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LETTER TO EDITOR
Year : 2004  |  Volume : 52  |  Issue : 1  |  Page : 126

Unusual cause of recurrent flaccid paralysis in a child


Neurology Unit,Department of Neurological Sciences,Christian Medical College Hospital, Vellore - 632004

Correspondence Address:
Neurology Unit,Department of Neurological Sciences,Christian Medical College Hospital, Vellore - 632004
sk@cmcvellore.ac.in



How to cite this article:
Kumar S. Unusual cause of recurrent flaccid paralysis in a child. Neurol India 2004;52:126


How to cite this URL:
Kumar S. Unusual cause of recurrent flaccid paralysis in a child. Neurol India [serial online] 2004 [cited 2019 Nov 13];52:126. Available from: http://www.neurologyindia.com/text.asp?2004/52/1/126/6724


Sir,
I read with interest the recent article by Jain et al[1] They report a child with two episodes of acute flaccid paralysis occurring at ages two and four years respectively, as a manifestation of serum sickness (related to cefadroxyl administration). However, I would like to make certain observations.
Firstly, Jain et al have not presented the details of the nerve conduction studies and therefore, the electrophysiological pattern (axonal or demyelinating) is not apparent in this report. However, the child fulfils the diagnostic criteria[2] (flaccid quadriparesis, universal areflexia and albuminocytological dissociation in the cerebrospinal fluid analysis) for the Guillain-Barre syndrome (GBS). A detailed report of nerve conduction studies would help in further characterization of the disease.
Secondly, we need to exclude certain other conditions in a child presenting with arthritis and flaccid quadriparesis, as GBS is a rare manifestation of serum sickness. These include Lyme disease,[3] Campylobacter jejuni infection[4] and common variable immunodeficiency with autoimmune disease.[5] Exclusion of these possibilities would have further supported a diagnosis of GBS.
Finally, I have concerns regarding the use of steroids in treating this child. The current consensus is to use either plasmapheresis or immunoglobulins for treating GBS in children as steroids have not been found to be beneficial.[6] Moreover, children treated with steroids have been found to have a higher rate of relapse of GBS.[7] 

     References Top

1.Jain S, Swami G, Arya A, Chowdhry B. A case of acute flaccid paralysis as an unusual presentation of serum sickness. Neurol India 2003;51:293.  Back to cited text no. 1    
2.Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barre syndrome. Ann Neurol 1990;27:S21-4.  Back to cited text no. 2  [PUBMED]  
3.Shapiro EE. Guillain-Barre syndrome in a child with serologic evidence of Borrelia burgdorferi infection. Pediatr Infect Dis J 1998;17:264-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Bereswill S, Kist M. Recent developments in Campylobacter pathogenesis. Curr Opin Infect Dis 2003;16:487-91.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Conley ME, Park CL, Douglas SD. Childhood common variable immunodeficiency with autoimmune disease. J Pediatr 1986;108:915-22.  Back to cited text no. 5  [PUBMED]  
6.Hughes RA, Wijdicks EF, Barohn R, et al. Practice parameter: Immunotherapy for Guillain-Barre syndrome: Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2003;61:736-40.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Dias-Tosta E, Brasil JP, Figueiredo MA. The use of corticosteroids in Guillain-Barre syndrome: study of 51 cases. Arq Neuropsiquiatr 1986;44:117-24.  Back to cited text no. 7    

 

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Online since 20th March '04
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