Utility of multiple segment stimulation and serial nerve conduction studies in Guillain Barre Syndrome

Ajith, M (2011) Utility of multiple segment stimulation and serial nerve conduction studies in Guillain Barre Syndrome. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Guillain-Barre syndrome is a common cause of acute and severe generalised neuropathic weakness. Nerve conduction studies are the most important diagnostic tests. It is classified into various subtypes based on the electrophysiological characteristics. Prolonged distal motor latency and conduction block are features of AIDP. The characteristic electrophysiological features of AMAN are reduced amplitude or absence of distal compound muscle action potentials indicating axonal degeneration. Recently there is growing recognition of reversible conduction blocks in AMAN. OBJECTIVES: To evaluate the utility of multiple segment stimulation of motor nerves, proximal conductions and serial nerve conduction studies in patients with Guillain Barre syndrome. METHODS: Ten patients admitted within the first week of onset of weakness diagnosed with GBS were included in the study and underwent multiple segment stimulation of upper limb motor nerves as well as proximal conductions as part of the electrophysiological study and were followed up with serial nerve conduction study every week till they improved by one Hughes grade or till 4 weeks. The data was analysed using the SPSS software and the chi-square test was used for analysis of significance. RESULTS: H-reflex abnormalities and prolonged / absent F-wave latencies were the most common electrophysiological abnormalities in the nerve conduction study done in the first week of illness. Multiple segment stimulation of motor nerves showed a higher yield of detecting conduction blocks in the first week especially across the entrapment sites. Two patients who had conduction blocks in the multiple segment stimulation in the first study and fulfilling the criteria for AIDP, had completely in-excitable motor nerves in the second conduction done one week later with evidence of active denervation on needle EMG suggestive of an axonal pathology. CONCLUSION: Multiple segment stimulation helps in the detection of a higher percentage of conduction blocks in patient with GBS. Serial nerve conductions are important as there can be change in the electrophysiological classification with time. Some of the motor nerves showing conduction blocks may be on follow up show evidence of axonal degeneration and may indicate an electrophysiological feature of acute motor axonal neuropathy.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Guillain Barre Syndrome, multiple segment stimulation, serial nerve conduction studies.
Subjects: MEDICAL > Neurology
Depositing User: Subramani R
Date Deposited: 14 Feb 2020 02:56
Last Modified: 14 Feb 2020 02:56
URI: http://repository-tnmgrmu.ac.in/id/eprint/11925

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