How Different is AMAN from AIDP in Childhood GBS? A Prospective Study from North India
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To compare the clinical profile and short-term outcome of children with axonal and demyelinating subtypes of childhood Guillain Barré syndrome (GBS).
This is a prospective observational study conducted in a tertiary care teaching hospital in North India. Consecutive children with Guillain Barré syndrome were recruited to compare the clinical profile and short term outcome among the subtypes.
Among 9847 children admitted to the emergency, 95 had acute flaccid paralysis; 57 of whom had GBS. Electrophysiological studies were completed in 57; of whom 20 had acute inflammatory demyelinating polyneuropathy (AIDP); 19 had acute motor axonal neuropathy (AMAN); 12 had non-reactive nerves; five were unclassifiable; 1 had acute motor sensory axonal neuropathy (AMSAN). More children in AMAN group had preceding gastroenteritis (4 vs. 2), while AIDP group had upper respiratory infections (12 vs. 7). Ataxia was only seen in AIDP subtype while wrist drop, foot drop and hyperreflexia were seen only with AMAN subtype. Respiratory muscle involvement (6 vs. 3) and artificial ventilation (5 vs. 2) was more in AMAN. At discharge, children with AIDP were less likely to be non-ambulant (12 vs. 6, p = 0.036). Mean disability scores at hospital discharge (4.9 ± 1.2 vs. 4 ± 0.9, p = 0.015) and at last follow-up (0.7 ± 1.01 vs. 0.05 ± 0.2, p = 0.016) were higher in AMAN. Children with AIDP were more likely to achieve normalcy on follow-up (19 vs. 12, p = 0.023).
Children with AMAN appear to have a more severe clinical course; higher short-term morbidity; and slower recovery than those with AIDP.
KeywordsAcute inflammatory demyelinating polyneuropathy Acute motor axonal neuropathy Clinical features Guillain-Barré syndrome Neurophysiology
PKG: Patient management, data collection and prepared the first draft of the manuscript; PS: Patient management, critical review of manuscript; SS: Patient management, concept of the study, critical review of manuscript; AK: Patient management, review of literature and revision of the manuscript; NS: Concept of the study, supervised data collection, critical review of manuscript and final approval of the version to be published. He will act as guarantor for the paper.
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