Methylprednisolone as an adjunct to intravenous immunoglobulin in pediatric Guillain–Barré syndrome: a prospective comparative study

Abstract

Guillain–Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in children. Intravenous immunoglobulin (IVIG) is considered the standard therapy; however, the potential benefit of adjunctive corticosteroids remains uncertain.This study aimed to explore whether the addition of short-course intravenous methylprednisolone to IVIG may accelerate recovery and alleviate neuropathic pain in pediatric patients with GBS. A prospective, comparative study was conducted at Al-Azhar University Hospitals, enrolling 28 pediatric patients with clinically and electrophysiologically confirmed GBS. Participants were randomized into two equal groups: Group A received IVIG alone (1 g/kg/day for two days), while Group B received IVIG combined with pulse-dose methylprednisolone (30 mg/kg/day for five days). Clinical outcomes including time to initial improvement, unaided ambulation, Hughes Disability Score, neuropathic pain, and adverse events were assessed over a six-month follow-up period. Baseline characteristics were comparable between groups. The combination therapy group demonstrated faster initial improvement (median 3 vs. 4.5 days), earlier independent ambulation (21 vs. 28 days), and modest improvement in Hughes score at three months (median 0 vs. 1, p = 0.016), though clinical significance is limited. Neuropathic pain resolved completely in the steroid group but persisted in 57.1% of the IVIG-only group (p = 0.002). By six months, nearly all patients achieved complete recovery. Adverse events in the combination group were limited to mild weight gain and increased appetite. Short-course methylprednisolone as an adjunct to IVIG may provide early benefits, particularly in pain resolution, without major safety concerns. These findings are preliminary and hypothesis-generating, requiring confirmation in larger multicenter trials. These findings highlight a feasible and safe strategy that could be particularly valuable in resource-limited healthcare settings, though confirmation in larger multicenter trials is warranted.