Ortiz Corredor F, Mieth Alviar K W
Departamento de Medicina Física y Rehabilitación, Instituto de Ortopedia Infantil Roosevelt, Universidad Nacional de Colombia. Bogota, Colombia.
Rev Neurol. 2003;36(12):1113-20.
The purpose of this study was to evaluate the clinical and electrophysiological variables that are linked to prognosis in Guillain Barre syndrome (GBS) in children.
A retrospective cohort study was conducted on 99 children admitted to hospital after being diagnosed as suffering from GBS over a 3 year period. The time before reaching functional grade III on the Hughes scale was taken into account for the outcome, and the following factors were considered to be prediction variables: the electrical excitability of the motor nerves, the need for assisted ventilation, the presence of dysautonomia, age, the degree of maximum weakness on day 10 after the onset of the disease, cranial nerve involvement and origin (town or country).
Patients with an excitable pattern, i.e. the presence of an electrical response in at least one of the three motor nerves, at the onset of the disease reached functional grade III on Hughes scale 3.55 times (CI 95% 1.5 6.0) quicker than individuals with a non excitable pattern after adjusting the variable with the strength of the quadriceps and a electromyography study that revealed signs of denervation in the anterior tibial muscle. The clinical variable associated with a favourable prognosis was the presence of any kind of muscular activity in the quadriceps (muscular strength between 1 and 5), regardless of different degrees of strength. Thus, patients with some muscular activity in the quadriceps on day 10 after the onset of the disease reached functional grade III 3.6 times (CI 95% 1.8 7.1) quicker than those who did not present any activity (muscular strength= 0). No differences were found in the time the two physiopathological types, acute axonal neuropathy and demyelinating polyneuropathy, required to reach Hughes grade III.
The absence of electrical excitability in the motor nerves and the absence of muscular activity in the quadriceps on day 10 of the disease are factors that are independently related to a prolonged recovery time in children with GBS.
本研究旨在评估与儿童吉兰-巴雷综合征（GBS）预后相关的临床和电生理变量。
对99名在3年期间被诊断为GBS后入院的儿童进行了一项回顾性队列研究。将达到休斯量表功能三级之前的时间作为研究结果，并将以下因素视为预测变量：运动神经的电兴奋性、是否需要辅助通气、是否存在自主神经功能障碍、年龄、发病后第10天最大肌无力程度、是否累及脑神经以及来源地（城镇或乡村）。
在调整了股四头肌力量变量以及一项显示胫前肌失神经支配迹象的肌电图研究后，疾病发作时具有兴奋模式（即三条运动神经中至少一条存在电反应）的患者达到休斯量表功能三级的速度比无兴奋模式的个体快3.55倍（95%置信区间1.5至6.0）。与良好预后相关的临床变量是股四头肌存在任何类型的肌肉活动（肌力在1至5级之间），无论力量程度如何。因此，疾病发作后第10天股四头肌有一些肌肉活动的患者达到功能三级的速度比没有任何活动（肌力 = 0）的患者快3.6倍（95%置信区间1.8至7.1）。在达到休斯三级所需时间方面，急性轴索性神经病和脱髓鞘性多发性神经病这两种病理生理类型之间未发现差异。
运动神经无电兴奋性以及疾病第10天股四头肌无肌肉活动是与GBS患儿恢复时间延长独立相关的因素。
