Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(04): 248-254
DOI: 10.1590/0004-282X20170026
REVIEW

Acute muscular weakness in children

Fraqueza muscular aguda em crianças
Ricardo Pablo Javier Erazo Torricelli
1   Hospital Luis Calvo Mackenna, Provencia, Santiago, Chile;
2   Clinica Alemana, Vitacura, Santiago, Chile.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Acute muscle weakness in children is a pediatric emergency. During the diagnostic approach, it is crucial to obtain a detailed case history, including: onset of weakness, history of associated febrile states, ingestion of toxic substances/toxins, immunizations, and family history. Neurological examination must be meticulous as well. In this review, we describe the most common diseases related to acute muscle weakness, grouped into the site of origin (from the upper motor neuron to the motor unit). Early detection of hyperCKemia may lead to a myositis diagnosis, and hypokalemia points to the diagnosis of periodic paralysis. Ophthalmoparesis, ptosis and bulbar signs are suggestive of myasthenia gravis or botulism. Distal weakness and hyporeflexia are clinical features of Guillain-Barré syndrome, the most frequent cause of acute muscle weakness. If all studies are normal, a psychogenic cause should be considered. Finding the etiology of acute muscle weakness is essential to execute treatment in a timely manner, improving the prognosis of affected children.

RESUMO

A fraqueza muscular aguda (FMA) na criança é uma emergência pediátrica. Durante a abordagem diagnóstica, é crucial obter uma anamnese detalhada que inclua: início da fraqueza, história de estados febris associados, ingestão de substâncias tóxicas/toxinas, imunizações e história familiar. O exame neurológico também deve ser acurado. Nesta revisão, nós descrevemos as doeças mais frequentemente associadas com FMA, agrupadas pelo local de origem (desde o neurçnio motor superior até a unidade motora). A detecção precoce de aumento de CK pode levar ao diagnóstico de miosite, e a hipopotassemia orienta para o diagnóstico de paralisia periódica. A oftalmoparesia, ptose e sinais bulbares são sugestivos de miastenia gravis ou de botulismo. Fraqueza distal e hiporeflexia são dados clínicos da síndrome de Guillain Barré (SGB), a mais frequente causa de FMA. Se todos os estudos são normais, uma causa psicogênica pode ser considerada. A busca da etiologia da FMA é essencial para que o tratamento seja feito a tempo, melhorando o prognóstico da criança afetada.

muscle weakness - poliomyelitis - Guillain-Barré syndrome - botulismo - myasthenia gravis
debilidade muscular - poliomielite - síndrome de Guillain-Barré - botulismo - miastenia gravis


Publication History

Received: 12 July 2016

Accepted: 29 July 2016

Article published online:
05 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Oostvogel PM, Spaendonck MA, Hirasing RA, Loon AM. Surveillance of acute flaccid paralysis in the Netherlands. Bull World Health Org. 1998;76(1):55-62.
  • 2 Leshner RT, Campbell WW. Pediatric neuromuscular emergencies. In: Pellock JM, Myer EC, editors. Neurologic emergencies. Philadelphia: Harper and Row; 1984.
  • 3 Erazo R. Parálisis flácida aguda. Rev Chil Pediatr. 1995;66(Suppl 1):9-13.
  • 4 Campos-Olazábal P. Parálisis flácida aguda. Rev Neurol. 2002;34(2):131-3.
  • 5 Antoniuk SA. Debilidad muscular aguda: diagnósticos diferenciales. Rev Neurol 2013;57(Suppl 1):S149-54.
  • 6 Medical Research Council. Aids to the examination of the peripheral nervous system. London: Her Majesty’s Stationery Office; 1981. (Memorandum, Nº 45).
  • 7 Acute flaccid paralysis surveillance: a global platform for detecting and responding to priority infectious diseases. Wkly Epidemiol Rec. 2004;79(48):425-32.
  • 8 Tenembaum S. Acute disseminated encephalomyelitis. In: Dulac O, Lassonde M, Sarnat HB, editors. Pediatric neurology Part II. Amsterdam: Elsevier; 2013. p. 1255-62. (Handbook of clinical neurology, Vol 112).
  • 9 Reynolds T. Polio: an end in sight? BMJ. 2007;335(7625):852-4. https://doi.org/10.1136/bmj.39367.426655.AD
  • 10 Jasem JA, Marof K, Nawar A, Khalaf I, Al-Hamdani S, Ali A et al. Surveillance of acute flaccid paralysis in Iraq: 1998 to 2011. BMC Infect Dis. 2014;11(3):164-73. https://doi.org/10.1186/1471-2334-14-4481
  • 11 Huang CC, Liu CC, Chang YC, Chen CY, Wang ST, Yeh TF. Neurologic complications in children with enterovirus 71 infection. N Engl J Med. 1999;341(13):936-42. https://doi.org/10.1056/NEJM199909233411302
  • 12 Leis AA, Stokic DS, Polk JL, Dostrow V, Winkelmann M. A poliomyelitis-like syndrome from West Nile virus infection. N Engl J Med. 2002;347(16):1279-80. https://doi.org/10.1056/NEJM2002c021587
  • 13 Asbury AK. New concepts of Guillain-Barré syndrome. J Child Neurol. 2000;15(3):183-91. https://doi.org/10.1177/088307380001500308
  • 14 Sladky JT. Guillain-Barré syndrome. In: Jones HR Jr, De Vivo DH, Darras BT, editors. Neuromuscular disorders of infancy, childhood and adolescente: a clinical approach. Oxford: Butterworth Heinemann; 2003. p. 407-44.
  • 15 Erazo Torricelli R. Síndrome de Guillain Barré en pediatría. Medicina (B. Aires). 2009;69(1 supp 1):84-91.
  • 16 Korinthenberg R. Acute polyradiculoneuritis: Guillain-Barré syndrome. Handb Clin Neurol. 2013;112:1157-62. https://doi.org/10.1016/B978-0-444-52910-7.00036-2
  • 17 Keka A, Ramosaj A, Toro H, Azemi M, Baloku A, Sylaj B et al. Acute poisoning in children: changes over the years, data of pediatric clinic department of toxicology. J Acute Dis. 2014;3(1):56-8. https://doi.org/10.1016/S2221-6189(14)60012-3
  • 18 Kukreti V, Shamim M, Khilnani P. Intensive care unit acquired weakness in children: critical illness polyneuropathy and myopathy. Indian J Crit Care Med. 2014;18(2): 95-101. https://doi.org/10.4103/0972-5229.126079
  • 19 Pickett J, Berg B, Chaplin E, Brunstetter-Shafer MA. Syndrome of botulism in infancy: clinical and electrophysiologic study. N Engl J Med. 1976;295(14):770-2. https://doi.org/10.1056/NEJM197609302951407
  • 20 Erazo R, Marambio E, Cordero J, Fielbaum O, Triviño X. Botulismo infantil: comunicación de un caso. Rev Med Chil. 1987;115(4):344-8.
  • 21 Erazo R. Miastenia gravis y síndromes miasténicos en el niño. Rev Chil Pediatr. 1990;61(5):287-90.
  • 22 Schenone H. Cuadros tóxicos producidos por mordeduras de araña en Chile: latrodectismo y loxoscelismo. Rev Med Chil. 2003;131(4):437-44. https://doi.org/10.4067/S0034-98872003000400013
  • 23 Gothe R, Kunze K, Hoogstraal H. The mechanisms of pathogenicity in the tick paralyses. J Med Entomol. 1979;16(5):357-69. https://doi.org/10.1093/jmedent/16.5.357
  • 24 Papazian O, Alfonso I, Araguez N. Miastenia gravis juvenil. Medicina (B. Aires). 2009;69(1 suppl 1):71-83.
  • 25 Wendell LC, Levine JM. Myasthenic crisis. Neurohospitalist .2011;1(1):16-22. doi:10.1177/1941875210382918
  • 26 Bird SJ, Levine JM. Myasthenic crisis. UpToDate. 2014 [cited 2016 Jan 27]. Available from: http://www.uptodate.com/contents/myasthenic-crisis
  • 27 Mackay MT, Kornberg AJ, Shield LK, Dennett X. Benign acute childhood myositis. laboratory and clinical features. Neurology. 1999;53(9):2127-31. https://doi.org/10.1212/WNL.53.9.2127
  • 28 Miller TM, Silva MRD, Miller HA, Kwiecinski H, Mendell JR, Tawil R et al. Correlating phenotype and genotype in the periodic paralyses. Neurology. 2004;63(9):1647-55. https://doi.org/10.1212/01.WNL.0000143383.91137.00
  • 29 Williams S, Horrocks IA, Ouvrier RA, Gillis J, Ryan MM. Critical illness polyneuropathy and myopathy in pediatric intensive care: a review. Pediatr Crit Care Med. 2007;8(1):18-22. https://doi.org/10.1097/01.pcc.0000256623.01254.40
  • 30 Maida AM, Molina ME, Erazo R. [Münchausen-by-proxy syndrome: report of one case]. Rev Med Chil. 2001;129(8):917-20. Spanish. https://doi.org/10.4067/S0034-98872001000800011