Residual fatigue in Guillain-Barré syndrome is related to axonal loss
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Abstract
Objective: To determine the occurrence of residual loss of peripheral nerve axons by motor unit number estimation (MUNE) and conventional nerve conduction studies (NCS) in patients with and without severe fatigue.
Methods: Thirty-nine patients at a median of 8 years (range 1–23 years) after diagnosis of Guillain-Barré syndrome were neurologically examined and divided in 2 subgroups based on the presence of severe fatigue (defined as a fatigue severity score ≥5). All patients were investigated with standard NCS and MUNE. Normal values for MUNE were collected in 14 healthy controls.
Results: MUNE of the thenar muscles was lower in the 15 patients with severe fatigue (median 125, interquartile range 65–141) compared with the 24 patients without severe fatigue (median 258, interquartile range 120–345) (p = 0.002). In the healthy controls, MUNE was 358 (245–416). Severe fatigue was also related to lower sensory nerve action potential amplitude of the median (p = 0.01) and ulnar nerve (p = 0.03). The 2 subgroups did not differ regarding neurologic deficits, disability, and the remaining conventional motor NCS.
Conclusion: This study demonstrates that severe fatigue after Guillain-Barré syndrome is related to more pronounced axonal loss, represented by lower MUNEs and lower sensory nerve action potentials.
GLOSSARY
- CMAP=
- compound muscle action potential;
- FSS=
- Fatigue Severity Scale;
- GBS=
- Guillain-Barré syndrome;
- HADS=
- Hospital Anxiety and Depression Scale;
- IQR=
- interquartile range;
- MRC=
- Medical Research Council;
- MU=
- motor unit;
- MUNE=
- motor unit number estimation;
- MUP=
- motor unit potential;
- NCS=
- nerve conduction studies;
- ODSS=
- overall disability sum score;
- SNAP=
- sensory nerve action potential
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received May 17, 2013.
- Accepted in final form August 21, 2013.
- © 2013 American Academy of Neurology
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Letters: Rapid online correspondence
- Re:Clinical fatigue in Guillain-Barre syndrome.
- Judith Drenthen, MD, Erasmus MCj.drenthen@erasmusmc.nl
- Judith Drenthen, Rotterdam, The Netherlands; Bart C. Jacobs, Rotterdam, The Netherlands; Ellen M. Maathuis, Rotterdam, The Netherlands; Pieter A. van Doorn, Rotterdam, The Netherlands; Gerhard H. Visser, Heemstede, The Netherlands; Joleen H. Blok, Delft,
Submitted May 12, 2014 - Clinical fatigue in Guillain-Barre syndrome.
- Albert Cuetter, Professor, Paul L. Foster School of Medicinealbert.cuetter@ttuhsc.edu
- El Paso, Texas
Submitted January 28, 2014
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