Peripheral nerve injury leads to changes in the proximal axon. Traumatic nerve injuries in humans were investigated to characterize such electrophysiological changes. Mixed nerve conduction studies (MNCS) and motor conduction studies (MCS) were performed proximal to the injury. Control values were obtained from the uninjured limb. Median (n = 24) and ulnar (n = 35) nerve injuries were studied. The injured nerves had significant mixed nerve action potential (MNAP) amplitude reductions (median: P < 0.0001; ulnar: P < 0.0001). The majority of the MNAP amplitude reductions were severe and early. There was slowing in the mixed nerve conduction velocity (MNCV) (median: P = 0.09; ulnar: P = 0.04) and motor conduction velocity (MCV) (median: P = 0.046; ulnar: P = 0.005). Axonal loss appears to play a significant role in producing the MNCS changes observed, and its early occurrence is noteworthy. Proximal MCV reduction could be secondary to the effects of injury as well as collateral sprouting of uninjured axons. Proximal axonal changes may have an impact on recovery.
Objectives: To evaluate Guillain-Barre syndrome (GBS) subtypes in Sri Lanka. Design setting:The patients satisfying established criteria for diagnosis of GBS were included. The cases were classified into GBS subtypes based on electrodiagnostic findings. Patient intervention: NoneMeasurements: Clinical neurophysiological evaluations were done. The studies were repeated as appropriate. Results:The evaluations were done between 2 and 143 days from onset (median = 7 days). There were 1153 patients (Male: Female = 1.4 :1) with age 1 to 86 years (mean = 43.7). Of them 191 (16.6%) were below 13 years (Male: Female = 1.2:1). GBS subtypes were demyelinating type 577 (50%), axonal forms 475 (41.2%), Miller-Fisher syndrome 5 (0.4%) and unclassifiable 96 (8.3%). Among the children there were 99 (51.8%) with demyelinating type, 82 (42.9%) with axonal forms, 10 (5.2%) with unclassifiable findings and none with MFS. There was some clustering of both demyelinating and axonal cases in the early and late months of the year whereas in children there is excessive occurrence of GBS cases of both types in the first 5 months of the year. There is a second peak of axonal GBS later in the year. Overall tendency of reduction in the number of cases, especially axonal forms, is noticeable over the years. Interpretation:The age and sex distribution of the cases is similar to that of other countries. The occurrence of axonal subtypes is prominent. The proportions of GBS subtypes and case clustering in children may be related to the preceding infection.
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