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Diagnosis and management of Guillian Barre Syndrome in children and adolescents

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- Appendix

Table3 :GBS disability scale (Hughes and Cornblath) (45)

0 - healthy

1 - minor symptoms or signs of neuropathy, but capable of manual work and running

2 - can walk without the aid of a stick for 5 m across an open space, but is not capable of manual work or running

3 - can walk with a stick, orthosis or support (5 m across an open space)

4 - bedridden or wheelchair-bound

5 - ventilation assistance required (for any part of the day or night)

6 – dead


Table 4:Medical Research Council (MRC) Scale for Manual Muscle Testing

 

5 - patient can maintain position against maximal resistance and through the entire physiological range of motion of the joint

4 - patient can maintain position against moderate resistance, and moves actively through the entire physiological range of motion of the joint

3 - patient cannot maintain position against resistance, but can move the extremity against gravity through the full range of motion

2 - patient can move the extremity through part of the physiological range of motion if gravity is eliminated

1 - muscle contraction can be detected by palpation if gravity is eliminated

0 - no contractions identifiable

 

Table 5.  The erasmus Guillain–Barré syndrome (GBS) Respiratory Insufficiency Score (eGRIS)

Measures

Categories

Score

Days between onset of weakness and hospital admission

<7

4-7                                                  

<3

0

1

2

Facial and/or bulbar weakness at hospital admission

Absent

Present

0

1

MRC sum score at hospital admission

60-51

50-41

40-31

30-21

<20

0

1

2

3

4

EGRIS

NA

0-7

NA, not applicable.

An eGRIS of 0–2 indicates a low risk of mechanical intervention, 3–4 indicates an intermediate risk of mechanical intervention and ≥5 indicates a high risk of mechanical intervention.

 Table 6: The most important differential diagnoses of GBS

Intracranial

·        Meningeosis neoplastica/leucaemica

·        Brain stem encephalitis

Peripheral Nerves

·        Axonal sub-acute recurrent neuropathy, with elevated CSF lactate levels in patients with a PDHcIa-mutation

·        Metabolic disorders such as hypermagnesemia or hypophosphatemia

·        Tick paralysis

·        Heavy metal toxicity such as arsenic, gold and thallium

·        Medication-induced neuropathy (e.g. vincristine, platinum compounds, nitrofurantoin, paclitaxel)

·        Porphyria

·        Critical illness neuropathy

·        Vasculitis

·        Diphtheria

Spinal cord

·        Infarction, myelitis, compression

·        Anterior horn motor neurons Polio and other enteroviruses that can trigger poliomyelitis, including West Nile Virus

 Nerve roots

·        Chronic inflammatory demyelinating polyneuropathy (CIDP)

·        Cauda equina compression

Neuromuscular end-plate

·        Myasthenia gravis

·        Organophosphate poisoning

·        Botulism

Muscle

·        Critical illness

·        Polymyositis

·        Dermatomyositis

·        Hypo-/hyperkalemia

·        Periodic paralysis