Diagnostic accuracy of neurophysiological criteria for early diagnosis of AIDP: a prospective study

OBJECTIVE: To assess the diagnostic accuracy of electrodiagnostic (EDX) criteria for the early detection and characterization of Guillain-Barré syndrome (GBS) in clinical practice. METHODS: We conducted a prospective study in patients referred for an EDX exam with clinical suspicion of GBS. We evaluated four sets of neurophysiological criteria and four neurophysiological tests among those recently proposed for the early diagnosis of GBS. RESULTS: We recruited 84 patients. Acute inflammatory demyelinating polyneuropathy (AIDP) was the final diagnosis in 23 patients. No axonal forms were found. The best sensitivity was obtained using Rajabally et al.’s criteria (82.1%), whereas the specificity was 90.0% for Ho et al.’s and Hadden et al.’s criteria and 100% for the Dutch GBS study group and Rajabally's criteria. Regarding the neurophysiological tests proposed for early diagnosis, the sensitivity ranged from 16.6 to 100%, whereas specificity ranged from 73.1 to 98.3%. CONCLUSION: The Dutch GBS study group and Rajabally et al.’s criteria showed an optimal combination of sensitivity and specificity for clinical practice, although with a slightly higher sensitivity for Rajabally et al.’s criteria. None of the neurophysiological parameters recently proposed for early diagnosis have good diagnostic accuracy for clinical application. SIGNIFICANCE: In a real clinical setting with patients referred by neurologists and emergency doctors, an EDX study performed within a week of symptom onset supports the diagnosis of AIDP in 82% of cases

Data on multimodal approach for early poor outcome (Cerebral Performance Categories 3-5) prediction after cardiac arrest

The data presented in this article are related to our research article entitled ‘Neurophysiological and neuroradiological multimodal approach for early poor outcome prediction after cardiac arrest’ (Scarpino et al., 2018) [1]. We reported two additional analyses, including results gathered from somatosensory evoked potentials(SEPs), brain computed tomography(CT) and electroencephalography(EEG) performed on 183 subjects within the first 24 h after cardiac arrest(CA). In the first analysis, we considered the Cerebral Performance Categories(CPC) 3, 4 and 5a,b (severe disability, unresponsive wakefulness state, neurological death and non-neurological death, respectively) as poor outcomes. In the second analysis, patients that died from non-neurological causes (CPC 5b) were excluded from the analysis. Concerning the first analysis, bilateral absent/absent-pathologic(AA/AP) cortical SEPs predicted poor outcome with a sensitivity of 49.3%. A Grey Matter/White Matter(GM/WM) ratio <1.21 predicted poor outcome with a sensitivity of 41.7%. Isoelectric/burst-suppression EEG patterns predicted poor outcome with a sensitivity of 33.5%. If at least one of these poor prognostic patterns was present, the sensitivity for an ominous outcome increased to 60.9%. Concerning the second analysis, AA/AP cortical SEPs predicted poor outcome with a sensitivity of 52.5%. GM/WM ratio <1.21 predicted poor outcome with a sensitivity of 50.4%. Isoelectric/burst-suppression EEG patterns predicted poor outcome with a sensitivity of 39.8%

SSEP amplitude accurately predicts both good and poor neurological outcome early after cardiac arrest; a post-hoc analysis of the ProNeCA multicentre study

AIM: To assess if, in comatose resuscitated patients, the amplitude of the N20 wave (N20amp) of somatosensory evoked potentials (SSEP) can predict 6-months neurological outcome.SETTING: Multicentre study in 13 Italian intensive care units.METHODS: The N20amp in microvolts (muV) was measured at 12h, 24h, and 72h from cardiac arrest, along with pupillary reflex (PLR) and a 30-min EEG classified according to the ACNS terminology. Sensitivity and false positive rate (FPR) of N20amp alone or in combination were calculated.RESULTS: 403 patients (age 69[58-68] years) were included. At 12h, an N20amp &gt;3muV predicted good neurological outcome (Cerebral Performance Categories [CPC] 1-2) with 61[50-72]% sensitivity and 11[6-18]% FPR. Combining it with a benign (continuous or nearly continuous) EEG increased sensitivity to 91[82-96]%. For poor outcome (CPC 3-5), an N20Amp ≤0.38muV, ≤0.73muV and ≤1.01muV at 12h, 24h, and 72h, respectively, had 0% FPR with sensitivity ranging from 61[51-69]% and 82[76-88]%. Sensitivity was higher than that of a bilaterally absent N20 at all time points. At 12h and 24h, a highly malignant (suppression or burst-suppression) EEG and bilaterally absent PLR achieved 0% FPR only when combined with SSEP. A combination of all three predictors yielded a 0[0-4]% FPR, with maximum sensitivity of 44[36-53]%.CONCLUSION: At 12h from arrest, a high N20Amp predicts good outcome with high sensitivity, especially when combined with benign EEG. At 12h and 24h from arrest a low-voltage N20amp has a high sensitivity and is more specific than EEG or PLR for predicting poor outcome