The prognostic value of demyelinating electrophysiologic findings and cerebrospinal fluid protein levels in acute inflammatory demyelinating polyneuropathy

TUNÇ, Abdulkadir; TEKEŞİN, Aysel; GÜZEL, Vildan; ÜNLÜBAŞ, Yonca; SEFEROĞLU, Meral

doi:10.1590/0004-282X20200042

Acessibilidade / Reportar erro

Brasil

Arquivos de Neuro-Psiquiatria

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Articles • Arq. Neuro-Psiquiatr. 78 (08) • Aug 2020 • https://doi.org/10.1590/0004-282X20200042 copy

The prognostic value of demyelinating electrophysiologic findings and cerebrospinal fluid protein levels in acute inflammatory demyelinating polyneuropathy

O valor prognóstico dos achados eletrofisiológicos desmielinizantes e os níveis de proteína do líquido cefalorraquidiano na polineuropatia desmielinizante inflamatória aguda

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

Guillain-Barre syndrome is an acute immune-mediated polyneuropathy characterized by rapidly evolving symptoms and disability. Cerebrospinal fluid analysis and electrophysiological studies are crucial in the diagnosis of this syndrome.

Objective:

To evaluate the prognostic value of the type and number of demyelinating findings and cerebrospinal fluid protein levels in patients with acute inflammatory demyelinating polyneuropathy.

Methods:

We retrospectively analyzed electrophysiological data and cerebrospinal fluid of 67 consecutive patients with acute inflammatory demyelinating polyneuropathy from Istanbul, Turkey (2011-2019) studied ≤ 24 hours post-onset.

Results:

The patients who met a higher number of demyelinating criteria had increased disability scores in the first day and first month, and higher cerebrospinal fluid protein levels were correlated with worse prognosis both on the first day and the first month. However, the disability scores did not correlate with any single specific criterion, and no significant correlation was found between the number of satisfied criteria and cerebrospinal fluid protein levels.

Conclusions:

The number of demyelinating criteria that are met and high cerebrospinal fluid protein levels at the disease onset may be valuable prognostic markers. More systematic studies conducted with serial nerve conduction studies are required to highlight the roles of the suggested criteria in clinical practice.

Keywords:
Guillain-Barre Syndrome; Prognosis; Electromyography

		Min-Max	Median	Mean±SD/n (%)
Age		17-84	55	51.6±18.4
Gender	Female			28 (41.8)
Gender	Male			39 (58.2)
CSF protein		19-277.1	96.1	111.4±68.6
HDS score 1st day		1-5	3	2.9±1.1
HDS Score 1st month		0-6	2	1.8±1.1
Slowed conduction velocities (+)				31 (46.2)
Conduction block (+)				33 (49.2)
Prolonged distal latencies (+)				39 (58.2)
Abnormal F-waves (+)				45 (67.1)
Number of criteria	None			13 (19.4)
	1 Criteria			15 (22.3)
	2 Criteria			6 (8.9)
	3 Criteria			11 (16.4)
	4 Criteria			22 (32.8)

			Slowed conduction velocities (-)		Slowed conduction velocities (+)				p-value
Age		Mean±SD (Median)	52±18.2	57.5	51.1±19	53			0.816	^m
Gender	Female	n-%	15	41.7%	13	41.9%			0.982	^X²
Gender	Male	n-%	21	58.3%	18	58.1%
CSF protein		Mean±SD (Median)	112.1±71.2	88.3	110.7±66.8	103.1			0.995	^m
HDS score on the first day		Mean±SD (Median)	2.7±1.1	3	3.1±1.1	3			0.173	^m
HDS score at the first month		Mean±SD (Median)	1.6±1.2	1.5	2.0±1.1	2			0.054	^m
First day - First month change		Mean±SD (Median)	-1.1±1.2	-1	-1.1±0.7	-1			0.256	^m
HDS intragroup change p			<0.01 ^w		<0.01 ^w
			Abnormal F-waves (-)		Abnormal F-waves (+)				p-value
Age		Mean±SD (Median)	49.8±18.3	53	52.5±18.6			59	0.575	^m
Gender	Female	n-%	8	36.4%	20			44.4%	0.529	^X²
Gender	Male	n-%	14	63.6%	25			55.6%
CSF protein		Mean±SD (Median)	105.9±69	77.8	114.1±69.1			102.1	0.669	^m
HDS score on the first day		Mean±SD (Median)	2.6±1.1	2.5	3.0±1.1			3	0.12	^m
HDS score at the first month		Mean±SD (Median)	1.3±0.8	1	2.0±1.2			2	0.011	^m
First day - First month change		Mean±SD (Median)	-1.3±0.6	-1	-1.0±1.1			-1	0.326	^m
HDS intragroup change p			<0.01 ^w		<0.01 ^w
			Prolonged distal latencies (-)		Prolonged distal latencies (+)				p-value
Age		Mean±SD (Median)	51.3±18.1	57.5	51.8±18.9	54	0.98		^m
Gender	Female	n-%	12	42.9%	16	41%	0.881		^X²
Gender	Male	n-%	16	57.1%	23	59%
CSF protein		Mean±SD (Median)	98.1±65.8	72	121.0±69.9	115.9	0.145		^m
HDS score on the first day		Mean±SD (Median)	2.7±1.2	3	3.1±1.1	3	0.241		^m
HDS score at the first month		Mean±SD (Median)	1.6±1.3	1.5	1.9±1	2	0.084		^m
First day - First month change		Mean±SD (Median)	-1.1±1.4	-1	-1.1±0.6	-1	0.335		^m
HDS intragroup change p			<0.01 ^w		<0.01 ^w
			Conduction block (-)		Conduction block (+)				p-value
Age		Mean±SD (Median)	51.1±17.8	54	52.1±19.3		61	0.90	^m
Gender	Female	n-%	11	32.4%	17		51.5%	0.112	^X²
Gender	Male	n-%	23	67.6%	16		48.5%
CSF protein		Mean±SD (Median)	102.5±72	64.4	120.6±64.8		110	0.124	^m
HDS score on the first day		Mean±SD (Median)	2.7±1.2	3	3.1±1		3	0.077	^m
HDS score at the first month		Mean±SD (Median)	1.6±1.3	2	2.0±0.9		2	0.112	^m
First day - First month change		Mean±SD (Median)	-1.1±1.3	-1	-1.2±0.7		-	0.871	^m
HDS intragroup change p			<0.01 ^w		<0.01 ^w

		None		One criteria		Two or more criteria		p-value
		Mean±SD/n-%	Median	Mean±SD/n-%	Median	Mean±SD/n-%	Median	p-value
Age		51.5±18.5	53	55.5±16.2	61	50.2±19.4	53	0.655	^K
Gender	Female	5	38.5%	6	40%	17	43.6%	0.937	^X²
Gender	Male	8	61.5%	9	60%	22	56.4%
CSF protein		110.8±64.6	87.6	92.8±73.5	67.9	118.8±68.4	103.5	0.323	^K
HDS score on the first day		2.5±1.1	2	2.7±1.3	3	3.1±1	3	0.242	^K
HDS score at the first month		1.2±0.8	1	1.9±1.5	2	1.9±1	2	0.058	^K
First day - First month change		-1.4±0.7	-1	-0.8±1.7	-1	-1.1±0.7	-1	0.646	^K
HDS intragroup change p		<0.01 ^w	<0.01 ^w			<0.01 ^w

		CSF protein	HDS score 1st day	HDS score 1st month	HDS intra group change
Number of criteria	r	0.139	0.241	0.318	0.121
Number of criteria	p	0.264	0.049	0.009	0.33
CSF protein	r		0,334	0.292	-0.182
CSF protein	p		0.006	0.016	0.14

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Abdulkadir Tunç; E-mail: drkadirtunc@hotmail.com