Electrophysiological patterns in patient with Guillain-Barre syndrome

Background: Guillain-Barre syndrome (GBS) is an acute, frequently severe and fulminant polyradiculoneuropathy that is autoimmune in nature. Incidence and predominant subtypes of GBS differ geographically. Electrophysiology has important role in subtyping GBS. This study aimed to evaluate the electrophysiological findings in patient of GBS. Methods: This was a hospital based cross-sectional descriptive study and conducted at the Department of Neurology in Sir Salimullah Medical College & Mitford Hospital, Dhaka and National Institute of Neurosciences and Hospital, Dhaka during July 2017 to June 2018. Clinically diagnosed 53 patients with GBS were enrolled according to prefixed selection criteria. Detail history taking, clinical examination, nerve conduction study and cerebrospinal fluid (CSF) examination was performed in all cases. Clinical findings, nerve conduction study (NCS) parameters, CSF findings and demographic profiles were evaluated. Results: Mean ± SD age of presentation was 41.64 (±14.56) years and median age was 42.0 years. There were total 33(62 %) males and 20 (38 %) females with male: female ratio of 1.7:1. Clinically two-thirds(62.3%) of patients had both upper and lower limb involvement (62.3%), facial weakness was in 32.1% and 13.2% had bulbar involvement. Acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN)were found to be 51%, 32% and 17% respectively. CSFprotein was elevated in most of the patients with a range of 16-725 mg/dl. Highest CSF protein was found in AIDP. Conclusion: Electrophysiological studies play an important role in the early detection; characterization of GBS.In this study, the commonest type of GBS was AIDP. Higher levels of CSF protein, absent H-reflex and Fresponse, sural sparing and unexcitable nerves are more frequently present in AIDP. BIRDEM Med J 2022; 12(1): 16-21

Correlation of nerve conduction study parameters with thyroid hormone in newly diagnosed hypothyroid patients

Background: Thyroid hormones act on many organs including central and peripheral nervous system for maintaining metabolic homeostasis. Entrapment neuropathies are most common in hypothyroidism. Nerve conduction parameters are impaired even in newly diagnosed cases of hypothyroid. Aims and Objectives: This study aims to study the correlation between thyroid hormone and nerve conduction study (NCS) parameters in newly diagnosed hypothyroid patients. Materials and Methods: This cross-sectional, descriptive study included newly diagnosed hypothyroid patients (n=30; age: 31.96±9.12). In all subjects, NCS was performed in median, ulnar, tibial motor nerve and median, ulnar, sural sensory nerve using Nihon Kohden machine in Neurophysiology lab 2, B. P. Koirala Institute of Health Science. Thyroid function test (TFT) was analyzed by ELISA. The association between thyroid hormone and NCS parameters was done using Pearson’s correlation. Results: In NCS sensory parameters; SNAP amplitude of the left sural nerve showed significant positive correlation with t3 (lt; r=0.451, P=0.012). Among motor parameters, distal latency of left median nerve showed significant negative correlation with t3 whereas nerve conduction velocity of the left median nerve showed positive correlation with t3. In rest of the nerve, the association between NCS parameters and TFT (t3, t4, and TSH) parameters did not show any significant changes. Conclusion: Our study reveals that in newly diagnosed cases of hypothyroidism, nerve impairment occurs in which the left side is affected much earlier than right side and further its severity can be correlated with level of T3 rather than TSH.

A COMPARISON OF FUNCTIONAL ASSESSMENT OF PRE- AND POSTSURGICAL CARPAL TUNNEL SYNDROME USING BOSTON CARPAL TUNNEL QUESTIONNAIRE AND NERVE CONDUCTION STUDY: A PROSPECTIVE STUDY FROM A TERTIARY CENTER OF SOUTH INDIA

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment syndrome of median nerve causing frequent disability especially among working populations. Boston Carpal Tunnel Questionnaire and Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after surgical release of carpal tunnel. OBJECTIVES: To assess functional outcome of patients with Carpal Tunnel Syndrome after surgery as assessed by Boston Carpel Tunnel Questionnaire and Electrophysiological study. METHODS: A prospective observational study conducted over a period of one year (January 2017 to January 2018). The study was conducted among consecutive 31 electrophysiological conrmed carpal tunnel syndrome attending the outpatient department of Physical Medicine and Rehabilitation, Government Medical College, Thiruvananthapuram. All patients underwent open carpal tunnel release. Functional outcome was assessed using Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at interval of 3 weeks, 6weeks and 3 months postoperatively. Electrophysiological study assessed using nerve conduction study both preoperatively and 3 weeks post operatively. Data was entered in Microsoft excel and analyzed using SPSS statistical software. RESULTS: The study involves 31 conrmed cases of Carpal tunnel syndrome patients. Mean Boston Carpal Tunnel Questionnaire (BCTQ) score preoperatively was 58.52 ± 12.73 which was markedly improved postoperatively at 3weeks with mean score of 29.77±6.68. At 6 weeks and 3 month follow up period it was reduced respectively to mean score of 23.94±4.23 and 22.94±4.62. Preoperative NCS shows decreased conduction velocity with mean nerve sensory velocity (NSV) score 21.51±8.19 and mean nerve motor velocity (NMV) score of 20.72±8.81 which statistically improved following surgery with mean NSV score of 32.04±9.01 and mean NML score of 33.78±8.1. Correlation between pre- and post-operative BCTQ and NCS parameters shows positive correlation with latency and negative correlation with amplitude and conduction velocity. Increased latency and decreased conduction velocity associated with higher BCTQ score with signicant 'p' value (p<0.05). CONCLUSION: There is statistically signicant improvement of functional outcome following carpal tunnel release surgery assessed through Boston Carpal Tunnel Questionnaire and Electrophysiological ndings

A case of spinal nerve neurotoxicity with ropivacaine after combined spinal and epidural anesthesia

Background Neurotoxicity caused by a local anesthetic after regional anesthesia is a rare but serious problem for anesthesiologists. It is difficult to diagnose neurotoxicity from anesthetics because of the large number of possible diagnoses. In this case report, careful monitoring by neurological examinations helped to diagnose local neurotoxicity caused after epidural anesthesia. Case description A 41-year-old pregnant woman who underwent emergency cesarean delivery under combined spinal-epidural anesthesia suffered left leg paralysis after surgery. Multiple neurological examinations (e.g., electromyography, nerve conduction study) revealed that the paralysis was induced by the neurotoxicity of ropivacaine. The neurological examinations were also useful to monitor the recovery process. Conclusions This is the first clinical case report that describes the diagnosis of and recovery from local anesthesia-induced neurotoxicity monitored by electromyography and nerve conduction study. Neurological disorders caused by regional anesthetics should be carefully examined and diagnosed using these neurological examinations.

Electrophysiological study of peripheral neuropathies in chronic kidney disease patients and relation of severity of peripheral neuropathy with degree of renal failure

Background: Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. Peripheral neuropathy occurs in 60-100% patients of CKD. Nerve conduction study is the gold standard method to diagnose uremic neuropathy. In this study we have examined the correlation of nerve conduction latency, amplitude and nerve conduction velocity with serum creatinine, blood urea, serum uric acid levels and compared these parameters among dialysis and non-dialysis dependent CKD patients.Methods: The present cross-sectional study was conducted on 100 adult patients diagnosed to have and treated for CKD. All cases were subjected to nerve conduction study (NCS) which was performed on median nerve, ulnar nerve, common peroneal nerve, tibial nerve and sural nerve.Results: The prevalence of neuropathy was 68% in both dialysis and non-dialysis dependent groups. The most involved nerve was sural nerve. On NCS, there was prolongation of nerve latency, decrease in nerve amplitude and nerve conduction velocity with rising blood urea and serum creatinine levels. All these abnormalities were more evident in dialysis dependent patients as compared to non-dialysis dependent patients. Depressed amplitude was the most common abnormality in all the tested nerves.Conclusions: The nerve latency, amplitude and nerve conduction velocity worsened with rise in blood urea, serum creatinine and decrease in eGFR suggesting that neuropathy progress with increased severity of renal failure. Nerve conduction abnormalities were more prominent in dialysis dependent patients and therefore was associated with more advanced stage of CKD.

Superficial radial neuropathy: an unobserved etiology of chronic dorsoradial wrist pain

Background Superficial radial neuropathy is considered an uncommon cause of chronic dorsoradial wrist pain. Its clinical diagnosis is usually missed. The purpose of the research was to investigate the existence of superficial radial neuropathy as a cause of chronic dorsoradial wrist pain. The study included 98 upper limbs obtained from 72 patients [58 women (80.6%)] with a primary complaint of chronic dorsoradial wrist pain and 91 asymptomatic upper limbs obtained from 63 apparently healthy individuals [46 women (73.0%)] as a control group. Clinical assessment and superficial radial nerve conduction study were done. Results No significant differences between patients and control group were present regarding sex and age. Among the participated patients, there were 29 upper limbs (29.6%) from 26 patients (36.1%) who had superficial radial neuropathy proved clinically and electrophysiologically. From them, three patients (11.5%) had bilateral superficial radial neuropathy. It was the solitary cause of chronic dorsoradial wrist pain in 15 upper limbs (51.7%) from 13 patients (50%). The remaining patients were associated with other musculoskeletal wrist conditions. The most common associated local wrist pathology was three and half fingers till the level of the distalin 8 upper limbs (27.6%) from 8 patients (30.8%). Conclusions Superficial radial neuropathy is common among patients with chronic dorsoradial wrist pain and should be considered in the differential diagnosis.