Multiple A waves in Guillain-Barré syndrome

Muscle & Nerve
M E KornhuberB Conrad

Abstract

In 13 of 14 patients with Guillain-Barré syndrome (GBS), we observed multiple A waves in at least one limb nerve on routine electroneurographic studies within 7 days after onset of symptoms. The patient without A waves had a severe axonal type of GBS with tetraplegia and almost complete loss of M responses following electrical stimulation of limb nerves. In the remaining 13 patients, on average 8 +/- 2 (mean +/- SD) A waves were present in each tibial nerve (n = 24) and 4 +/- 1 A waves in each peroneal nerve (n = 26). About half of the A waves were below 50 microV in amplitude, whereas amplitudes were higher than 120 microV in only 22 of 299 A waves. Of these A waves, 68 were not constantly elicitable. There was a significant correlation between the number of A waves up to 50 ms poststimulus and the reduction in amplitude of the compound muscle action potential when elicited with proximal compared to distal stimulation in the peroneal (n = 26, P < 0.0005; Kendall's tau) and tibial nerves (n = 24, P < 0.002). Therefore, in GBS both conduction block and A waves are presumably signs of inflammatory nerve lesions. The existence of multiple A waves soon after onset of symptoms seems to be a sensitive sign of GBS.

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Citations

Oct 23, 2003·Muscle & Nerve·Leena PuksaBjörn Falck
Aug 29, 2012·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Tulay Kurt IncesuCumhur Ertekin
Nov 8, 2011·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Shingo KawakamiTeruo Shimizu
Jun 23, 2011·Journal of the Peripheral Nervous System : JPNS·Maria A AlbertíCarlos Casasnovas
Apr 3, 2012·Journal of the Peripheral Nervous System : JPNS·Emilio Geijo-BarrientosCarlos Pastore-Olmedo
Jan 11, 2005·Neurophysiologie clinique = Clinical neurophysiology·F Mesrati, M F Vecchierini
Apr 30, 2019·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Reda Badry
Sep 25, 2018·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Liborio RampelloAntonio Arcidiacono
Aug 23, 2017·Brain and Behavior·Iva SrotovaJosef Bednarik
May 31, 2018·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Sindhuja LakshminarasimhanLakshminarasimhan Ranganathan
Jul 13, 2002·Muscle & Nerve. Supplement·Kimiyoshi ArimuraMitsuhiro Osame
Jul 13, 2002·Muscle & Nerve. Supplement·Christian Bischoff
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