Early Prediction of Respiratory and Autonomic Complications of GBS Using Neuromuscular Ultrasound
试验速览
- 阶段
- 不适用
- 入组人数
- 100
- 试验地点
- 1
- 主要终点
- Neuromuscular ultrasound
研究概览
简要总结
Neuromuscular US will be a good and non invasive predictor for respiratory and autonomic dysfunctions in GBS through evaluation of diaphragmatic thickness, phrenic and vagus nerve cross sectional area.
详细描述
Patients presented in the ER with clinical manifestations and examination suggesting GBS are admitted to neurology department. Confirmation of the diagnosis of GBS is done by fulfilling the clinical diagnostic criteria, CSF examination is done searching for cytoalbuminous dissociation ,serum electrolytes, toxicological screening ,virology to exclude mimics of GBS.
Patients will undergo electrophysiological study (motor NCS of both median ulnar ,tibial ,and peroneal nerves ). Distal motor latency (dmL), nerve conduction velocity (CV) and compound muscle action potential (CMAP)amplitude measurements were undertaken as well as measurements of the mean F-M-latencies of both median ,ulnar and tibial nerves (F-wave latency-dmL). Similarly, sensory nerve conduction study is applied on both median and ulnar nerves ,(dml is assessed. According to the electophysiological study results, patients will be grouped into:
- AIDP: If two or more nerves showed demyelinating features (distal latency prolongation, slow nerve conduction velocity, conduction block, or prolonged F wave latency) on motor nerve conduction study.
- AMAN: Normal sensory conduction studies and unrecordable or reduced compound muscle action potential on motor nerve conduction study. There should not be more than one demyelinating feature in any nerve.
- AMSAN: If both motor and sensory nerve conduction studies revealed features of axonal neuropathy such as reduced or absent CMAP and SNAP, marginal slowing or normal conduction velocity and absence of conduction block.
- Inexcitable: Absent CMAP in all motor nerves (or present in only one nerve with CMAP <10%of lower limit of normal).
- Equivocal: GBS patients not fulfilling the above neurophysiologic criteria.
Then patients will be assessed clinically using the Medical Research Council (MRC) grading for power and Hughes functional grading scale scores.
Muscle groups (right and left) assessed in the measurement of the MRC sums core are:
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients that will fulfill the published diagnostic criteria of GBS.
- •Age: 18-65
- •Both sexes
排除标准
- •History of cardiopulmonary dysfunction
- •BMI>30 Kg/m2
- •Renal or hepatic failure
- •Autonomic or respiratory dysfunction from the start
- •Patients with hypo- or hyperkalemic paralysis, porphyria, viral myositis, botulism, diphtheritic neuropathy, and history of potential toxic exposure were excluded.
- •Abnormal pulmonary function test from the start.
结局指标
主要结局
Neuromuscular ultrasound
时间窗: 24-48 hours
Sensitivity and specificity of US in predicting respiratory and autonomic complications in Guillain Barre Syndrome
次要结局
- Respiratory and autonomic complications(1 month)
- Correlation between clinical scores and reference US values(48-72 hours)
研究者
Ahmed Esmael
Assistant Prof of Neurology
Mansoura University Hospital