Ghulam Shabbir, Assadullah, Lakhair M A, Ali Majid Al, Emran Rashid.
Early abnormal sponteneous activity findings in axonal variant of Guillain Barre Syndrome: is this a new variant of guillain barre syndrome?.
Pak J Neurological Sci Jan ;7(3):01-7.

Objective: To evaluate the earliest denervation potentials in axonal variant of GBS. Background: Guillain Barre Syndrome (GBS) is one of the most important acute neurolological emergency. Denervation potentials on needle EMG is the hallmark of axonal damage. Usually this is a time dependent phenomenon. The degeneration of axon depends upon length of axon to be degenerated. Studies claim variable time duration for denervation potentials from two weeks to three weeks. Material/Methods: This is a cross-sectional survey of patients admitted and referred for neurophysiologic assessment. Clinical and neurophysiological data of GBS patients over a period of three years and three months and ten days was collected. NCS/EMG performed by a qualified neurophysiologist. Diagnosed cases of GBS with available data of NCS/EMG were included. Patients with history of Diabetes Mellitus, previous history of any sort of neuropathy and demyelinating variants after diagnosis were excluded as well. Clinical and Neurophysiologic data were collected on Performa for analysis. Result: Total forty- three patients were diagnosed as GBS and those with axonal variants were finally included. Out of forty-three, eighteen had axonal variant of GBS and rest of them demyelinating variants. Twelve patients of axonal variant (31%) showed fibrillation potentials, positive Sharp Waves and increased insertional activity within 4-12 days of symptoms onset and six (69%) beyond that period. Total twelve patients were finally included. Active denervation in the form of fibrillation potentials and positive sharp waves were noted frequently and decreased interference pattern in almost all patients. NCS were performed before EMG examination. Conclusion: Fibrillation Potentials, Positive Sharp Waves and decreased interference pattern were noted in early course of disease in GBS patients interestingly before two weeks of symptoms onset. This study raises the query for a possible new Hyperacute or Fulminant variant of GBS. These findings need further histopathology and etiologic correlation as well as further prognostic importance.

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