Utility of Serial Nerve Conduction Studies in the Electrodiagnosis of Guillain–Barre Syndrome

Mani, Arun Mathai; Prabhakar, Appaswamy Thirumal; Alexander, Pullumpallil T; Nair, Aditya; Vijayaraghavan, Asish; Shaikh, Atif; Benjamin, Rohit Ninan; Sivadasan, Ajith; Mathew, Vivek; Aaron, Sanjith; Alexander, Mathew

doi:10.4103/0028-3886.314529

Cited by 5 publications

(3 citation statements)

References 2 publications

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“…A subset of these patients (n = 31, 2015 to 2017) had been included in an earlier study. 17 Patients' characteristics are described in Table 1. Most patients underwent NCS in the second week of illness.…”

Section: Resultsmentioning

confidence: 99%

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Sensitivity and specificity of phrenic nerve electrophysiology to predict mechanical ventilation in the Guillain‐Barré syndrome

et al. 2023

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Introduction/Aims In Guillain–Barré syndrome (GBS), the sensitivity and specificity of phrenic compound muscle action potential (CMAP) measurements to predict endotracheal mechanical ventilation are unknown. Hence, we sought to estimate sensitivity and specificity. Methods We performed a 10‐year retrospective analysis of adult GBS patients from our single‐center laboratory database (2009 to 2019). The phrenic nerve amplitudes and latencies before ventilation were recorded along with other clinical and demographic features. Receiver operating curve (ROC) analysis with area under the curve (AUC) was used to determine the sensitivity and specificity with 95% confidence interval (CI) for phrenic amplitudes and latencies in predicting the need for mechanical ventilation. Results Two hundred five phrenic nerves were analyzed in 105 patients. The mean age was 46.1 ± 16.2 years, with 60% of them being male. Fourteen patients (13.3%) required mechanical ventilation. The average phrenic amplitudes were lower in the ventilated group (P = .003), but average latencies did not differ (P = .133). ROC analysis confirmed that phrenic amplitudes could predict respiratory failure (AUC = 0.76; 95% CI, 0.61 to 0.91; P < .002), but phrenic latencies could not (AUC = 0.60; 95% CI, 0.46 to 0.73; P = .256). The best threshold for amplitude was ≥0.6 mV, with sensitivity, specificity, and positive and negative predictive values of 85.7%, 58.2%, 24.0%, and 96.4%, respectively. Discussion Our study suggests that phrenic CMAP amplitudes can predict the need for mechanical ventilation in GBS. In contrast, phrenic CMAP latencies are not reliable. The high negative predictive value of phrenic CMAP amplitudes ≥0.6 mV can preclude mechanical ventilation, making these a useful adjunct to clinical decision‐making.

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Section: Resultsmentioning

confidence: 99%

“…One hundred and five patients were included in the final analysis (Figure 1). A subset of these patients (n = 31, 2015 to 2017) had been included in an earlier study 17 . Patients’ characteristics are described in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Sensitivity and specificity of phrenic nerve electrophysiology to predict mechanical ventilation in the Guillain‐Barré syndrome

et al. 2023

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“…25 Rajabally et al 7 reported that a single NCS is sufficient for electrophysiological subtyping according to their own criteria, but did not mention the exact timing of that. Although different studies have performed follow-ups at various times (e.g., within 2 months, 2-13 weeks, and 2-8 weeks after symptom onset, respectively) by applying the revised criteria, 20,26,27 an effective follow-up period was not suggested.…”

Section: Recommended Follow-up Timingmentioning

confidence: 99%

Serial Nerve Conduction Studies in Guillain–Barré Syndrome: Its Usefulness and Precise Timing

Lee,

Suh,

Kim

et al. 2022

Journal of Clinical Neurophysiology

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Purpose: Nerve conduction study (NCS) is essential for subclassifying Guillain–Barré syndrome (GBS). It is well known that the GBS subclassification can change through serial NCSs. However, the usefulness of serial NCSs is debatable, especially in patients with early stage GBS. Methods: Follow-up NCS data within 3 weeks (early followed NCS, EFN) and within 3 to 10 weeks (late-followed NCS, LFN) were collected from 60 patients with GBS who underwent their first NCS (FN) within 10 days after symptom onset. Each NCS was classified into five subtypes (normal, demyelinating, axonal, inexcitable, and equivocal), according to Hadden's and Rajabally's criteria. We analyzed the frequency of significant changes in classification (SCCs) comprising electrodiagnostic aggravation and subtype shifts between demyelinating and axonal types according to follow-up timing. Results: Between FN and EFN, 33.3% of patients with Hadden's criteria and 18.3% with Rajabally's criteria showed SCCs. Between FN and LFN, 23.3% of patients with Hadden's criteria and 21.7% with Rajabally's criteria showed SCCs, of which 71.4% (Hadden's criteria) and 46.2% (Rajabally's criteria) already showed SCCs from the EFN. The conditions of delayed SCCs between EFN and LFN were very early FN, mild symptoms at the FN, or persistent electrophysiological deterioration 3 weeks after symptom onset. Conclusions: A substantial proportion of patients with GBS showed significant changes in neurophysiological classification at the early stage. Serial NCS may be helpful for precise neurophysiological classification. This study suggests that follow-up NCSs should be performed within 3 weeks of symptom onset in patients with GBS in whom FN was performed within 10 days of symptom onset.

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Effect of intravenous immunoglobulin and plasmapheresis on nerve conduction parameters compared to the natural course of Guillain-Barré syndrome

Kalita,

Mahajan,

Kumar

2024

Journal of Clinical Neuroscience

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Utility of Serial Nerve Conduction Studies in the Electrodiagnosis of Guillain–Barre Syndrome

Cited by 5 publications

References 2 publications

Sensitivity and specificity of phrenic nerve electrophysiology to predict mechanical ventilation in the Guillain‐Barré syndrome

Sensitivity and specificity of phrenic nerve electrophysiology to predict mechanical ventilation in the Guillain‐Barré syndrome

Serial Nerve Conduction Studies in Guillain–Barré Syndrome: Its Usefulness and Precise Timing

Effect of intravenous immunoglobulin and plasmapheresis on nerve conduction parameters compared to the natural course of Guillain-Barré syndrome

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