Neuropediatrics 2023; 54(01): 020-030
DOI: 10.1055/a-1941-4513
Original Article

Sural Sparing Pattern and Sensory Ratio as Electrodiagnostic and Prognostic Markers in Pediatric Guillain–Barré Syndrome

1   Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
1   Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
1   Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
1   Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
› Author Affiliations
Funding None.


Background We aimed to evaluate the presence of sural sparing pattern (SSP) and sensory ratio in pediatric Guillain–Barré syndrome (GBS), their distribution to subtypes, and their relationship with demographic and clinical features with a focus on the disability and muscle strength.

Methods This single-center retrospective study was conducted on pediatric GBS patients of both sexes with 2 years follow-up and two nerve conduction studies in which SSP and sensory ratio were calculated. Three subgroups of SSP were formed by separate calculation of median (SSP-m) and ulnar (SSP-u) and both median and ulnar sensory nerve action potentials (SNAPs; SSP-total). Muscle strength and disability were evaluated with the Medical Research Council (MRC) sum score and Hughes functional grading scale (HFGS), respectively.

Results SSP total was identified in 70.6% (n: 24) of the patients, while sensory ratio >1 was observed in 20 (66.7%) patients. Patients with SSP-m, SSP-u, SSP-total, or sensory ratio >1 had higher HFGS scores, while patients with SSP-m, SSP-u, or SSP-total had lower MRC sum scores. SSP parameters were significantly associated with muscle strength and disability scores in acute motor axonal neuropathy patients.

Conclusion Both SSP and sensory ratio can be used for diagnostic and prognostic purposes. Disability and muscle strength are associated with SSP and sensory ratio in pediatric GBS.


All authors have seen and approved the final version of the main text.

Ethical Approval

The present study was conducted in accordance with the 1964 Declaration of Helsinki and approved by the Ethics Committee of Dokuz Eylul University Faculty of Medicine (number of approval: 2022/08-10).

Publication History

Received: 05 May 2022

Accepted: 24 August 2022

Accepted Manuscript online:
12 September 2022

Article published online:
27 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Wang Y, Sun S, Zhu J, Cui L, Zhang H-L. Biomarkers of Guillain-Barré syndrome: some recent progress, more still to be explored. Mediators Inflamm 2015; 2015: 564098
  • 2 Albertí MA, Alentorn A, Martínez-Yelamos S. et al. Very early electrodiagnostic findings in Guillain-Barré syndrome. J Peripher Nerv Syst 2011; 16 (02) 136-142
  • 3 Freiha J, Zoghaib R, Makhoul K. et al. The value of sensory nerve conduction studies in the diagnosis of Guillain-Barré syndrome. Clin Neurophysiol 2021; 132 (05) 1157-1162
  • 4 Umapathi T, Li Z, Verma K, Yuki N. Sural-sparing is seen in axonal as well as demyelinating forms of Guillain-Barré syndrome. Clin Neurophysiol 2015; 126 (12) 2376-2380
  • 5 Yadegari S, Nafissi S, Kazemi N. Comparison of electrophysiological findings in axonal and demyelinating Guillain-Barre syndrome. Iran J Neurol 2014; 13 (03) 138-143
  • 6 Capasso M, Notturno F, Manzoli C, Uncini A. Involvement of sensory fibres in axonal subtypes of Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry 2011; 82 (06) 664-670
  • 7 Korinthenberg R, Trollmann R, Felderhoff-Müser U. et al. Diagnosis and treatment of Guillain-Barré Syndrome in childhood and adolescence: An evidence- and consensus-based guideline. Eur J Paediatr Neurol 2020; 25: 5-16
  • 8 Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain 2014; 137 (Pt 1): 33-43
  • 9 Roodbol J, de Wit MY, van den Berg B. et al. Diagnosis of Guillain-Barré syndrome in children and validation of the Brighton criteria. J Neurol 2017; 264 (05) 856-861
  • 10 Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990; 27 (Suppl): S21-S24
  • 11 Al-Shekhlee A, Robinson J, Katirji B. Sensory sparing patterns and the sensory ratio in acute inflammatory demyelinating polyneuropathy. Muscle Nerve 2007; 35 (02) 246-250
  • 12 Ryan CS, Conlee EM, Sharma R, Sorenson EJ, Boon AJ, Laughlin RS. Nerve conduction normal values for electrodiagnosis in pediatric patients. Muscle Nerve 2019; 60 (02) 155-160
  • 13 Hiew FL, Rajabally YA. Sural sparing in Guillain-Barré syndrome subtypes: a reappraisal with historical and recent definitions. Clin Neurophysiol 2016; 127 (02) 1683-1688
  • 14 Derksen A, Ritter C, Athar P. et al. Sural sparing pattern discriminates Guillain-Barré syndrome from its mimics. Muscle Nerve 2014; 50 (05) 780-784
  • 15 Al-Hillali A, Baqi Z, Almusawi A, Majeed R. Sural sparing pattern in the diagnosis of guillian barre syndrome in children. Ann Trop Med Public Health 2020; 23 DOI: 10.36295/ASRO.2020.231027.
  • 16 Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet 2016; 388 (10045): 717-727
  • 17 Webb AJS, Brain SAE, Wood R, Rinaldi S, Turner MR. Seasonal variation in Guillain-Barré syndrome: a systematic review, meta-analysis and Oxfordshire cohort study. J Neurol Neurosurg Psychiatry 2015; 86 (11) 1196-1201
  • 18 Doets AY, Verboon C, van den Berg B. et al; IGOS Consortium. Regional variation of Guillain-Barré syndrome. Brain 2018; 141 (10) 2866-2877
  • 19 Yao S, Chen H, Zhang Q. et al. Pain during the acute phase of Guillain-Barré syndrome. Medicine (Baltimore) 2018; 97 (34) e11595
  • 20 Leonhard SE, Mandarakas MR, Gondim FAA. et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019; 15 (11) 671-683
  • 21 Gupta PK, Singhi P, Singhi S, Kasinathan A, Sankhyan N. How different is AMAN from AIDP in childhood GBS? A prospective study from North India. Indian J Pediatr 2019; 86 (04) 329-334
  • 22 Kalita J, Kumar M, Misra UK. Prospective comparison of acute motor axonal neuropathy and acute inflammatory demyelinating polyradiculoneuropathy in 140 children with Guillain-Barré syndrome in India. Muscle Nerve 2018; 57 (05) 761-765
  • 23 Nagasawa K, Kuwabara S, Misawa S. et al. Electrophysiological subtypes and prognosis of childhood Guillain-Barré syndrome in Japan. Muscle Nerve 2006; 33 (06) 766-770