Long term clinical and electrophysiological assessment of Croatian children with corticospinal tract involvement in Guillain-Barré syndrome (GBS)

Transcranial Magnetic Stimulation as an Additional Diagnostic Tool in Children with Acute Inflammatory Demyelinating Polyneuropathy

CONTEXT

The diagnosis of polyneuropathy may be challenging at the early stages of the disease. Despite electromyography (EMG) efficacy in the establishment of polyneuropathy diagnosis, in some cases, results are dubious and neurophysiologists may implement additional techniques to ensure that conduction is affected.

AIMS

The aim of the study was to evaluate motor-evoked potential (MEP) characteristics in children with acute inflammatory demyelinating polyneuropathy (AIDP).

SETTINGS AND DESIGN

The study was conducted at a pediatric research and clinical center for infectious diseases.

SUBJECTS AND METHODS

Twenty healthy children (7-14 years old) without signs of neurological disorders were enrolled as controls. Thirty-seven patients (8-13 years old) with AIDP were enrolled as the main group. EMG and transcranial magnetic stimulation (TMS) were performed on the 3^rd-7^th days from the onset of the first symptoms.

STATISTICAL ANALYSIS USED

Descriptive statistics and Student's t-test were used. Bonferroni method was applied to implement appropriate corrections for multiple comparisons.

RESULTS

Significant differences between children with AIDP and controls on latencies of both cortical and lumbar MEPs were registered. Cortical MEP shapes were disperse in 100% of the cases and lumbar MEPs were disperse in 57% of the cases.

CONCLUSIONS

Diagnostic TMS on the early stage of the AIDP in children may be implemented as the additional tool. The main finding in this population is lengthening of the latency of cortical and lumbar MEPs. Disperse shape of the lumbar MEPs may be used as the early sign of the acute demyelization.

Acute motor-sensory axonal neuropathy with hyperreflexia in Guillain-Barré syndrome

Guillain-Barré syndrome is an acute inflammatory autoimmune polyradiculoneuritis. Progressive motor weakness and areflexia are essential for its diagnosis. Hyperreflexia has rarely been reported in the early healing period of Guillain-Barré syndrome following Campylobacter jejuni infection in patients with acute motor axonal neuropathy with antiganglioside antibody positivity. In this study, we report a 12-year-old girl presenting with complaints of inability to walk, numbness in hands and feet, and hyperactive deep tendon reflexes since the onset of the clinical picture, diagnosed with acute motor-sensory axonal neuropathy type of Guillain-Barré syndrome.