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Motor recovery after Guillain-Barré syndrome in childhood.
Disabil Rehabil. 2007 Jun 15;29(11):883-9.
Ortiz-Corredor F, Peña-Preciado M, Díaz-Ruíz J.
Department
of Physical Medicine and Rehabilitation, Universidad Nacional de
Colombia and Instituto de Ortopedia Infantil Roosevelt.
Purpose.
To determine the clinical factors that modify the recovery time for
gait after Guillain-Barré syndrome (GBS) in childhood. Method. Medical
records of patients admitted to Instituto de Ortopedia Infantil
Roosevelt (IOIR) between years 1991 and 2001, were reviewed. Age, sex,
cranial nerve impairment, requirement of assisted ventilation, number
of days of assisted ventilation, muscular strength at day 10 of the
disease, presence of quadriplegia, intravenous infusion of human gamma
globulins (IVIG), were taken as independent variables.
The number of
needed days to reach Hughes State III was taken as the major outcome.
First, univariate analysis was performed and with the factors that
showed a statistically significant association with recovery time,
multiple linear regression analysis and Cox regression were also
performed. Results. Data of 332 children under 15 years old was
collected. (Mean age: 7.1 years). A sample of 215 children was gathered
for the study, all of them were regarded as functional states IV or V.
Acute Motor Axonal Neuropathy (AMAN) was found in 30% of all cases. In
the univariate analysis Cranial nerve impairment, requirement of
assisted ventilation, presence of quadriplegia and presence of
non-excitable motor nerves were associated with delayed motor recovery
time. Patients who received IVIG reached Hughes state III faster than
those who received only support treatment. This finding, that was more
important in the presence of Acute Inflammatory Demyelinating
Polyradiculoneuropathy (AIDP), lost its value in the Cox regression
analysis. In the multivariate analysis, muscular strength, assessed at
day 10 of the disease was the most important predictor to determine
motor recovery. The presence of quadriplegia was strongly associated
with a delayed recovery time. Relative risk: 3.3 (95% Confidence
Interval 2.1 - 5.2). Conclusions. Muscular strength at day 10 of the
disease is the most useful clinical factor to determine prognosis of
motor recovery in children who have suffered Guillain-Barré syndrome.
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