Unusual variants of Guillain-Barré syndrome in infancy

To identify unusual variants within a paediatric population of patients with Guillain-Barré syndrome (GBS), to determine the frequency of their occurrence and to describe their clinical and electrophysiological characteristics. The medical records of 179 patients diagnosed with GBS were reviewed. Those who strictly satisfied the Asbury criteria were excluded. Twenty patients, with a mean age of 7.6 years at the onset of symptoms, presented the following clinical variants: multiple cranial polyneuropathy (4 cases), Miller Fisher syndrome (MFS) (3 cases), pharyngeal-cervical-brachial palsy (PCBP) (2 cases), combined MFS and PCBP (3 cases), paraparesis (4 cases), palpebral ptosis without ophthalmoplegia (1 case), ophthalmoplegia without ataxia (1 case), paresis of the abducent nerve with paresthesias (1 case), and saltatory (1 case). Albuminocytologic dissociation was reported in 77.8% of patients and neuroconduction with a demyelinating pattern was noted in 75%. Patients progressed favourably in 94.4% of cases. In our study, 11.2% of a population of children with GBS presented unusual variants and did not meet the criteria established by Asbury et al. Recognising these variants of GBS in patients with complex pictures such as those described here enables therapy to be established quickly. The question remains as to whether these variants represent a clinical response to different antibodies or to a regional susceptibility of the host.