralysis at the second month post onset of disease was highly associated with patients of age 8-14 years (65.2%) in this setting, which is compatible with findings reported by a study conducted in Iraq. 12 In addition, GBS cases with cranial and autonomic involvement had a poor functional outcome, which was a similar finding to this study, but with no statistically significant differences. 42 Additionally, in studies where GBS and acute myelitis were concurrent, all cases suffered residual paralysis. 35 Furthermore, reoccurrence or relapse of GBS is not uncommon. Findings in the literature suggest that 1%-6% of patients who have had GBS will experience a recurrent attack, 43 which makes the prevalence of recurrent cases in this setting at the upper limits.