Outcome of Acute Flaccid Paralysis in Children Experience of Tripoli Children Hospital 2012-2017

Abstract

Acute flaccid paralysis in children is an emergency demanding prompt diagnosis and treatment without delay
to prevent life-threatening complications. Guillain-Barré Syndrome (GBS) is the most common cause of acute
flaccid paralysis in children, it is an acute monophasic demyelinating neuropathy, Etiology of GBS is incompletely
understood, prognosis is usually good with early detection and prompt treatment. This retrospective study was done
to assess the clinico-laboratory profile of children admitted to Tripoli Children Hospital with acute flaccid paralysis.
In this study, we performed a clinical analysis and reviewed the data of 58 infants/children presented with AFP
and admitted to Tripoli Children Hospital in the period from July 2012 – July 2017 medical records were reviewed
for the demographic data (age, sex), seasonal distributions, history of preceding events, time from onset to nadir,
co-morbid conditions, clinical features, need of mechanical ventilation, results of CSF examination, spinal MRI,
electrophysiological data, mode and results of the treatment.
Study group of 58 patients consisted of 25 (34.1%) males and 33 females (56.9%), with male to female ratio
0.76:1. Mean age of onset was 4.2± 3.5 years (range from 8 months-14years) 23 patients (39.9%) presented at
summer season. Upper respiratory tract infections were the most common antecedent infections (55.2%). and the
neurological findings were weakness of both lower limbs in all patients (100%), while cranial neuropathies were
found in 31%. Nerve conduction study revealed that acute inflammatory demyelinating polyradiculoneuropathy
was found in 16% of cases, acute motor axonal neuropathy in 36% of cases, whereas acute motor-sensory axonal
neuropathy was found in 40%. The outcome according to Hughes motor scale (HMS) the majority of patients
(79.3%) were healthy while 12.1 have minor weakness and one mortality (1.7%).
Conclusion: Guillain-Barre syndrome (GBS) is the commonest cause of acute flaccid paralysis in children. The
diagnosis of GBS is based primarily on the clinical evaluation and the exclusion of important possible alternative
diagnoses. In this study two patients were diagnosed as transverse myelitis, one as paraspinal collection, other
as spinal canal ependymoma. Cranial neuropathy is common in GBS and bulbar palsy is an indicator for need of
ventilatory support