Clinical and electrophysiologic predictors of outcome in 27 children with Guillain-Barre syndrome were determined by a retrospective review of records at the University of Iowa Hospitals and Clinics, Iowa City, IA. Patients were divided into 2 groups; Group 1, recovery (complete or partial) after more than 2 months, and group 2, within 2 months of onset. Age at presentation ranged from 1 to 16 years (mean 9 years). Males outnumbered females 2:1. Antecendent infection (within 1 month of onset) occurred in 70%; cytomegalovirus infection was present in 26%. Numbness was the the most common presenting symptom, occurring in 48%. Cranial nerve involvement in 70% (mainly VII (55%), some multiple (29%)) occurred especially in group 1. Intubation was required in 36% of group 1 only. Intravenous immunoglobulin had been used more frequently in the early recovery group 2 than group 1 patients. Features significantly different between the 2 groups were as follows: 1) maximum disability score at presentation; 2) intubation; 3) cranial nerve involvement, and 4) nerve conduction block. The maximum disability score at presentation and the probability of intubation were also significantly correlated. Features not significantly different in the 2 groups included: age, gender, preceding infection, cytomegalovirus, severity of presenting weakness, csf protein level, nerve conduction velocities and muscle and nerve action potential amplitudes, fibrillation potentials, F wave, insertional activity, axonopathy or demyelinating patterns, and IV immunoglobulin therapy. [1]

COMMENT. Predictors of poor outcome and delayed recovery in childhood Guillain-Barre syndrome include maximum disability score at presentation, intubation, cranial nerve involvement, and conduction block. Other electrophysiological findings are not of predictive value in children. The axonal form of neuropathy, sometimes associated with a poor prognosis in adults, was present only in 2 children of the present series, both in group 1 with a delayed recovery. The difference was not significant. Campylobacter jejuni infection has been linked to a poor prognosis of GBS in 5 reports in the literature, but was not isolated in the above patient series. (See Progress in Pediatric Neurology III, 1997;pp353-4, for reports of GBS associated with C. jejuni infection).

Atypical presentation of Guillain-Barre syndrome. Eight children with GBS presented with CNS symptoms, including drowsiness, headache, and meningismus, suggesting a meningoencephalitis [2]. Prominent CNS symptoms at onset of GBS should be recognized as part of the syndrome to avoid delay in diagnosis and treatment.