Clinical and electrophysiological predictors of outcome in Guillain-Barre syndrome

To determine the clinical and electrophysiological predictors of outcome in patients with Guillain-Barre syndrome [GBS]. This study was carried out on 24 patients [14 males and 10 females] with GBS. All patients were subjected to [1] history taking including informations about course of the disease, duration of illness and history of antecedent illness; [2] general clinical examination; [3] neurological examination including cranial nerves examination, muscle status and the degree of affection of the motor and sensory systems as well as the deep tendon reflexes. The muscle power was graded according to the Medical Research Council scale. Assessment of the functional ability by the functional ability score was done before and after treatment; [4] Electrophysiological studies including nerve conductions and electromyography. There was a significant correlation between the age of patients and the prognosis; the younger the patients, the better the prognosis. On the other hand, there was no significant correlation between the gender and the outcome. There was an inverse relationship between the time to maximal weakness and the outcome. Patients with respiratory muscle affection, sphincter disturbance, bradycardia or tachycardia, hypotension or hypertension, facial diplegia, and absent deep tendon reflexes in both upper and lower limbs had bad outcome. There was a significant correlation between the presence of muscle wasting, superficial and deep sensory affection as well as grade 2 muscle power and the bad outcome. Also, there was a significant correlation between initial functional ability score and the outcome. Electrophysiologically, there was a significant correlation between each of the distal motor latencies of the studied nerves [median, ulnar and common peroneal nerves], the mean amplitude of the compound muscle action potential on distal stimulation, and the motor conduction velocities of peripheral segments of the three studied nerves and the outcome. On the other side, there was a non-significant correlation between each of the sensory conduction velocities of peripheral segments of the studied nerves and the latencies of F-wave of both ulnar and common peroneal nerves and the outcome. Also, there was a non-significant correlation between distal motor latency, motor conduction velocity and the F-wave latency of the studied nerves. There was a significant improvement in the conduction studies in the studied nerves after 3 months of treatment. The clinical predictors of outcome in patients with GBS are the age, the mode of onset and the severity of clinical involvement. Manifest respiratory muscle affection, sphincter disturbance, marked autonomic disturbance, cranial nerve affection, marked degree of muscle wasting, severe degree of muscle weakness, absent deep tendon reflexes and the presence of sensory affection; all are associated with bad outcome. On the other hand, the electrophysiological findings can provide a prognostic value in patients with GBS. Delayed motor conduction velocity and reduced amplitude of cMAP on distal stimulation carry a bad outcome, but other measures including sensory conduction velocity, F-wave response and distal motor latency have no significant correlation with the outcome

Risk of epilepsy after electrographically proven neonatal seizures

Neonatal seizures often are manifestations of significant neurological disease and major predictors of adverse neurological outcome in the newborn. The present work aimed at estimation of outcomes of neonatal seizures especially the development of epilepsy. The present study was conducted on 30 patients [15 males and 15 females] with neonatal seizures, their ages ranged from one to 30 days. All patients were subjected to full history taking and through clinical examination. Laboratory investigations included: complete blood picture, metabolic screening tests [blood glucose, serum Ca, Mg and Na, blood urea, serum creatinine, serum bilirubin and ferric chloride test], sepsis screen [blood, CSF and urine culture, and TORCH titers], brain C. T. scan and EEG [interictal and follow up]. The etiologic diagnosis of neonatal seizures was based on positive clinical data, laboratory data and/or imaging data. Follow up for at least 6 months was performed with serial neurological evaluation and EEG. From this study, it was found that the seizures etiologies were diverse, hypoxic ischemic encephalopathy [HIE] was the most common cause 46.7%, meningitis 16.7%, cerebral dysgenesis 10%. Metabolic causes 13.3% and intracranial hemorrhage 13.3%. Etiology of seizures was significantly correlated with total outcome, subsequent development of epilepsy and developmental delay. There was significant correlation between findings of neurological examination and total outcome, epilepsy and developmental delay. Neonates with mildly abnormal neurological findings had favorable outcome in 100% of cases. Patients with severely abnormal neurological findings were associated with unfavorable outcome [mortality, epilepsy or developmental delay] in 81.8% of cases. Type of seizures was significantly correlated with the total outcome and mortality. Generalized tonic seizures had the worst prognosis. There was significant correlation between brain CT findings and total outcome, subsequent development of epilepsy and developmental delay. EEG findings were significantly correlated with the outcomes findings of neurological examination and frequency of seizures but insignificantly correlated with type of seizures, onset of seizures and brain CT findings. The 3-months follow up EEG was significantly correlated with the development of epilepsy. Seizure etiology, neurological evaluation of the newborn at birth [mildly, moderately and severely abnormal], clinical characteristics of seizures [onset, frequency and types], brain CT. and EEG findings [interdicted EEG background activity], 3-months follow-up EEG and meticulous follow-up clinical examination were the most important determinants for prediction of the neurological outcome of neonatal seizures. Epilepsy and developmental delay after neonatal seizures were more frequent in presence of one or more of the following: severely abnormal neurological examination at birth, cerebral dyesgenesis as an etiology of seizures, generalized tonic seizures, seizure frequency >/= 2 seizures/h, abnormal brain CT scan findings and abnormal inter-ictal EEG background. EEG is recommended to be performed for all cases with neonatal convulsions as a diagnostic and prognostic tool. Meticulous follow up [clinical examination, EEG] of cases with neonatal seizures is essential to predict the subsequent development of epilepsy and developmental delay