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Guillain-Barré syndrome. A prospective clinical study in 25 children and comparison with adults.

Children who fulfilled the recognized diagnostic criteria for Guillain-Barré syndrome (GBS) were studied prospectively from 1982. After detailed clinical evaluation and investigation, severity of disease was graded on a disability scale ranging from 1 to 6, and the time taken from the 1st day of illness to reach important clinical landmarks was noted. All children were monitored for a minimum of 1 year and observations on them were then compared with those on 92 adults with GBS seen during the same period. Twenty-five children, evenly distributed between the sexes, were seen between 1982 and 1989 and constituted 22% of all GBS patients seen during this period. Children had a more acute form of onset than adults, 80% becoming bedbound within 7 days, and a higher incidence of cranial nerve palsies (76% vs 55%). The incidence of respiratory paralysis was 40% and of dysautonomia 20%, which was similar to findings in adults. Children fared marginally better than adults: 72% were ambulant at 1 year, 12% bedbound and 16% decreased. The prognosis of ventilated patients was relatively poor in both groups, but children with the hyperacute form of the disease had twice the probability of adults to attain independent walking at 1 year (0.63 vs 0.33).