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التقييم الكهروفسلجي للانواع الفرعيه لمتلازمة غوليان - باريه لشريحه من الاطفال العراقيين == ELECTROPHYSIOLOGICAL ASSESSMENT OF GUILLAIN - BARRE SUBTYPES IN A SAMPLE OF IRAQI CHILDREN
Author name:
لميس منصور حسين
Supervisor name:
نجيب حسن محمد
General topic:
Medicine
Specific topic:
Neurophysiology
Degree:
Master
University:
University of Baghdad - Faculty Of Medicine
Language:
English
University location:
Baghdad
First pages:
19T1436 - p.pdf
Abstract:
Guillain - Barre syndrome represents the most common cause of acute motor paralysis in children. It is clinically characterized by an acute non - febrile, post - infectious illness marked as ascending weakness, and areflexia. However; sensory, autonomic and brainstem abnormalities may also be seen.This study aimed to assess the role of electrophysiological study (NCS and EMG) in the diagnosis of Guillain - Barre syndrome subtypes in children, estimate the frequency of subtypes whether demyelinating or axonal form of Guillain - Barre syndrome and match the electrophysiological results with the findings of CSF protein analysis.Two groups of either sex are involved in this study, children with Guillain - Barre (19 males and 11 females) with a mean age of (5 ± 2) years and normal healthy children served as control group (16 males and 14 females) matched for gender and age with a mean age of (6 ± 3) years. Each child submitted to medical history, brief clinical examination, and electrophysiological study. This study was performed at the unit of neurophysiology of Baghdad teaching hospital and Nursing house hospital in a period from December/2015 to June/2016.The electrophysiological assessments involve the following tests : 1 - Sensory NCS for bilateral median, right ulnar and bilateral medial plantar nerves in which latency, sensory nerve action potential amplitude (SNAP) and sensory nerve conduction velocity (SNCV) were studied.2 - Motor NCS for bilateral median, right ulnar and bilateral common peroneal nerves (fibular nerve) in which, distal motor latency (DML),compound muscle action potential amplitude (CMAP), motor nerve onduction velocity (MNCV), conduction block and temporal dispersio were performed.3 - Minimal F - wave latency for bilateral median, right ulnar and bilateral fibular nerves.4 - H - reflex latency of bilateral tibial nerve.5 - Needle EMG for bilateral proximal and distal muscles of upper (first dorsal interosseous) and lower limbs (tibialis anterior and extensor digitorum brevis) in which insertional activity, spontaneous activity, motor unit action potential MUAP and interference pattern were applied.The results of this study revealed that acute inflammatory demyelinating polyneuropathy (AIDP) is the most frequent subtype followed by acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN) respectively. Children with an age (3 - 6) years among other age groups are more vulnerable to develop GBS following infection in the preceding 3 months.The sensory nerve parameters (sensory latency is prolonged, SNAP is reduced and SNCV is slowed) are significantly changed between GBS children and control groups.The motor nerve parameters (DML is prolonged, CMAP is reduced and MNCV is slowed) are significantly changed between GBS children and control groups. Moreover among the GBS subtypes, there were significant differences in which the prolonged (DML) mostly in AIDP subtype, while the reduced (CMAP) mostly in axonal subtype was reported.Concerning minimal F - wave, it was absent in lower limbs more than upper limbs (46.6% and 26.6% respectively). Whereas H - reflex was absent in (73.3%) of children.Needle EMG had showed reduced recruitment in all GBS subtypes in addition to the evidence of spontaneous activity particularly in axonal subtype.In conclusion, this study detected that the AIDP was the most frequent subtype of GBS compared to others. Motor nerve conduction study is more useful than sensory nerve conduction study in GBS subtyping.Additionally Late responses (minimal F - wave and H - reflex) are very informative in the early course of the disease since they reflect the involvement of proximal nerve segment, which is more vulnerable to demyelination than terminal and intermediate nerve trunk segments, in addition CSF protein analysis showed no significant differences between GBS subtypes.
