Early electrophysiological findings in acute inflammatory demyelinating polyradiculoneuropathy variant of Guillain‐Barre syndrome in the Pakistani population – a comparison with global data

Abstract

Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy are the most common variants of Guillian-Barre syndrome documented in the Asian population. However, the variability of early neurophysiologic findings in the Asian population compared to western data has not been documented. Eighty-seven cases of AIDP were retrospectively reviewed for their demographic, clinical, electrophysiological, and laboratory data. Mean age of subjects was 31 ± 8 years with males more commonly affected. Motor symptoms (97%) at presentation predominated. Common early nerve conduction findings included low motor amplitudes (85%), recordable sural sensory responses (85%), and absent H-reflex responses (65%). Prolonged F-latencies were found most commonly in posterior tibial nerves (23%) in the lower limbs and median and ulnar nerves (18%) in the upper limbs. Blink reflex (BR) studies were performed in 57 patients and were abnormal in 80% of those with clinical facial weakness and in 17 of 52 patients (33%) with no clinical cranial nerve signs, suggesting subclinical cranial nerve involvement. Abnormal motor and sensory amplitudes are seen early. Prolonged distal latencies, temporal dispersion/conduction blocks and sural sparing pattern are other common early nerve conduction study findings of AIDP seen in the Pakistani population. There are no significant differences in abnormalities of conduction velocities and delayed reflex responses compared to published data. The BR can help in the early diagnosis of AIDP.

Very early and early neurophysiological abnormalities in Guillain–Barré syndrome: A 4‐year retrospective study

“…As described elsewhere [10,11,19,21,22], we noted that an absent H reflex was more frequent than other neurophysiological parameters, and more frequent than CSF hyperproteinorrachia as well.…”

“…As described elsewhere [ 10 , 11 , 19 , 21 , 22 ], we noted that an absent H reflex was more frequent than other neurophysiological parameters, and more frequent than CSF hyperproteinorrachia as well. Although a usual finding in S1 radiculopathy [ 23 ], the absence of bilateral H reflex could be a meaningful electrophysiological finding in the diagnosis of GBS in its early stages.…”

“…In our patients, the sural‐sparing pattern was observed more frequently in MFS than GBS. According to the literature, its frequency is reported to vary between 17.8% [ 21 ] and 73% [ 22 ].…”

Case Report: Early-Onset Guillain–Barre Syndrome Mimicking Stroke

“…In these patients, a repeat electrodiagnostic study 2-3 weeks later can be helpful. Prolonged F latencies have been found most commonly in the posterior tibial nerves (23%) in the lower limbs and in the median and ulnar nerves (18%) in the upper limbs of GBS patients (21), but this patient did not show typical F-wave changes. Note that the reduced amplitudes could be due to axonal loss but also to distal conduction block.…”

Sural-sparing pattern: A study against electrodiagnostic subtypes of Guillain–Barre syndrome

“…Sural-sparing occurrence rates in GBS are highly variable, depending on sural-sparing definitions, electrodiagnostic criteria, sensory NCS protocol (e.g., number of tested nerves), and EDX timing. Increasing the strictness from at least one to two abnormal upper-limb SNAPs reduced the detection rate from 39 % to 83 % to 19.1 %–65 % in demyelinating GBS ( Bromberg and Albers, 1993 , Al-Shekhlee et al, 2005 , Al-Shekhlee et al, 2007 , Chanson and Echaniz-Laguna, 2014 , Umapathi et al, 2015 , Hiew and Rajabally, 2016 Surpur and Govindarajan, 2017 , Wali et al, 2017 , Al-Hillali et al, 2020 ). Sural-sparing occurrence rates in axonal GBS were 18.7 %–38.5 % and 0 %–9.5 %, considering at least one and two abnormal upper-limb SNAPs, respectively ( Capasso et al, 2011 , Umapathi et al, 2015 , Hiew and Rajabally, 2016 ).…”