Guillain-Barré syndrome in children.

The Guillain-Barré syndrome is a pediatric neurologic emergency and the most common cause in children of rapidly evolving, usually flaccid, weakness with associated areflexia. Two treatable illnesses, namely tick paralysis and acute cord compression, demand immediate differential diagnosis. Rarely, poliomyelitis still mimics infantile Guillain-Barré syndrome. Specific precursor infections, such as Campylobacter jejuni, are now recognized to affect the clinical presentation of Guillain-Barré syndrome. Cerebrospinal fluid evaluation and electromyography are usually diagnostic; new modalities, such as anti-GM1 antibodies, magnetic resonance imaging, and magnetic stimulation, are being evaluated in childhood Guillain-Barré syndrome. Although most cases of Guillain-Barré syndrome have benign courses, all require initial respiratory and autonomic monitoring to prevent fatal outcomes. No well-controlled pediatric studies comparing plasmapheresis with intravenous immunoglobulin have occurred. Results of treatment with either modality are encouraging. A synopsis of these reports is included in this review.