Diagnosis of Guillain–Barré syndrome in children and validation of the Brighton criteria

Abstract

To describe the key diagnostic features of pediatric Guillain–Barré syndrome (GBS) and validate the Brighton criteria. Retrospective cohort study of all children (<18 years) diagnosed with GBS between 1987 and 2013 at Sophia Children’s Hospital, Erasmus MC, Rotterdam. Clinical information was collected and the sensitivity of the Brighton criteria was calculated. 67 children (35 boys) were included, with a median age of 5.0 years [interquartile range (IQR) 3.0–10.0 years]. Bilateral limb weakness was present at hospital admission in 93% of children, and at nadir in all patients. Children presented with tetraparesis in 70% or with paraparesis in 23%. Reduced reflexes in paretic limbs were observed at hospital admission in 82% and during follow-up in all children. The progressive phase lasted median 6 days (IQR 3–8 days) and less than 4 weeks in all children. A monophasic disease course was seen in 97%, including 5 children with a treatment-related fluctuation. Two children had a later relapse at 9 weeks and 19 weeks after onset. 77% of the children showed an elevated protein level in CSF. Nerve conduction studies showed evidence for a poly(radiculo)neuropathy in 91% of the children. 46 children had a complete data set, the sensitivity of the Brighton criteria level 1 was 72% (95% CI 57–84) and 96% (95% CI 85–99) for level 2 and 98% (95% CI 88–100) for level 3. The majority of the pediatric GBS patients presented in this cohort fulfilled the current diagnostic criteria.Electronic supplementary materialThe online version of this article (doi:10.1007/s00415-017-8429-8) contains supplementary material, which is available to authorized users.

Clinical Variants and Evaluation of Clinical Severity of Guillain Barre Syndrome in a Tertiary Care Hospital of Nepal

“…Western studies have higher AIDP incidence, whereas axonal variants in most Asian studies [2,4]. In this current study, we also found predominant axonal variants, AMAN being the commonest variant.…”

“…Previous studies have shown that AIDP is reported as the most common variant in western countries, while in Asian countries like Japan, China and India, it comprises only 20-40% [2,4]. Axonal variants were found to be clinically more severe than demyelinating variants in most of the studies [5,6].…”

Diagnosis of Guillain‐Barré syndrome and validation of the Brighton criteria in Malaysia

“…There have been several studies reporting on the sensitivity of the Brighton criteria in their GBS patient population (Table 4). 10‐15,21 The sensitivities range from 9% to 91% in different cohorts. In the current study, a level 1 diagnostic certainty was achieved in 67% of patients who had the full complement of clinical and investigation findings.…”

“…The case definitions were based on key diagnostic characteristics, CSF examination and NCS 9 . The Brighton criteria has since been widely used by clinicians and has been validated in GBS patients from India, The Netherlands, Korea, Bangladesh, and China with sensitivities for the highest diagnostic certainty ranging from 9% to 91% 10‐15 . However, to date, no study has validated the Brighton criteria in MFS patients.…”

Retrospective Analysis of Cases with Guillain-Barré Syndrome in Pediatric Intensive Care Unit

“…GBS'nin tanısında 1990 yılında tanımlanan, klinik ve laboratuvar bulguları temel alan Asbury tanı ölçütleriyle birlikte 2009 yılında tanımlanan Brighton tanı ölçütleri de mevcuttur. 10 Tanısal olarak klinik bulgular ön planda olmakla birlikte BOS bulguları ve EMG sonuçları da önem taşımaktadır. Düşük BOS hücre sayısı (≤10 hücre/mm 3 ) ile birlikte yüksek BOS proteini albüminositolojik dissosiasyon olarak adlandırılır ve GBS için tipik sayılan bulgulardandır.…”