Objectives: To determine the outcome of autonomic disturbances in childrenwith Guillain Barre Syndrome. Study Design: Case series study. Setting: Pediatric ICU andNeurology ward of Nishtar Medical University/hospital Multan. Period: 9th June 2014 to 8th June2015. Methods: 48 children having age less than 18 years. Clinical examination of centralnervous system was conducted by single examiner to see presence of acute flaccid paralysisand to detect autonomic dysfunction. Cerebrospinal fluid analysis for albumino-cytologicdissociation, electromyography and nerve conduction studies was done in every patient ofGuillain Barre Syndrome. Outcome was noted as expired, discharged or LAMA. Results: Meanage was 5.4 years and male female ratio was 1.2:1. Total 34 children were found to have clinicalevidence of autonomic instability. Among 48 children, 17 children (35.4%) received no therapy,28 children (58.3%) received Intravenous immunoglobulin (IVIG) therapy, and 3 children (6.3%)received plasmapheresis. In children with autonomic disturbance, 24 children (70.6%) weredischarged, 8 children (23.5%) expired and 2 children (5.9%) LAMA. Of the total 14 childrenwithout autonomic disturbance, 11 children (78.6%) were discharged, 3 children (21.4%)expired and no child LAMA (p-value >0.05). Mean duration of stay for patients with autonomicinstability was 130 days versus 63 days in patients without autonomic instability (p-value<0.005). Demyelination variety was seen in 35 children (72.9%) and axonal degenerationin 13 children (27.1%). Mortality was high in children who had axonal degeneration but withinsignificant p-value of >0.05. Conclusions: Autonomic instability is common in patients ofGBS and is associated with increased risk of morbidity. Prompt recognition and treatment ofautonomic instability can improve the outcomes of children with GBS.
GUILLAIN-BARRÉ SYNDROME
