8/12/2019 GBS jurnal
1/4
J Neurol Neurophysiol: - , Vo ume 4 Issue 1
Research Ar ticle Open Access
Neurology &Neurophysiology
Geetan ali et al!, J NeurolNeurophysiol 2"1#,
4:1http:$$%&!%oi!or'$1"!41(2$2155-9562!1"""142
R e s e a r c h A r t i c l e O p e n A c c e ss
Early Electrodiagnostic Findings of Guillain Barre
SyndromeSharma Geetanjali 1*, Sood Sushma 1 and Sharma Sudhir 2
1Department of Physiology, University of Health Sciences,
Haryana, India2 Department of Medicine, University of Health
Sciences, Haryana, India
Abstract
Purpose : Guillain Barre Syndrome (GBS) is an acute immune
mediated de-mylelinating poly-radiculo-neuropathy. As early
diagnosis favors a good outcome after treatment, this study was
carried out to analy e theelectro-physiological a!normalities in
the first wee" of GBS in this region.
Basic procedures : #he study was carried out for early
confirmation of GBS in $% clinically diagnosed patientsreporting
within a wee" of muscle wea"ness !y electro-physiological tests in
the years &' '- &.
Results : Slowing of motor conduction velocities, decreased
amplitude and increased distal motor latencies( *+) was seen in
peroneal, ti!ial, median and ulnar nerves in descending order of
severity. onduction !loc"was seen in the lower lim! in ' ( %. /)
patients. 0-wave was completely a!sent in upper and lower lim!s in
%'(1$.2&/) patients while % patients (& .'1/) showed
decreased 0-wave conduction velocity in !oth lim!s.
Sensoryconduction velocity of median nerve was less compared to
sural. 3*G studies showed that demyelinating type of neuropathy was
predominant ( . /).
Discussion : 3lectro-physiological studies play an important
role in the early detection4 characteri ation 5treatment of GBS
!ecause timely intervention reduces mor!idity and disa!ility.
6ncreased *+, a!sent 0- wave,decreased median with normal Sural S 7
(sensory conduction velocity) is diagnostic of early GBS.
Keywords: Peripheral neuropathic weakness;
Electro-diagnosis;Early signs
IntroductionGBS is an auto-immune mediated de-myelinating
polyradiculo-
neuropathy. Males females are e!ually at risk. "linical
featuresinclude progressi#e$ symmetrical ascending muscle weakness
of morethan two lim%s$ arefle&ia with or without sensory$
autonomic and
%rainstem a%normalities '(a%le )*. +eakness is prominent in
legmuscles as compared to arms; there is a%sence of fe#er at the
onsetof neural symptoms. "ranial ner#e in#ol#ement may affect
airway andfacial muscles$ eye mo#ements and swallowing ,) . t
usually presentswith num%ness and tingling in the feet ,/ .
n )010$ 2aymaker and 3ernohan reported the
histo-pathologicalfeatures of 45 fatal cases of GBS. (he earliest
features were edema of
pro&imal ner#es followed %y degeneration of myelin sheath
within the
)st week of illness ,6 .Electro-diagnosis plays an important
role in early detection and
characteri7ation of inflammatory de-myelinating
polyradiculopathies,1 .
8er#e conduction a%normalities %ecome more prominentduring the
initial weeks of the disease e#en if patients clinical status
sent to the 9epartment of Physiology for ner#e conduction. (he
studywas conducted on these :4 su% ects '1/ males /6 females*
%etweenthe age group of :-
8/12/2019 GBS jurnal
3/4
Citation Geetan8ali S, Sushma S, Sudhir S (&' ) 3arly
3lectrodiagnostic 0indings of Guillain Barre Syndrome. > =eurol
=europhysiol ?: ?&.doi: '.? 1&@& %%-2%$&. '''
?&
)a'e 2 o* #
#ariables $o% o& patients
*ales@females ?&@&
Age range $-1'
Age $' %2Cea"ness $%@$%
ArefleDia % @$%
'able 1 linical features in $% patients of GBS.
#ariable $o () o& patients
. 0 waves A!normal, total
a. pper lim!
A!sent %' (1$.2&/)
9rolonged latency % (& .'1/)
=ormal '
!. +ower lim!
A!sent %' (1$.2&/)
9rolonged latency % (& .'1/)
=ormal '
&. S 7
a. pper lim!
=ormal %% ( ?.$ /)
ecrease '% (1.$2/)
A!sent '% (1.$2/)
!. +ower +im! (Sural)
=ormal ?' ($ .&2/)
ecrease &' ( '.1$/)
A!sent % (1.$2/)
. *A9 (compound muscle action potential)
A. onduction velocity( 7) 5 amplitude
a. pper lim!
ecrease in !oth lnar 5median nerves ?? ($1.$/)
ecrease in only ulnar nerve ( &. /)
=ormal 7 (&'. /)
!. +ower lim!ecrease in !oth ti!ial 5
peroneal nervesecrease in only ti!ial nerve
%' (1$.2&/)
% (1.$2/)
onduction !loc" ' ( %. /)
B. istal motor latency
a. pper lim!6ncrease in !oth lnar 5
median nerves ?& ($?/)
6ncrease in only ulnar nerve ( &/)
!. +ower lim!
6ncrease in !oth ti!ial 5peroneal nerves %' (1$.2&/)
6ncrease in only ti!ialnerve % (1.$2/)
onduction !loc" ' ( %. /)
?. 3*Gemyelinating type $' (2&. '/)
ADonal type % (1.$2/)'able 2 3lectro-diagnostic findings in
patients with Guillain Barre Syndrome within
wee".
1. EMG studies 'Electro-myographic studies*? "onducted in9eltoid
@%ductor digiti minimii 'Cpper Dim%* and (i%ialisanterior Peroneus
longus muscles 'lower lim%*.
Electro-diagnostic criteria
@ccording to 9utch Guillain Barre study group criteria only
oneof the following a%normalities in at least two ner#es should
%econsidered ,)) .
). ncreased distal motor latency )45F of upper limit of
normal
/. 9ecreased conduction #elocity
8/12/2019 GBS jurnal
4/4
)a'e # o* #
F wa#e is the most sensiti#e diagnostic test for early GBS. nour
study$ motor conduction #elocity was decreased and
pro&imalconduction %lock was noticed mainly in the lower lim%s.
(he a%o#e
results are in tandem with findings of Gordon$ Kun 3imura
and3uwahara ,1$)5$)1-. n a study done %y =opper et al. on 1)
patients of GBS who underwent electro-diagnostic studies within a
week of onsetof symptoms$ ): patients had a%normalities of compound
muscleaction potentials including dispersion$ delayed latency$ low
amplitude$conduction #elocity slowing$ conduction %lock or a%normal
F-wa#es,)4 . Similar results ha#e %een !uoted %y "louston et al.
,): .
Prolonged distal motor latencies prolonged or a%sent F
wa#esreflect early predilection for in#ol#ement of pro&imal
spinal roots anddistal motor terminals. Cpper lim% S8@PAs
particularly of the medianner#e can %e affected more se#erely and
earlier than those of the suralner#e. (he e&planation of this
finding is multifactorial. Entrapmentsites are more prone i.e.
median ner#e in "arpal (unnel. =educed
S8@P amplitudes can %e the result of secondary a&onal
degenerationand conduction %lock ,)< . (he conduction %lock was
ma&imal in theterminal segment in the upper and lower lim%s$
more so in the lower lim%. (hese findings were consistent with
those of Brown ,) . 2eattri%uted %eing due to relati#e deficiency
of the %lood ner#e %arrier.9ecrease in conduction #elocity is
damage to the myelin sheath;
%oth cellular and immune mechanisms play important roles in
it.Early inflammatory lesions consist of lymphocytic infiltrate;
later onmacrophages %ecome prominent. (he peripheral ner#e
changesconsist of peri#ascular oedema$ accumulation of mono-nuclear
cellsand para- nodal less commonly segmental demyelination ,)0
.
(he EMG studies were conducted on 65 of the :4 patients %ecause
of pro&imity of electro-diagnosis to the symptom onset.EMG
studies showed that demyelinating type of neuropathy was the
predominant form of GBS ' 6.66F* in our series. (his was
inconsistence with the results of Lakoo% et al. ,/5 .
Conclusion
(he glo%al incidence of Guillain Barre Syndrome has
%eenestimated %etween ).)J)55$555Jyear to ). J)55$555Jyear ,/) .
(hus$this syndrome constitutes a ma or load of demyelinating
polyneuropathy cases worldwide. (here seems to %e a slight
preponderance of @ 9P 'acute inflammatory demyelinating
polyneuropathy* #ariety in ndia as suggested %y Gupta et al.
andMeena et al. ,//$/6 @ 9P was the preponderant #ariant in our
studyi.e. in the state of 2aryana. (he results were in line with
the electro-diagnostic criteria for early diagnosis of GBS as
descri%ed in
literature. Electro-diagnostic techni!ues play an important role
inthe early detection and characteri7ation of
inflammatorydemyelinating poly-radiculopathy in the first week of
symptomologyand assume importance in treatment of this syndrome
%ecause timelyinter#ention reduces mor%idity and disa%ility.
Ac+no ledgements
#he authors sincerely than" *r. Eandhir Singh, Senior +a!oratory
#echnician,epartment of 9hysiology, niversity of ;ealth Sciences,
for his untiring co-
operation during nerve conduction studies of the patients.
Re&erences
. ;auser S+, As!ury AF (&''2) Guillain-Barre Syndrome 5
other immune-mediated neuropathies: &$$1-&$1 .
&. Amato AA (&''%) Guillain Barre syndrome 5 related
disorders. Eev *eD=euroci $: ?%%- ?$2.
. ;ayma"er C, Fernohan >C ( 2?2) #he +andry-Guillain-Barr
syndrome4
a clinicopathologic report of %' fatal cases and a critiHue of
the literature.*edicine (Baltimore) & : %2- ? .
?. Gordon 9;, Cil!ourn A> (&'' ) 3arly electrodiagnostic
findings in Guillain-Barr syndrome. Arch =eurol % : 2 -2 1.
%. Al!ers >C ( 2 2) AA3* ase report I?- Guillain Barre
Syndrome &: 1'%J1 .
$. *c+eod >G ( 22%) 6nvestigation of peripheral neuropathy.
> =eurol =eurosurg9sychiatry % : &1?-& .
1. Eoth G, *agistris *E ( 222) 6ndirect discharges as an early
nerve conductiona!normality in the Guillain-Barr syndrome. 3ur
=eurol ?&: - 2.
. Aminoff *>, Green!erg A, Simon E9 (&''%) 6n linical
=eurology. $th ed.*cGraw-;ill *edical, =ew Kor".
2. 0isher *A (&''&) ; refleDes and 0 wave fundamentals
normal and a!normalpatterns. =eurol lin = Am &': 2.
'. Fimura >, But er >0 ( 21%) 0-wave conduction velocity
in Guillain-Barrsyndrome. Assessment of nerve segment !etween
aDilla and spinal cord. Arch=eurol &: %&?-%&2.
. *eulstee >, 7an er *eche 0G ( 22%) 3lectrodiagnostic
criteria for polyneuropathy and demyelination: application in %
patients with Guillain-Barr syndrome. utch Guillain-Barr Study
Group. > =eurol =euro Surg9sychiat %2: ? &-? $.
&. *ishra 7A, Falita > (&''$) linical
=europhysiology, (&ndedn). 3lsevier ;ealthSciences, Gurgaon:
& %.
. =adir LF, =arullah * ( 22 ) 3lectrodiagnostic study of ?'
cases presenting asGuillain Barre Syndrome. 9a" > =eurol ?:
%'-%?.
?. Fuwa!ara S, Mgawara F, *i o!uchi F, Foga *, *ori *, et al.
(&''') 6solateda!sence of 0 waves and proDimal aDonal
dysfunction in Guillain-Barrsyndrome with antiganglioside
anti!odies. > =eurol =eurosurg 9sychiatry $ :
2 - 2%.
%. Eopper A;, Ci8dic"s 30, Shahani B# ( 22') 3lectrodiagnostic
a!normali ties in consecutive patients with Guillain-Barr syndrome.
Arch =eurol ?1: -
1.
$. louston 9 , Fiers +, Luniga G, ros ( 22?) Nuanti tative
analysis of thecompound muscle action potential in early acute
inflammatory demyelinatingpolyneuropathy. 3lectroencephalogr lin
=europhysiol 2 : &?%-&%?.
1. Amato AA, umitru (&''&) AcHuired neuropathies. 6n:
umitru , Amato AA,Lwarts *>. 3ditor. 3lectrodiagnostic medicine,
(&ndedn). 9hiladelphia: ;anley5 Belfus, 6nc: 2 1J '? .
. Brown C0, Snow E ( 22 ) 9at terns and severi ty of conduction
a!normalities inGuillain-Barr syndrome. > =eurol =eurosurg
9sychiatry %?: 1$ -11?.
2. Eamachandran #S, +oren o =K (&' ) Acute 6nflammatory
emyelinating9olyradiculoneuropathy.
&'. Ka"oo! *K, Eahman A, >amil B, Syed =A (&''%)
haracteristics of patients
with Guillain Barre Syndrome at a tertiary care centre in
9a"istan, 22%-&'' .> 9a" *ed Assoc %%: ?2 -?2$.
& . *cGrogan A, *adle G , Seaman ;3, de 7ries S (&''2)
#he epidemiologyof Guillain-Barr syndrome worldwide. A systematic
literature review.=euroepidemiology &: %'- $ .
&&. Gupta , =air *, Baheti ==, Sarma 9S, Furuvilla A, et
al. (&'' ) iplomate- American Board (&'' )
3lectrodiagnostic and clinical aspects of Guillain-Barrsyndrome: an
analysis of ?& cases. > lin =euromuscul is ': ?&-% .
& . *eena AF, Fhadi l"ar S7, *urthy >* (&' ) #rea
tment guidelines for Guillain-Barr Syndrome. Ann 6ndian Acad
=eurol.
Citation Geetan8ali S, Sushma S, Sudhir S (&' ) 3arly
3lectrodiagnostic0indings of Guillain Barre Syndrome. > =eurol
=europhysiol ?: ?&.doi: '.? 1&@& %%-2%$&. '''
?&
http://www.ncbi.nlm.nih.gov/pubmed/18115402http://www.ncbi.nlm.nih.gov/pubmed/18115402http://www.ncbi.nlm.nih.gov/pubmed/11405806http://www.ncbi.nlm.nih.gov/pubmed/7897405http://www.ncbi.nlm.nih.gov/pubmed/7897405http://www.ncbi.nlm.nih.gov/pubmed/7897405http://www.ncbi.nlm.nih.gov/pubmed/7897405http://www.ncbi.nlm.nih.gov/pubmed/7897405http://www.ncbi.nlm.nih.gov/pubmed/10473979http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/7521284http://www.ncbi.nlm.nih.gov/pubmed/7521284http://www.ncbi.nlm.nih.gov/pubmed/7521284http://www.ncbi.nlm.nih.gov/pubmed/7521284http://www.ncbi.nlm.nih.gov/pubmed/7521284http://www.ncbi.nlm.nih.gov/pubmed/7521284http://www.ncbi.nlm.nih.gov/pubmed/1659615http://www.ncbi.nlm.nih.gov/pubmed/1659615http://www.ncbi.nlm.nih.gov/pubmed/1659615http://var/www/apps/conversion/tmp/scratch_5/emedicine.medscape.com/article/1169959-overviewhttp://var/www/apps/conversion/tmp/scratch_5/emedicine.medscape.com/article/1169959-overviewhttp://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/19088488http://www.ncbi.nlm.nih.gov/pubmed/19088488http://www.ncbi.nlm.nih.gov/pubmed/19088488http://www.ncbi.nlm.nih.gov/pubmed/19088488http://www.ncbi.nlm.nih.gov/pubmed/19088488http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/21847334http://www.ncbi.nlm.nih.gov/pubmed/21847334http://www.ncbi.nlm.nih.gov/pubmed/21847334http://www.ncbi.nlm.nih.gov/pubmed/21847334http://www.ncbi.nlm.nih.gov/pubmed/21847334http://www.ncbi.nlm.nih.gov/pubmed/18115402http://www.ncbi.nlm.nih.gov/pubmed/18115402http://www.ncbi.nlm.nih.gov/pubmed/11405806http://www.ncbi.nlm.nih.gov/pubmed/7897405http://www.ncbi.nlm.nih.gov/pubmed/10473979http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/1156212http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/8530930http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/10644786http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/2375695http://www.ncbi.nlm.nih.gov/pubmed/7521284http://www.ncbi.nlm.nih.gov/pubmed/7521284http://www.ncbi.nlm.nih.gov/pubmed/1659615http://var/www/apps/conversion/tmp/scratch_5/emedicine.medscape.com/article/1169959-overviewhttp://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/16304870http://www.ncbi.nlm.nih.gov/pubmed/19088488http://www.ncbi.nlm.nih.gov/pubmed/19088488http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/19169089http://www.ncbi.nlm.nih.gov/pubmed/21847334
