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

Serum IgA, IL-2, IL-6 and TNF- alpha concentrations in patients with pharmacoresistant epilepsy

The concept that the immune system plays a role in the epileptogenesis was first proposed more than 20 years ago. Since then, several laboratory and clinical studies have reported on the existence of a variety of immunological abnormalities in epileptic patients, on the observation of favourable responses of refractory epilepsy syndromes to immunomodulatory treatment, and on the association of epilepsy with certain well-known immunemediated disorders. In this study we try to verify if there is a link between pharmacoresistant epilepsy and immune system. We compared the serum levels of IgA, IL-2, IL-6, and TNF-a, in 45 patients with pharmacoresponsive epilepsy, in 30 patients with pharmacoresistant epilepsy and in 15 healthy reference subjects. Low serum levels of IgA were found in epileptic patients than reference subjects and in pharmacoresistance epilepsy group than pharmacoresponsive epileptic group .There were significant high serum levels of IL-2, IL-6 and TNF-a in epileptic patients than reference subjects and in pharmacoresistance group than pharmacoresponsive epileptic group. There was significant association between the serum levels of the IL-2, IL-6 and TNF-a and frequency of seizures and not the duration of the epilepsy or its type. These results give additional evidence for activation of the cytokine network and the magnitude of these changes is related to severity of seizures. Since this activation may promote important neuromodulatory functions and may serve as a link between excessive neuronal activity and various immunological changes that can lead to refractoriness of seizures