Guillain barre syndrome and its association with covid-19 infection – A clinical case series

A novel coronavirus (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2). This pandemic has been globally alarming in the current period. Several neurological manifestations are reported occurring with the infection. Guillain barre syndrome (GBS) or acute onset inflammatory polyradiculoneuropathy has been among the frequent manifestations observed among them. To know the pattern and outcome of GBS in COVID-19 affected individuals. We have taken six individuals admitted with flaccid quadriparesis in the last two months. All were affected recently by COVID 19 infection, which RT PCR of the nasopharyngeal swab confirmed. The study participants have undergone nerve conduction studies and have been diagnosed with Guillain Barre syndrome using Brighton criteria. We did cerebrospinal fluid (CSF) analysis after admission. We initiated all patients on Intravenous immunoglobulin according to body weight (2g/kg divided over five days). We used the Barthel index score to assess the outcome of the individuals. We observed a mean duration of 18.25 days between the COVID-19 infection and the onset of symptoms. Apart from motor quadriparesis and sensory symptoms being in common, we also noticed cranial nerves and autonomic involvement. We made the diagnosis using the nerve conduction studies and Brighton criteria. After initiating intravenous immunoglobulin, all patients had a good outcome, and quality of life was better after two months of follow up. Guillain Barre syndrome is one of the neurological manifestations of COVID-19 and has a dramatic response with intravenous immunoglobulin and better outcome with treatment.

The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis

Aim of the study Systematic review and meta-analysis to assess the effectiveness of manual therapy in improving carpal tunnel syndrome (CTS) symptoms, physical function, and nerve conduction studies. Method MEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP database, and PEDro databases were searched from the inception to September 2021. PICO search strategy was used to identify randomized controlled trials applying manual therapy on patients with CTS. Eligible studies and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by PEDro scale. Outcomes assessed were pain intensity, physical function, and nerve conduction studies. Results Eighty-one potential studies were identified and six studies involving 401 patients were finally included. Pain intensity immediately after treatment showed a pooled standard mean difference (SMD) of − 2.13 with 95% confidence interval (CI) (− 2.39, − 1.86). Physical function with Boston Carpal Tunnel Syndrome Questionnaire (BCTS-Q) showed a pooled SMD of − 1.67 with 95% CI (− 1.92, − 1.43) on symptoms severity, and a SMD of − 0.89 with 95% CI (− 1.08, − 0.70) on functional status. Nerve conduction studies showed a SMD of − 0.19 with 95% CI (− 0.40, − 0.02) on motor conduction and a SMD of − 1.15 with 95% CI (− 1.36, − 0.93) on sensory conduction. Conclusions This study highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with CTS.

Effect of estrogen and progesterone on nerve conduction studies during ovarian cycle

Objectives: This study aims to investigate the effects of estrogen and progesterone on nerve conduction studies (NCSs) in three different hormonal phases of the ovarian cycle. Patients and methods: Between April 2008 and July 2008, a total of 40 healthy volunteer women (mean age: 24.1±5.1 years; range 21 to 43 years) with regular menstrual cycles were included in this prospective study. The participants were regularly menstruating for at least one year, without any hormonal disease and without taking any medication that could lead to hormonal dysregulation. Motor and sensory conduction velocities, amplitudes, and distal latencies were analyzed at the dominant extremities within the early follicular phase (EFP), late follicular phase (LFP), and the midluteal phase (MLP). Results: Except for the median nerve motor conduction velocity (MCV), there were no statistically significant differences between the peripheral NCS results in the three ovarian cycle phases (p=0.033). After adjusting for multiple comparisons, a significant difference was found between the EFP and LFP (p=0.004). Conclusion: Our study results showed that only median nerve MCV was affected in the menstrual cycle. However, this would be an incidental finding, or an increased sensibility of the median nerve motor fibers to ovarian steroids by an unknown mechanism. Further studies are warranted.

Automatic Electrodiagnosis of Carpal Tunnel Syndrome Using Machine Learning

Recent literature has revealed a long discussion about the importance and necessity of nerve conduction studies in carpal tunnel syndrome management. The purpose of this study was to investigate the possibility of automatic detection, based on electrodiagnostic features, for the median nerve mononeuropathy and decision making about carpal tunnel syndrome. The study included 38 volunteers, examined prospectively. The purpose was to investigate the possibility of automatically detecting the median nerve mononeuropathy based on common electrodiagnostic criteria, used in everyday clinical practice, as well as new features selected based on physiology and mathematics. Machine learning techniques were used to combine the examined characteristics for a stable and accurate diagnosis. Automatic electrodiagnosis reached an accuracy of 95% compared to the standard neurophysiological diagnosis of the physicians with nerve conduction studies and 89% compared to the clinical diagnosis. The results show that the automatic detection of carpal tunnel syndrome is possible and can be employed in decision making, excluding human error. It is also shown that the novel features investigated can be used for the detection of the syndrome, complementary to the commonly used ones, increasing the accuracy of the method.

Clinical, Neurophysiological and Histopatological correlations in Pure Neural Leprosy

Although neuropathy remains one of the most problematic issues faced by leprosy patients, the evolving process of its findings continues a challenge particularly in pure neural leprosy (PNL). We evaluated neurological examination, nerve conduction studies and histhopathological data of patients with PNL and ulnar neuropathy. Patients with longer duration of symptoms had reduction in the motor conduction velocities and patients with fibrosis in the biopsy had axonal damage in the nerve conduction studies. This suggests that focal demyelination may be present in leprosy patients at the moment of the diagnosis and be related to the duration of the neuropathy.

Nerve Conduction Studies and Needle Electromyography

Nerve conduction studies (NCSs) and needle electromyography (EMG) should be considered extensions of the neurologic history and examination of the peripheral sensory and motor systems. NCSs assess large, myelinated sensory and motor nerve fibers. EMG assesses primarily type 1 muscle fibers. Because of the limitations of NCSs and EMG, small-fiber function (ie, small-fiber neuropathies) and, to an extent, type 2 muscle-fiber diseases (ie, steroid myopathy) cannot be excluded with these studies. The main goal of NCSs and EMG is to obtain objective evidence of disease within the peripheral nervous system and to assist with localization of the problem.