A compelling case presentation of Guillain-Barre's Syndrome in Female Pediatric patient

1. Unraveling the Mysteries of
Guillain-Barré Syndrome in
Children : A Compelling
Case Presentation
Presented by : Syeda Tazeen, Pharm-D Intern

2. Introduction
Guillain-Barré Syndrome (GBS)is a rarebut serious
autoimmune neurological disorder characterized by
muscle weakness and paralysis. While it can occur at any
age, but it is particularlyhighlyconcerning when it occurs
in children.
This case presentation will explore a specific case of GBS
in a young patient, highlighting the importance of early
recognition and treatment of this condition.

3. Background
GBS is an autoimmune condition wherethe body's immune
system attacks the peripheral nerves which thereby causes
demylination of nerves & conduction of nerve impulses is reduced.
The exact etiology remains unknown, but it is often preceded bya
bacterial infection that disturbs GI tract or viral
infection that effects respiratory system.
HANDS
• Tingling sensation & numbness
• Parasthesis affecting distal extremities
FEET
• Muscle weakness
• Flaccid paralysis & Absent reflexes
PAIN
• Shoulders and Thigh
• Lower back pain
SIGNS
&
SYMPTOMS
*NOTE : Symptoms are in Symmetrical Ascending order

4. Patient History
A 9-year-old female patient weighing 25kgs wasadmitted to the pediatric
department with the chief complaints of weakness in bilateral lowerlimbs, tingling
sensation, di£ficulty in walking. Parents noticed frequent falls while walking over
the past three days.
PRESENT ILLNESS HISTORY :
Two weeks prior to admission, the patient experiencedillness characterized by
Upper Respiratory symptoms including dry cough & lowgrade fever for which she
wastreated at a clinic and recovered. This is a common precursor to GBS, as
immune system may over-react and attack body's own nerves in response to an
infection.
Within 24hrs she developed bilateral lowerlimb weaknes; overnext few days her
condition worsened ; she felt parasthesis(abnormal sensations) in lower limbs,
weakness extended slowly and gradually to upper limbs therefore she
experienced difficulty in walking and performing fine motor tasks

5. Previous History
PAST MEDICAL HISTORY : No known comorbidities
PAST MEDICATION HISTORY : Took medications for fever & cough
PAST SURGICAL HISTORY
FAMILY HISTORY
VITAL DATA
PROVISIONAL DIAGNOSIS
: Nil
: No similar complaints in family
: Stable
: Peripheral neuropathy? GBS?

6. Diagnostic Evaluation
1.Electrophysiological studies indicated demyelination and nerve damage, as
seen in nerve conduction studies (NCS) & needle electromyography (EMG).
2.Cerebrospinal Fluid(CSF)analysis showed elevated C-protein levels(85 mg/dl)
without pleocytosis (cell count and glucose levels).
3.Laboratory investigations; including complete blood count, renal/liver function
tests, serum electrolytes, and inflammatory markers, were within normal limits.
4.Serological tests for preceding infections (e.g., Campylobacter jejuni, Epstein-
Barr virus, cytomegalovirus) were negative.
DIAGNOSIS :
A diagnosis of Guillain-Barré syndrome (GBS)
was made based on clinical presentation,
electrophysiological studies, and CSF analysis.

7. The primary goal of treating pediatric GBS is to reduce symptoms, prevent complications, and
promote recovery. Patient was initiated on the following management strategies:
Treatment and Management
• Patient was immediately started on intravenous immunoglobulin (IVIG) therapy, which is a standard
treatment for GBS. It works by providing the patient with antibodies that can help fight off the disease.
• The patient received course of IVIG (400mg/kg over 14 days in 2 sessions) to modulate the immune
response and hasten recovery.
Intravenous
Immunoglobulin
(IVIG) Therapy
• Frequent neurological assessments to monitor the progression of weakness & respiratory function.
• Strict bed rest with frequent repositioning to prevent complications such as pressure sores & deep
vein thrombosis.
• Adequate hydration & nutritional support to maintain optimal health.
Supportive Care
• Physiotherapy was initiated to maintain joint mobility, prevent contractures, and
promote functional recovery.
Rehabilitation
However, there were some challenges that were faced during the treatment process.
The patient experienced some mild side effects from the IVIG therapy, including headache & fatigue.
Additionally, the treatment was quite expensive & the family had to work with their insurance company
to ensure that it would be covered.

8. Over the following weeks, the patient's muscle strength
improved gradually, with motor function returning in a
proximal-to-distal manner. After three months, she made
significant progress, almost recovering with only slight
weakness in distal lower limb muscles. Follow-up neurology
consultations were planned to ensure long-term monitoring
of her condition.
Outcome

9. Guillain-Barré syndrome is a rare but significant neurological
condition in pediatric patients. Timely recognition, early
diagnosis & appropriate management, including supportive
care, and rehabilitation are crucial for optimizing outcomes.
This case highlights the importance of a multi-disciplinary
approach and regular follow- up to facilitate the recovery &well-
being of pediatric patients with GBS.
In order to improve outcomes for pediatric patients with GBS,it is
essential to raise awareness about this condition & promote early
recognition and treatment. Healthcare professionals should
consider GBS as a possible diagnosis in patients presenting with
unexplained weakness or paralysis, and take prompt action to
ensure the best possible outcome for the patient.
Conclusion

10. Thanks
Do you have any
questions?
LinkedIn : Tazeen Syed