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ARTICLES: I. Nachamkin, P. Arzate Barbosa, H. Ung, C. Lobato, A. Gonzalez Rivera, P. Rodriguez, A. Garcia Briseno, L. Maria Cordero, L. Garcia Perea, J. Carlos Perez, M. Ribera, J. Veitch, C. Fitzgerald, D. Cornblath, M. Rodriguez Pinto, J. W. Griffin, H. J. Willison, A. K. Asbury, and G. M. McKhann Patterns of Guillain-Barré syndrome in children: Results from a Mexican population Neurology 2007; 69: 1665-1671 [Abstract] [Full text] [PDF]

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Patterns of Guillain-Barré syndrome in children: Results from a Mexican population

Usha K Misra, Jayantee Kalita   (14 February 2008)

Patterns of Guillain-Barré syndrome in children: Results from a Mexican population 14 February 2008
Usha K Misra, Sanjay Gandhi PGIMS Department of Neurology, SGPGIMS, Raebareily Road, Lucknow 226014, INDIA, Jayantee Kalita Send Correspondence to journal: Re: Patterns of Guillain-Barré syndrome in children: Results from a Mexican population drukmisra{at}rediffmail.com Usha K Misra, et al.	We read with interest the paper by Nachamkin et al. who reported that acute motor axonal neuropathy (AMAN) was more common (59%) than AIDP (41%).[1] This distribution of Guillain-Barré syndrome (GBS) is similar in China, Japan and South America whereas the acute inflammatory demyelinating neuropathy (AIDP) form of GBS is more common in Western Europe, America and Australia where it constitutes 80- 90% of GBS in children and adults. [2] We are interested in the number of nerves evaluated and the timing of the nerve conduction studies that were undertaken by Nachamkin et al; both which impact the results. We evaluated 51 GBS patients six of whom were children. The clinical presentation was pure motor in 31, sensory motor in 18 and pure sensory in 2 patients. However, after nerve conduction studies in all limbs including six motor and six sensory nerves, AIDP was diagnosed in 44 (86.3%), AMAN in four (7.8%) and acute motor sensory axonal in three (5.9%) patients. [3] This distribution is similar to that reported in Western countries. The sensitivity of neurophysiological studies increases with the duration of illness. In a Dutch GBS study, the sensitivity of nerve conduction was 60% in diagnosing demyelinating neuropathy in the first test (median 6 days) which increased to 72% in the third test (median 34 days). [4] It is important to consider the extent of nerve conduction evaluation and timing of the study before concluding the commonness of AMAN in a geographical area. A repeat nerve conduction study may also be crucial. References 1. Nachamkin I, Arzate Barbosa P, Ung H, et al. Patterns of Guillain Barre syndrome in children. Neurology 2007; 69:1665-1671. 2. Hughes RAC, Cornblath DR. Guillain Barre syndrome. Lancet 2005; 366:1653-1666. 3. Kalita J, Misra UK, Das M. Neurophysiological criteria in the diagnosis of different clinical types of Guillain Barre syndrome. J Neurol Neurosurg Psychiat 2007 (in the press). 4. Meulstee J, Van der Meche and the Dutch Guillain Barre Study group. Electrodiagnostic criteria for polyneuropathy and demyelination: application in 135 patients with Guillain Barre syndrome. J Neurol Neurosurg Psychiatry 1995; 59:482-486. Disclosure: The authors report no conflicts of interest. The authors had the opportunity to respond but declined.