J Clin Neurol.  2016 Oct;12(4):495-501. 10.3988/jcn.2016.12.4.495.

Early Electrodiagnostic Features of Upper Extremity Sensory Nerves Can Differentiate Axonal Guillain-Barré Syndrome from Acute Inflammatory Demyelinating Polyneuropathy

• Koo YS
• Shin HY
• Kim JK
• Nam TS
• Shin KJ
• Bae JS
• Suh BC
• Oh J
• Yoon BA
• Kim BJ

• KMID: 2385116
• DOI: http://doi.org/10.3988/jcn.2016.12.4.495

Abstract

BACKGROUND AND PURPOSE
Serial nerve conduction studies (NCSs) are recommended for differentiating axonal and demyelinating Guillain-Barré syndrome (GBS), but this approach is not suitable for early diagnoses. This study was designed to identify possible NCS parameters for differentiating GBS subtypes.
METHODS
We retrospectively reviewed the medical records of 70 patients with GBS who underwent NCS within 10 days of symptom onset. Patients with axonal GBS and acute inflammatory demyelinating polyneuropathy (AIDP) were selected based on clinical characteristics and serial NCSs. An antiganglioside antibody study was used to increase the diagnostic certainty.
RESULTS
The amplitudes of median and ulnar nerve sensory nerve action potentials (SNAPs) were significantly smaller in the AIDP group than in the axonal-GBS group. Classification and regression-tree analysis revealed that the distal ulnar sensory nerve SNAP amplitude was the best predictor of axonal GBS.
CONCLUSIONS
Early upper extremity sensory NCS findings are helpful in differentiating axonal-GBS patients with antiganglioside antibodies from AIDP patients.

Keyword

Guillain-Barré syndrome; acute inflammatory demyelinating polyneuropathy; early diagnosis; electrodiagnosis; neural conduction

MeSH Terms

Action Potentials
Antibodies
Axons*
Classification
Diagnosis
Early Diagnosis
Electrodiagnosis
Guillain-Barre Syndrome*
Humans
Medical Records
Neural Conduction
Retrospective Studies
Ulnar Nerve
Upper Extremity*
Antibodies

Figure

• 

  Fig. 1 Classification and regression tree (CART) diagram for discriminating acute axonal Guillain-Barré syndrome (GBS) from acute inflammatory demyelinating polyneuropathy (AIDP) using a set of independent variables. A: CART diagram involving a set of independent variables related to both motor and sensory nerves. According to this model, patients in nodes 1 and 2 were classified as AIDP and axonal-GBS patients, respectively. B: CART diagram involving variables for motor nerves only. According to this model, patients in nodes 3 and 4 were classified as axonal GBS, and those in node 2 were classified as AIDP patients. PerMDL: distal latency in peroneal motor nerve, TibMPDur: duration in proximal tibial motor nerve, UlnSDAm: distal amplitude in ulnar sensory nerve.

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