Clinical And Neurophysiologic Findings In Guillain-Barré Syndrome

Objection : The study was to investigate clinical findings and neurophysiologic abnormalities in patients with Guillain—Barre syndrome(GBS) who were within one month of symptom onset. The study could offer the objective indications for diagnosing and treatment of GBS.Methods: Clinical data from 23 GBS patients assessed within 1 month of symptom onset were reviewed during the period of 2001—2004. Motor conduction velocity(MCV), sensory conduction velocity(SCV), F wave, H reflex and electromyography(EMG) were regularly detected in 23 cases;and MCV, distal motor latency(DML), distal compound muscle action potential(CMAP) amplitude, SCV, sensory nerve action potential(SNAP), F-persistence and F response chronodispersion, H reflex and EMG were evaluated.Results: Clinical findings: Of 23cases, 17 were males, 6 were females, mean age was 45.7 years. 6 cases (26.1%) were preceded by a respiratory or gastrointestinal infection;21 cases (91.3%) were present with weakness;11 cases (47.8%) had sensory complaints, while neurologic examination showed only 7 cases (30.4%) had sensory disorders;tendon reflexes were absent and reduced in 20 cases ( 86.9%);facial diplegia occurred in 4 cases (17.4% );5 cases (21.7% ) showed bulbar paralysis;CSF examination showed 12 (60%) in 20 cases had increased protein concentration but a normal cell counts. 2 cases with normal muscle force were diagnosed pure sensory GBS and multiple cranial nerve paralysis. 23 cases were treated with intravenous immunoglulin(IVIG) , plasma extrange(PE) and/or corticosteroids, all the patients remitted after treatment.Neurophysiologic findings: Slowed MCV were found in 12 cases (52.2%) , DML was prolonged in 13 cases ( 56.5%);partial conduction block(CB) was present in 16 cases (69.6%) and possible conduction block/temporal dispersion(CB/TD) were noted in 7 cases (30.4%) . Needle electrode examination were performed in 12 of 23 cases and only 4 cases (33.3%) had fibrillation potentials and/or positive waves. 10 cases (43.5%) had slowed SCV;21 cases (91.3%) had reduced SNAP amplitude;in 13 cases (56.5%) the median and/or ulnar SNAP amplitude were reduced while the sural and superficial peroneal SNAP remained intact. Some abnormality of F waves, either low F-persistence or absence, were noted in 21 cases (91.3%), and increased F response chronodispersion was present in 22 cases (95.6%) . Tibial nerve H reflexes were examined in 5 cases and the H reflex was absent in 3 cases.Conclusion: 1 > GBS was a common cause of acute or subacute generalized paralysis, which was characterized by symmetric weakness and sensory disorders,usually more marked motor symptoms than sensory complaints. Tendon reflexes were absent or reduced. Facial diplegia and bulbar paralysis were also involved. The CSF showed increased protein concentration but a normal cell count.2^ Besides the typical case of GBS, there were variants of GBS such as multiple cranial nerve paralysis and pure sensory GBS. CSF examination, neurophysiologic studies and the pathologic findings of sural biopsy were very useful in the diagnosis and differential diagnosis of variants of GBS.3 > GBS had the following neurophysiologic abnormalities: slowed MCV, prolonged DML, low distal CMAP amplitude, CB/TD, slowed SCV, reduced SNAP amplitude, low F-persistence and increased F response chronodispersion. Reduced distal CMAP amplitude was caused by demyelination with secondary axonal damage, and distal conduction block was also another cause.4> The unusual combination of reduced amplitude of upper limb SNAP with normal lower limb SNAP amplitude would be a sensitive but specific neurophysiologic abnormality in the diagnosis of GBS. Reduced distal CMAP amplitude, redued SANP amplitude, low F-persistence and increased F response chronodispersion were the sensitive findings in GBS.5 -. Specific treatment of the presumed immune disorder that underlies GBS included intravenous immunoglobulin(IVIG) and plasma exchange(PE). IVIG was convenient for clinical use. And corticosteroids could still be an option in the treatment of GBS in case of economic consideration.