Neurophysiology of Guillain-Barré syndrome in children

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Abstract

Our aim was to evaluate sensitivity and specificity of conduction studies parameters for prognosis and differential diag nosis in children with acute motor axonal neuropathy (AMAN) & acute inflammatory demyelinating polyneuropathy (AIDP).

Methods. 40 children were included: 20 healthy controls (7-14 years) and 20 patients (8-15 years) with AIDP or AMAN. All underwent conduction studies on 3-7 day since the clinical symptoms onset. We registered and evaluated motor conduction velocity, compound muscle action potential (CMAP) amplitude of nn. tibialis, peroneus, medianus, ulnaris; sensory conduction velocity & sensory nerve action potential (SNAP) amplitude for nn. medianus, suralis, peroneus superficialis, ulnaris, H-reflex threshold & latency, reactivity of neural conductivity (RNC) in short-term hand ischemia in acute phase (3-14 day since the disease onset) and in early recovery period (15-30 day since the symptoms onset). ROC-analysis was performed.

Results. In 95% of the patients with Guillain-Barré syndrome H-reflex was absent. In first 10 days SNAP amplitude of median nerve >8.9 µV, peroneal nerve >3.6 µV, CMAP of peroneal nerve ≤0,4 µV with normal motor conduction velocity indicates AMAN presence. Motor axons of peripheral nerves in children in acute and recovery phase of AIDP are resistant towards ischemia. Prognostic criteria for long period of walk recovery (more than 30 days) in these patients are RNC on 10th minute of local ischemia ≤2.5%, ulnar nerve CMAP amplitude ≤1,1 mV and distal CMAP amplitude from median nerve ≤1.6 mV.

Conclusions. Conduction studies may be implemented on all phases of Guillain-Barré syndrome in children for prognosis and differential diagnosis between its axonal and demyelinating forms. H-reflex absence in children in the first 5 days of acute polyneuropathy may serve as additional diagnostic criteria for Guillain-Barré syndrome. RNC parameters may be implemented for the prognosis of the walk period recovery duration.

About the authors

Vladislav B. Voitenkov

Pediatric Research and Clinical Center for Infectious Diseases

Author for correspondence.
Email: Vlad203@inbox.ru

MD, PhD, Leading Scientist, Department of Clinical Neurophysiology

Russian Federation, Saint Petersburg

Natalia V. Skripchenko

Pediatric Research and Clinical Center for Infectious Diseases

Email: snv@niidi.ru

MD, PhD, Dr Med Sci, CEO

Russian Federation, Saint Petersburg

Andrey V. Klimkin

Pediatric Research and Clinical Center for Infectious Diseases

Email: klinkinpark@mail.ru

MD, PhD, Junior Researcher, Department of Clinical Neurophysiology

Russian Federation, Saint Petersburg

Stepan G. Grigoriyev

Pediatric Research and Clinical Center for Infectious Diseases

Email: gsg_rj@mail.ru

MD, PhD, Dr Med Sci, Researcher, Scientific Organizing Department

Russian Federation, Saint Petersburg

References

  1. Гусев Е.И., Гехт А.Б. Клинические рекомендации по диагностике и лечению синдрома Гийена - Барре. - М., 2014. [Gusev EI, Gekht AB. Klinicheskie relomendatsii po terapii sidroma Giyena-Barre. Moscow; 2014. (In Russ.)]
  2. Екушева Е.В., Дамулин И.В. К вопросу о межполушарной асимметрии в условиях нормы и патологии // Журнал неврологии и психиатрии им. C.C. Корсакова. - 2014. - Т. 114. - № 3. - С. 92-97. [Ekusheva EV, Damulin IV. The interhemispheric asymmetry in normalcy and pathology. Zh Nevrol Psikhiatr im S.S. Korsakova. 2014;114(3):92-97. (In Russ.)]
  3. Живолупов С.А., Шапкова Е.Ю., Самарцев И.Н., Федоров К.В. Патогенез и новая стратегия в коррекции нарушений невральной проводимости при компрессионно-ишемических невропатиях (клиническое и экспериментальное исследование) // Журнал неврологии и психиатрии им. С.С. Корсакова. - 2010. - Т. 110. - № 8. - С. 41-50. [Zhivolupov SA, Shapkova EY, Samartsev IN, Fedorov KV. Pathogenesis and new strategy in treatment of neuronal conductivity impairments in compression-ischemic neuropathies: a clinical and experimental study. Zh Nevrol Psikhiatr im S.S. Korsakova. 2010;110(8):41-50. (In Russ.)]
  4. Команцев В.Н., Скрипченко Н.В., Савина М.В. Клиническая электронейромиография при нейроинфекциях у детей // Педиатр. - 2011. - Т. 2. - № 2. - С. 34-37. [Komantsev VN, Skripchenko NV, Savina MV. Clinical electroneuromyography in neuroinfections in children. Pediatrician (St. Petersburg). 2011;2(2):34-37. (In Russ.)]
  5. Пирадов М.А., Супонева Н.А., Гришина Д.А., Гнедовская Е.В. Качество жизни и социальная адаптация пациентов, перенесших синдром Гийена - Барре // Журнал неврологии и психиатрии им. C.C. Корсакова. - 2013. - Т. 113. - № 8. - С. 61-67. [Piradov MA, Suponeva NA, Grishina DA, Gnedovskaya EV. Quality of life and social adaptation of patients with Guillain-Barré syndrome. Zh Nevrol Psikhiatr im S.S. Korsakova. 2013;113(8):61-67. (In Russ.)]
  6. Супонева Н.А., Мочалова Е.Г., Гришина Д.А., Пирадов М.А. Особенности течения СГБ в России: анализ 186 случаев // Нервно-мышечные болезни. - 2014. - № 1. - С. 37-46. [Suponeva NA, Mochalova EG, Grishina DA, Piradov MA. The specific features of Guillain-Barré syndrome in Russia: Analysis of 186 cases. Neuromuscular diseases. 2014;(1):37-46. (In Russ.)]
  7. Супонева Н.А., Шакарян А.К., Рахтеенко А.В., и др. Клинико-лабораторные характеристики, лечение и прогноз синдрома Гийена - Барре у детей // Детские инфекции. - 2015. - Т. 14. - № 3. - С. 17-26. [Suponeva NA, Shakaryan АК, Rakhteenko AV, et al. Clinical and Laboratory Features, Treatment and Prognosis in Children with Guillian-Barré Syndrome. Detskie Infektsii. 2015;14(3):17-26. (In Russ.)]
  8. Шнайдер Н.А., Кантимирова Е.А. Синдром Гийена - Барре // Вестник Новосибирского государственного университета. - Серия «Биология, клиническая медицина». - 2009. - Т. 7. - № 4. - С. 163-169. [Schnaider NA, Kantimirova EA. Sindrom Giyena-Barre. Vestnik Novosibirskogo gosudarstvennogo universiteta. Seriia “Biologiia, klinicheskaia meditsina”. 2009;7(4):163-169. (In Russ.)]
  9. Aminoff MJ. Electrodiagnosis in Clinical Neurology. 6th ed. Philadelphia: Saunders; 2012.
  10. Baraba R, Sruk A, Sragalj L, et al. Electrophysiological findings in early Guillain-Barre syndrome. Acta Clin Croat. 2011;50(2):201-207.
  11. Bostock H, Cikurel K, Burke D. Threshold tracking techniques in the study of human peripheral nerve. Muscle Nerve. 1998;21(2):137-158. doi: 10.1002/(sici)1097-4598(199802)21:2<137:: aid-mus1>3.0.co;2-c.
  12. Dachy B, Deltenre P, Deconinck N, Dan B. The H reflex as a diagnostic tool for Miller Fisher syndrome in pediatric patients. J Clin Neurosci. 2010;17(3):410-411. doi: 10.1016/j.jocn.2009.06.014.
  13. Gordon PH, Wilbourn AJ. Early Electrodiagnostic Findings in Guillain-Barré Syndrome. Arch Neurol. 2001;58(6):913. doi: 10.1001/archneur.58.6.913.
  14. Hadden RD, Cornblath DR, Hughes RA, et al. Electrophysiological classification of Guillain-Barre syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barre Syndrome Trial Group. Ann Neurol. 1998;44(5):780-8. doi: 10.1002/ana.410440512.
  15. Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. Oxford: Oxford University Press; 2013.
  16. Koo YS, Shin HY, Kim JK, et al. Early Electrodiagnostic Features of Upper Extremity Sensory Nerves Can Differentiate Axonal Guillain-Barre Syndrome from Acute Inflammatory Demyelinating Polyneuropathy. J Clin Neurol. 2016;12(4):495-501. doi: 10.3988/jcn.2016.12.4.495.
  17. Kuwabara S, Ogawara K, Misawa S, et al. Sensory nerve conduction in demyelinating and axonal Guillain-Barre syndromes. Eur Neurol. 2004;51(4):196-198. doi: 10.1159/000078485.
  18. Rajabally YA, Hiew FL. Optimizing electrodiagnosis for Guillain-Barre syndrome: Clues from clinical practice. Muscle Nerve. 2017;55(5):748-751. doi: 10.1002/mus.25433.
  19. Sudulagunta SR, Sodalagunta MB, Sepehrar M, et al. Guillain-Barre syndrome: clinical profile and management. Ger Med Sci. 2015;13:Doc16. doi: 10.3205/000220.
  20. Sun RD, Fu B, Li C, et al. Role of nerve stimulation at Erb point in early diagnosis of Guillain-Barre syndrome in children. Zhongguo Dang Dai Er Ke Za Zhi. 2015;17(7):683-686.
  21. Vucic S, Cairns KD, Black KR, et al. Neurophysiologic findings in early acute inflammatory demyelinating polyradiculoneuropathy. Clin Neurophysiol. 2004;115(10):2329-2335. doi: 10.1016/j.clinph.2004.05.009.
  22. Ye Y, Zhu D, Wang K, et al. Clinical and electrophysiological features of the 2007 Guillain-Barre syndrome epidemic in northeast China. Muscle Nerve. 2010;42(3):311-314. doi: 10.1002/mus.21701.

Supplementary files

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2. Fig. 1. ROC-analysis of specificity and sensitivity of conduction studies of sensory fibres

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3. Fig. 2. Typical H-reflex changes in female patient, 13 years, with AIDP on a 6th day since the disease onset. CMAP is 2.3 mV, H/M ratio – 0%

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Copyright (c) 2018 Voitenkov V.B., Skripchenko N.V., Klimkin A.V., Grigoriyev S.G.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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