Long-term Disability and Poor Outcome Predictors of Guillain-Barre Syndrome in Children: A Systematic Review

Background: Guillain-Barre syndrome (GBS) is an immune-mediated polyneuropathy and a common cause of acute ascending weakness in children.  Objectives: This study aims to report long-term disability and poor outcome predictors of GBS in children. Medline (via Pubmed), Embase, Cochrane Library, Web of Science, and Scopus database was searched for relevant studies until April 2022, with a designated search strategy, using MeSH terms and free keywords. Methods: Studies evaluating functional outcomes of GBS in children with at least one year of follow-up were included. All studies achieved acceptable quality for inclusion. After selecting studies based on inclusion criteria, data were extracted based on a modified standardized Joanna Briggs Institute (JBI) data extraction tool, and the methodological quality of studies were reviewed using the Joanna Briggs Institute (JBI) critical appraisal tool. Results: Fourteen studies were included in this systematic review consisting of 1141 patients (647 males, 466 females, and 28 unclassified). Follow-up duration varied from one year to 11 years. The prevalence of the GBS subtype was as follows, acute inflammatory demyelinating polyneuropathies (AIDP) 46.6%, acute motor axonal neuropathy (AMAN) 30.2%, acute motor and sensory axonal neuropathy (AMSAN) 6.8% and Miller fisher 6.1%. The most commonly reported poor outcome after at least one year of follow-up was walking disabilities and gait disorders. Motor deficits and weakness, sensory complaints, including pain or paresthesia and fatigue were other prevalent residual symptoms. Axonal form of GBS was the most reported poor outcome predictor, followed by Hughes disability score 3, a delay in independent walking, artificial ventilation, and rapid progression of symptoms. Conclusions: Despite the good prognosis of GBS in children, they could suffer long-term sequels, especially in walking abilities and gait. The axonal form is considered a crucial poor predictive factor.