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To test the efficacy and safety of corticotropin-based immunotherapies in pediatric opsoclonus-myoclonus syndrome, 74 children received corticotropin alone or with intravenous immunoglobulin (groups 1 and 2, active controls); or both with rituximab (group 3) or cyclophosphamide (group 4); or with rituximab plus chemotherapy (group 5) or steroid sparers (group 6). There was 65% improvement in motor severity score across groups ( P < .0001), but treatment combinations were more effective than corticotropin alone ( P = .0009). Groups 3, 4, and 5 responded better than group 1; groups 3 and 5 responded better than group 2. The response frequency to corticotropin was higher than to prior corticosteroids ( P < .0001). Fifty-five percent had adverse events (corticosteroid excess), more so with multiagents ( P = .03); and 10% had serious adverse events. This study demonstrates greater efficacy of corticotropin-based multimodal therapy compared with conventional therapy, greater response to corticotropin than corticosteroid-based therapy, and overall tolerability.

Guillain-Barré syndrome is the most common paralytic illness affecting children and adolescents in countries with established immunization programs. The term is currently used to encompass a group of disorders in which an autoimmune response occurs days or weeks after an antecedent infection or event (e.g., immunization) and results in an acute polyradiculoneuropathy with flaccid weakness, areflexia, and increased cerebrospinal fluid protein. This chapter reviews the epidemiology, clinical presentation, diagnostic criteria, pathogenesis, treatment, and outcome of this condition.