Abstract-Objective:To make evidence-based treatment recommendations for the medical and surgical treatment of patients with Parkinson disease (PD) with levodopa-induced motor fluctuations and dyskinesia. To that end, five questions were addressed.

Abstract-Objective:To provide an evidence-based statement to guide physicians in the management of Guillain-Barré syndrome (GBS). Methods: Literature search and derivation of evidence-based statements concerning the use of immunotherapy were performed. Results: Treatment with plasma exchange (PE) or IV immunoglobulin (IVIg) hastens recovery from GBS. Combining the two treatments is not beneficial. Steroid treatment given alone is not beneficial. Recommendations: 1) PE is recommended for nonambulant adult patients with GBS who seek treatment within 4 weeks of the onset of neuropathic symptoms. PE should also be considered for ambulant patients examined within 2 weeks of the onset of neuropathic symptoms; 2) IVIg is recommended for nonambulant adult patients with GBS within 2 or possibly 4 weeks of the onset of neuropathic symptoms. The effects of PE and IVIg are equivalent; 3) Corticosteroids are not recommended for the management of GBS; 4) Sequential treatment with PE followed by IVIg, or immunoabsorption followed by IVIg is not recommended for patients with GBS; and 5) PE and IVIg are treatment options for children with severe GBS. NEUROLOGY 2003;61:736 -740 Guillain-Barré syndrome (GBS) affects between 1 and 4 per 100,000 of the population annually throughout the world, 1 causing respiratory failure requiring ventilation in approximately 25%, death in 4 to 15%, 2-6 persistent disability in approximately 20%, 7 and persistent fatigue in 67%. 8 The costs in the United States have been estimated as $110,000 for direct health care and $360,000 in lost productivity per patient. 9 This practice parameter classifies the relevant evidence on immunotherapy to provide evidence-based recommendations for the management of GBS. 10Evidence review. A search of MEDLINE from 1966 and of the Cochrane library was performed in March 2002. "Polyradiculoneuritis" was limited by "human" and cross-referenced with "therapy." The search results were reviewed for each question by at least two members of the practice parameter group and supplemented from the reference lists in the articles retrieved and the personal reference lists of the members of the practice parameter group. Those titles representing relevant randomized controlled trials (RCTs) are included in the tables on the Neurology Web site for this article (www.neurology.org). Recommendations were graded according to the levels established by the AAN Quality Standards Subcommittee at the inception of this project (table).

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The incidence of carpal tunnel syndrome in the population of Rochester, Minnesota, from 1961 through 1980 was determined by use of the medical records-linkage system of the Rochester Epidemiology Program Project at the Mayo Clinic; 1,016 patients (1,600 affected hands) were identified. Incidence (cases per 100,000 person-years) was 99 (crude) overall, whereas the age-adjusted rates were 52 for the men, 149 for the women, and 105 for both sexes combined. Age-adjusted incidence rates increased from 88 during the 1961 to 1965 quinquennium to 125 during the 1976 to 1980 quinquennium; these rates probably reflect better recognition rather than a true increase in incidence rates. Age-specific rates generally increased with age in men, whereas in women a peak was reached in the 45 to 54 age group.

Objective To assess temporal trends in carpal tunnel syndrome (CTS) incidence, surgical treatment and work-related lost time. Methods Incident CTS and first-time carpal tunnel release among Olmsted County, Minnesota, residents were identified using the medical records linkage system of the Rochester Epidemiology Project; 80% of a sample were confirmed by medical record review. Work-related CTS was identified from the Minnesota Department of Labor and Industry. Results Altogether, 10,069 Olmsted County residents were initially diagnosed with CTS in 1981-2005. Overall incidence (adjusted to the 2000 U.S. population) was 491 and 258 per 100,000 person-years for women versus men (p < 0.0001) and 376 per 100,000 for both sexes combined. Adjusted annual rates increased from 258 per 100,000 in 1981-1985 to 424 in 2000-2005 (p < 0.0001). The average annual incidence of carpal tunnel release surgery was 109 per 100,000, while that for work-related CTS was 11 per 100,000. An increase in young, working-age individuals seeking medical attention for symptoms of less severe CTS in the early to mid-1980s was followed in the 1990s by an increasing incidence in elderly people. Conclusions The incidence of medically-diagnosed CTS accelerated in the 1980s. The cause of the increase is unclear, but it corresponds to an epidemic of CTS cases resulting in lost work days that began in the mid-1980s and lasted through the mid-1990s. The elderly present with more severe disease and are more likely to have carpal tunnel surgery, which may have significant health policy implications given the aging population.

The utility of electrodiagnostic testing in the evaluation of carpal tunnel syndrome (CTS) has been questioned. We studied patients who met the clinical criteria for CTS and compared patients who had normal nerve conduction studies (NCS) with patients who had abnormal NCS. We found that 25% of the CTS patients without confounding neurologic disorders had normal NCS with median palmar nerve stimulation. Patients with abnormal NCS were older and heavier and had more clinical features of CTS. NCS results could not be predicted accurately from clinical features by use of logistic regression models. This was especially true in clinically borderline cases. NCS did not predict the outcome of conservative management. We concluded that NCS provide independent information in the evaluation of suspected CTS, especially when fewer clinical criteria are present, but that NCS are not helpful in predicting the outcome of nonsurgical management.

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The electrodiagnosis of carpal tunnel syndrome is reviewed, including discussions of old and new techniques of motor and sensory nerve conduction, anomalous innervation, needle electrode examination, and one method of examining a patient with suspected carpal tunnel syndrome. The results of electromyographic testing of 505 patients with carpal tunnel synddrome in Rochester, Minnesota, from 1961 to 1980 are compared with result from previous studies. In the appendixes, a method of performing median motor and sensory nerve conduction studies and Mayo Clinic normal values are provided.