Acute polyneuropathy (Guillain-Barré syndrome) in children

Acute polyneuropathy, or Guillain-Barré syndrome, is an autoimmune inflammation of the peripheral and cranial nerves, with damage to the myelin sheaths and the development of acute neuromuscular paralysis.

Causes of Guillain-Barré syndrome in children.

Acute polyneuropathy occurs after acute respiratory infection or diarrhea, as well as in allergic conditions and toxic effects. In Guillain-Barré syndrome, bacteriological examination of feces often reveals Campylobacter jejunu. The syndrome is associated with bacterial infections such as Haemophilus influenzae, Mycoplasma pneumoniae and Borrelia burgdorferi, with cytomegaloviruses, Epstein-Barr virus, and also develops as a result of vaccination (against influenza, hepatitis C, etc.) and taking a number of medications.

Symptoms of Guillain-Barré syndrome in children.

In this variant of polyneuropathy, paresthesias in the fingers and toes, mild "stocking"-type sensory disturbances, ascending or simultaneously developing bilateral acute flaccid paralysis of the upper and lower extremities, facial muscles and respiratory muscles with rapid development of respiratory arrest, delirious syndrome, autonomic regulation disorders, circulatory disorders in the form of fluctuations in blood pressure and bradycardia are detected. The intensity of symptoms increases over several days, sometimes up to 4 weeks. Recovery begins 2-4 weeks after the cessation of disease progression and lasts 6-12 months.

Guillain-Barré syndrome is associated with acute inflammatory demyelinating polyneuropathy, acute motor and motor-sensory axonal neuropathy, and Miller-Fisher syndrome, which is characterized by ataxia, areflexia, and ophthalmoplegia.

Diagnostics of Guillain-Barré syndrome in children.

At the onset of the disease, no changes in body temperature are observed. To establish a diagnosis, it is necessary to make sure that there is increasing weakness in the upper and lower extremities, areflexia, autonomic dysfunction, cranial nerves are involved in the process, and the protein content in the cerebrospinal fluid is high. In the dynamics of the disease, no increase in sensitivity disorders is detected.

Treatment of Guillain-Barré syndrome in children.

In Guillain-Barré syndrome, emergency tracheal intubation, artificial ventilation, and, if necessary, sedative therapy are required. Beta-blockers and sodium nitroprusside are used to relieve arterial hypertension. In case of arterial hypotension, intravenous infusion of rheopolyglucin is indicated; in case of bradycardia, atropine is administered. Glucocorticosteroids are not used, since they are ineffective. If necessary, catheterization of the bladder is performed. Laxatives are prescribed. Since the analgesic activity of NSAIDs in Guillain-Barré syndrome is low, it is recommended to prescribe gabapentin or carbamazepine, as well as tricyclic antidepressants in combination with tramadol.

In a hospital setting, high doses of immunoglobulin (intratec and ipidacrine) are administered intravenously and plasmapheresis is performed. Sodium heparin [enoxaparin sodium, nadroparin calcium (fraxiparin)] must be prescribed. The patient with cranial nerve damage is fed through a nasogastric tube. Physiotherapy is indicated to prevent the development of muscle contractures.

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