Inflammatory oedema of nerve trunks may be pathogenic in very early Guillain-Barré syndrome

Association between hyperCKemia and axonal degeneration in Guillain-Barré syndrome

BACKGROUND

Elevated serum creatine kinase (CK) levels have been reported in patients with Guillain-Barré syndrome (GBS), more frequently in patients with acute motor axonal neuropathy (AMAN) than in those with acute inflammatory demyelinating polyneuropathy (AIDP). However, some patients with AMAN show reversible conduction failure (RCF), characterized by rapid recovery without axonal degeneration. The present study tested the hypothesis that hyperCKemia is associated with axonal degeneration in GBS, regardless of the subtype.

METHODS

We retrospectively enrolled 54 patients with AIDP or AMAN whose serum CK levels were measured within 4 weeks from symptom onset between January 2011 and January 2021. We divided them into hyperCKemia (serum CK ≥ 200 IU/L) and normal CK (serum CK < 200 IU/L) groups. Patients were further classified into axonal degeneration and RCF groups based on more than two nerve conduction studies. The clinical features and frequency of axonal degeneration and RCF were compared between groups.

RESULTS

Clinical characteristics were similar in the hyperCKemia and normal CK groups. Compared with that in the RCF subgroup, the frequency of hyperCKemia was significantly higher in the axonal degeneration group (p = 0.007). Patients with normal serum CK levels showed better clinical prognosis, evaluated by the Hughes score at 6 months from admission (p = 0.037).

CONCLUSION

HyperCKemia is associated with axonal degeneration in GBS, regardless of the electrophysiological subtype. HyperCKemia within 4 weeks from symptom onset might be a marker of axonal degeneration and poor prognosis in GBS. Serial nerve conduction studies and serum CK measurements will help clinicians understand the pathophysiology of GBS.

[Very-early and early neuroelectrophysiological features of childhood Guillain-Barré syndrome]

OBJECTIVES

To study the very-early and early neuroelectrophysiological features of childhood Guillain-Barré syndrome (GBS) and their association with clinical diagnosis.

METHODS

A retrospective analysis was performed on the neuroelectrophysiological data of 43 children with GBS. According to the interval from onset to neuroelectrophysiological examination, the children were divided into a very-early examination group with 18 children (an interval from onset to the examination of ≤7 days) and an early examination group with 25 children (an interval from onset to the examination of 7 to ≤14 days). The children with acute flaccid paralysis, matched for the examination time of GBS children, were enrolled as the control group. The abnormal rates of neuroelectrophysiological parameters were compared between the above groups. According to the results of the H reflex test, the GBS children were divided into an abnormal H reflex group and a normal H reflex group, and related clinical data were compared between the two groups.

RESULTS

Compared with the control group, the very-early and early examination groups had a significantly higher abnormal rate of H reflex (P<0.05), while there was no significant difference in the abnormal rates of F wave, motor nerve conduction, and sensory nerve conduction (P>0.05). Compared with the normal H reflex group, the abnormal H reflex group had a significantly shorter interval from onset to the time of confirmed diagnosis (P<0.05).

CONCLUSIONS

Absence of the H reflex is a valuable parameter of neuroelectrophysiological abnormalities in the early stage of GBS and can help with the diagnosis of GBS.

Re-evaluating the accuracy of optimized electrodiagnostic criteria in very early Guillain-Barré syndrome: a sequential study

Using recent optimized electrodiagnostic criteria sets, we aimed at verifying the accuracy of initial nerve conduction studies (NCS) in classic very early Guillain-Barré syndrome (VEGBS), ≤ 4 days after onset, compared with the results of serial NCS. This is a retrospective study based on unreported and consecutive VEGBS patients admitted to two university hospitals between 2015 and 2019. Each patient had serial NCS in at least four nerves. Initial NCS studies were done within 4 days after onset, and serial ones from days 20 to 94. Electrophysiological recordings were blinded evaluated by four of the authors, GBS subtype being established accordingly. Seven adult classic VEGBS patients were identified with a median age of 58 years. At first NCS, GBS subtyping was only possible in 1 case that exhibited an axonal pattern, the remaining patterns being equivocal in 3, and mixed (combining axonal and demyelinating criteria) in the remaining 3. Upon serial NSC there was a rather intricate evolution of electrophysiological GBS patterns, 3 of them being classified as axonal or demyelinating, and the remaining 4 as equivocal or mixed. NCS in VEGBS systematically allows detection of changes suggestive of peripheral neuropathy, though even after serial studies accurate GBS subtyping was only possible in 43% of cases. We provide new pathophysiological insights for better understanding of the observed electrophysiological changes.