Mani Arun Mathai, Prabhakar Appaswamy Thirumal, Alexander P T, Nair Aditya, Vijayaraghavan Asish, Shaikh Atif, Benjamin Rohit, Sivadasan Ajith, Mathew Vivek, Aaron Sanjith, Alexander Mathew
Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
The Brunei Neuroscience Stroke and Rehabilitation Centre, India.
Neurol India. 2021 Mar-Apr;69(2):369-375. doi: 10.4103/0028-3886.314529.
Guillain-Barre syndrome can be electrophysiologically classified into demyelinating and axonal subtypes and nerve conduction studies remain the mainstay in electrodiagnosis. Accurate electrodiagnosis has both therapeutic and prognostic significance and different criteria sets have been proposed for classification.
To electrophysiologically classify GBS patients into AIDP and axonal subtypes according to various published criteria (Cornblath, 1990: Hadden, 1998, Rajabally, 2015), investigate if serial NCS changes the classification, and to identify additional parameters which may support the electrodiagnosis.
In a retrospective study, we included all patients aged 15 to 80 years, admitted with a diagnosis of GBS between August 2015 and July 2017, who had at least two serial NCS. The various published criteria were applied to the two serial NCS and subtype classification along with diagnostic shifts on serial NCS were ascertained.
At the first test, the established criteria gave a yield of 45.2% to 71% for AIDP, while 29% to 54.8% of patients were classified as axonal GBS. In the second study, there was a change in electrodiagnosis, ranging from 9.6% to 16.1%. The resolution of reversible conduction failure and misclassification of subtypes were the major reason for diagnostic shifts. Sural sparing pattern, facial nerve dysfunction, abnormal blink reflex, and phrenic nerve dysfunction were more common in AIDP.
Serial nerve conduction studies allow an accurate electrodiagnosis of GBS subtypes, which has both therapeutic and prognostic implications. Also, the use of additional parameters such as blink reflex facial and phrenic nerve conduction may supplement routine NCS.
吉兰 - 巴雷综合征在电生理上可分为脱髓鞘型和轴索性亚型，神经传导研究仍是电诊断的主要手段。准确的电诊断具有治疗和预后意义，并且已经提出了不同的分类标准集。
根据各种已发表的标准（Cornblath，1990年；Hadden，1998年；Rajabally，2015年），通过电生理将吉兰 - 巴雷综合征患者分为急性炎症性脱髓鞘性多发性神经病（AIDP）和轴索性亚型，研究连续神经传导检查（NCS）是否会改变分类，并确定可能支持电诊断的其他参数。
在一项回顾性研究中，我们纳入了所有年龄在15至80岁之间、于2015年8月至2017年7月期间因吉兰 - 巴雷综合征诊断入院且至少进行了两次连续NCS检查的患者。将各种已发表的标准应用于两次连续的NCS检查，并确定亚型分类以及连续NCS检查中的诊断变化。
在首次检查时，既定标准对AIDP的诊断符合率为45.2%至71%，而29%至54.8%的患者被分类为轴索性吉兰 - 巴雷综合征。在第二次检查中，电诊断有变化，范围为9.6%至16.1%。可逆性传导障碍的缓解和亚型的错误分类是诊断变化的主要原因。AIDP中腓肠神经保留模式、面神经功能障碍、异常眨眼反射和膈神经功能障碍更为常见。
连续神经传导检查能够准确电诊断吉兰 - 巴雷综合征亚型，这具有治疗和预后意义。此外，使用诸如眨眼反射、面神经和膈神经传导等额外参数可能会补充常规NCS检查。
