From the Guidelines
Pediatric Guillain-Barré Syndrome (GBS) rehabilitation should be tailored to each child's specific needs, with treatment beginning as soon as possible after diagnosis, ideally in a specialized pediatric rehabilitation facility with experience in neurological conditions. The rehabilitation program typically includes:
- Physical therapy, focusing on range of motion exercises, progressive strengthening, and mobility training
- Occupational therapy, addressing activities of daily living and fine motor skills
- Respiratory therapy if breathing has been affected
- Speech therapy for children with bulbar involvement causing swallowing or speech difficulties
- Pain management, often using gabapentin (5-10 mg/kg/dose three times daily) or carbamazepine (5-10 mg/kg/day divided twice daily) for neuropathic pain, as suggested by 1 Psychological support should be integrated throughout recovery, as the sudden onset of paralysis can be traumatic for children. The rehabilitation process may last weeks to months, with most children showing significant improvement within 6-12 months, though some may have residual weakness. Regular reassessment is essential to adjust the rehabilitation plan as the child recovers. Family education and involvement are vital components of successful rehabilitation, helping to ensure continuity of care when the child returns home. According to 1, IVIg is usually the first-line therapy for children with GBS, and the standard adult regimen of 2 g/kg (body weight) over 5 days is recommended, as it has been shown to have fewer complications than the 2-day regimen.
From the Research
Pediatric GBS Rehabilitation
- The rehabilitation treatment for patients recovering from Guillain-Barre syndrome (GBS) is crucial for ensuring medical stability, appropriate treatment, and preventive measures to minimize long-term complications 2.
- Effective communication between the GP and rehabilitation physicians is imperative for improved functional outcomes and successful social reintegration 2.
Treatment Options
- Therapeutic plasma exchange (TPE) has shown promise in treating pediatric GBS, with significant improvement in neurological functions and minimal residual deficits 3.
- Intravenous immunoglobulin (IVIg) is also beneficial in hastening recovery and reducing long-term morbidity from GBS, with moderate quality evidence suggesting it is as effective as plasma exchange (PE) in severe disease 4.
- IVIg is recommended for severe or persistently-progressive GBS, while plasmapheresis is recommended in cases of IVIg intolerance or inefficacy 5.
Intensive Care and Treatment
- Up to 30% of patients with severe GBS develop respiratory failure and require mechanical ventilation and intensive care 6.
- Immunotherapies, mechanical ventilation, supportive care, and complication management are equally emphasized in the intensive care unit (ICU) setting 6.
- Multidisciplinary supportive care and prevention of life-threatening complications are crucial for severe cases of GBS 6.
Key Considerations
- The diagnosis and treatment of GBS in childhood and adolescence largely rely on findings in adult patients, due to the limited number of adequately-controlled studies in this age group 5.
- A high level of consensus can be reached for the crucial steps in diagnosis and treatment using a written, multi-step Delphi process 5.
- Corticosteroids are ineffective for GBS but can be considered when acute onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) is suspected due to a prolonged disease course 5.