Application Of SSR And RRIV In Guillain-Barre Syndrome

Guillain-Barre syndrome (GBS) is a class of immune-mediated acute inflammatory peripheral neuropathy. The main lesion is a wide range segmental demyelination of inflammatory peripheral nerve. The disease damages majority of spinal nerve roots and peripheral nerves, and often involves the cranial nerves. Doctors mainly rely on clinical symptoms, conventional electrophysiological examination of GBS for early diagnosis and prognosis. Mostly use electrophysiological indicators as MCV/SCV (movement/sensory nerve conduction velocity), F wave, and needle EMG electrodes. GBS patients who have autonomic symptoms of are often serious, have higher mortality rate. Sympathetic skin response (SSR) and heart rate interval variation (RRIV) are carried out in recent years, simple, quantitative and noninvasive electrophysiological autonomic means of detection. SSR is recording the the sympathetic response by electrical stimulation. RRIV is recording heart rate, to reflect parasympathetic function. They are two of the most advanced and sophisticated methods to assess the fuction of autonomic nervous system. They are simple and non-invasive application in clinical operations.Objective:By SSR and RRIV tests, assessed autonomic nerve disfunction in GBS patient, provided an objective electrophysiological basis to GBS patient who have autonomic nerve disfunction.Methods:We studied 40 cases of Guillain-Barre syndrome patients and 30 cases of age-matched healthy subjects.SSR Records:On upper limbs recording electrodes were placed on palms, the reference electrodes were placed on the back of the hands. On lower limbs recording electrodes were placed on feet, the reference electrodes were placed on the insteps. Stimulated the median nerve and the tibial nerve. The continuous stimulation time is 0.1ms, and the current intensity is at 10～30mA, to irregular stimulus. The interval is more than 15s. Recorded SSR latency and amplitude.RRIV record:Grounding line was placed on right wrist, recording electrode was placed on the precordial region, the reference electrode was placed on the sternum, so you can get QRS waveform. Keypoint EMG instrument can automatically calculate RRIV. Recorded the RRIV when people at normal breathing and deep breathingOther Records:Recorded subjects as MCV, SCV, F wave and protein content in cerebrospinal fluid of patients.Results:1.Compared demyelination group, axon group, Fisher group and the control group, the latency of SSR was no significant differences, and the amplitude of SSR was statistically significant.2.Compared demyelination group, axon group, Fisher group and the control group, both in quiet breathing and deep breathing RRIV were statistically significant.3. The abnormality of SSR and RRIV was no statistically significant.4. Between axonal and demyelination group, the results of SSR and conventional electrophysiological testing showed no correlation.5. GBS protein content in cerebrospinal fluid of patients was no correlation with nerve conduction velocity, F wave, SSR and RRIV.6. Between GBS patients who have autonomic symptoms and patients without them the abnormal rate was statistically significant, by SSR and RRIV testing.7. SSR, RRIV, MCV, SCV and F wave, abnormal rates of the five electrophysiological comparison,χ2=19.906, P<0.05, and was statistically significant.Conclusion:1. Compared demyelination group, axon group, Fisher group and the control group, the latency of SSR was no statistically significant, and the amplitude of SSR was statistically significant. Sympathetic nerve damage in GBS patient mostly effect the amplitude of SSR, and no significant change in latency may be coursed by a short time damage.2. Compared demyelination group, axon group, Fisher group and the control group, both in quiet breathing and deep breathing RRIV was statistically significant. GBS patients have parasympathetic disfuction, and may much serious than sympathetic damage.3. The abnormality of SSR and RRIV was no statistically significant. Two detection methods can prompt detection of autonomic nerve damage sensitive situation. 4. Between GBS patients who have autonomic symptoms and patients without them the abnormal rate was statistically significant, by SSR and RRIV testing. The detections of SSR and RRIV have higher sensitivity than the clinical symptoms, and electrophysiological tests can find sub-clinical lesions.5. SSR, RRIV, MCV, SCV, F wave, abnormal rates of the five electrophysiological comparison was statistically significant, indicating that five rates of electrophysiological abnormalities are different.