Changes in motor nerve excitability in acute phase Guillain-Barré syndrome

Background: The most common subtypes of Guillain-Barré syndrome (GBS) are acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). In the first days after the onset of weakness, standard nerve conduction studies (NCS) may not distinguish GBS subtypes. Reduced nerve excitability may be an early symptom of nerve dysfunction, which can be determined with the compound muscle action potential (CMAP) scan. The aim of this study was to explore whether early changes in motor nerve excitability in GBS patients are related to various subtypes. Methods: Prospective case–control study in 19 GBS patients from The Netherlands and 22 from Bangladesh. CMAP scans were performed within 2 days of hospital admission and NCS 7–14 days after onset of weakness. CMAP scans were also performed in age- and country-matched controls. Results: CMAP scan patterns of patients who were classified as AMAN were distinctly different compared to the CMAP scan patterns of the patients who were classified as AIDP. The most pronounced differences were found in the stimulus intensity parameters. Conclusions: CMAP scans made at hospital admission demonstrate several characteristics that can be used as an early indicator of GBS subtype.</p

Electrodiagnostic subtyping in Guillain–Barr\ue9 syndrome patients in the International Guillain–Barr\ue9 Outcome Study

\ua9 2024 The Authors. European Journal of Neurology published by John Wiley &amp; Sons Ltd on behalf of European Academy of Neurology.Background and purpose: Various electrodiagnostic criteria have been developed in Guillain–Barr\ue9 syndrome (GBS). Their performance in a broad representation of GBS patients has not been evaluated. Motor conduction data from the International GBS Outcome Study (IGOS) cohort were used to compare two widely used criterion sets and relate these to diagnostic amyotrophic lateral sclerosis criteria. Methods: From the first 1500 patients in IGOS, nerve conduction studies from 1137 (75.8%) were available for the current study. These patients were classified according to nerve conduction studies criteria proposed by Hadden and Rajabally. Results: Of the 1137 studies, 68.3% (N = 777) were classified identically according to criteria by Hadden and Rajabally: 111 (9.8%) axonal, 366 (32.2%) demyelinating, 195 (17.2%) equivocal, 35 (3.1%) inexcitable and 70 (6.2%) normal. Thus, 360 studies (31.7%) were classified differently. The areas of differences were as follows: 155 studies (13.6%) classified as demyelinating by Hadden and axonal by Rajabally; 122 studies (10.7%) classified as demyelinating by Hadden and equivocal by Rajabally; and 75 studies (6.6%) classified as equivocal by Hadden and axonal by Rajabally. Due to more strictly defined cutoffs fewer patients fulfilled demyelinating criteria by Rajabally than by Hadden, making more patients eligible for axonal or equivocal classification by Rajabally. In 234 (68.6%) axonal studies by Rajabally the revised El Escorial (amyotrophic lateral sclerosis) criteria were fulfilled; in axonal cases by Hadden this was 1.8%. Conclusions and discussion: This study shows that electrodiagnosis in GBS is dependent on the criterion set utilized, both of which are based on expert opinion. Reappraisal of electrodiagnostic subtyping in GBS is warranted

Headache – A Symptom not a Disease

Headache is a ubiquitous symptom, yet it is one that often elicits anxiety in both patients and physicians. No symptom more than headache gives a physician the chance to regain the time-honored role of “healer.” Most primary headache can be managed in primary care and investigations are rarely needed. When a patient presents with headache, the clinician must answer the following questions: (1) Is the headache “worrisome” (secondary to underlying disease)? (2) If the headache is benign, what type is it? (3) How is headache best treated ? Every presentation of headache requires care to exclude organic disease, and every presentation provides the opportunity to relieve suffering. The following review is intended to aid physicians in answering these questions. DOI: http://dx.doi.org/10.3329/jbcps.v31i4.21005 J Bangladesh Coll Phys Surg 2013; 31: 204-208</jats:p

Management of stroke - Bangladesh perspective

DOI: http://dx.doi.org/10.3329/bmj.v42i1.18979 Bangladesh Med J. 2013 Jan; 42 (1): 34-37</jats:p

Adrenoleukodystrophy: A Rare Case Report

A young boy of 18 years was admitted at department of Neurology, Dhaka Medical College Hospital with the complaints of progressive generalized hyper-pigmentation, gradual loss of vision, hearing impairment, abnormal behaviors and one episode of seizure. Examination finding revealed, abnormal behaviors, generalized hyper pigmentation of skin, oral mucosa, gum, tongue and palmer creases. He has diffuse hair loss, bilateral primary optic atrophy, bilateral sensoryneural deafness. All routine investigations revealed normal findings except, CSF protein were elevated, biochemical features (very high ACTH, low basal cortisol) of primary adrenal failure, Magnetic resonance imaging (MRI) of the head showed bilateral symmetrical white matter abnormalities in parieto-occipital regions. The diagnosis of Adreno-leukodystrophy (ALD) was strongly suggested from the medical history, biochemical and radiological (MRI) findings of brain. The purpose of our report is to highlight this very rare nontreatable disease to all. A patient of neuropsychiatric symptoms with Addison's disease we must think about ALD, because it's progression can be delayed with early diagnosis and supportive treatments, it's incidence can be reduced by genetic counseling.Key words: Adrenoleukodystrophy (ALD); Addison's disease; Very long chain fatty acid (VLCFA). DOI: 10.3329/jbcps.v28i3.6514J Bangladesh Coll Phys Surg 2010; 28: 189-192</jats:p