International Neuropsychiatric Disease Journal, ISSN: 2321-7235,Vol.: 12, Issue.: 1
Evaluation of Blink Reflex in Early Diagnosis of Cranial Nerve Neuropathy in Guillain Barre Syndrome
Geetanjali Sharma1* 1Department of Physiology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
1Department of Physiology, Pt. B.D. Sharma Post-Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
(1) Dr. Pasquale Striano, Pediatric Neurology and Muscular Diseases Unit, University of Genoa, G. Gaslini Institute, Genova, Italy.
(1) Muhammad Yusuf Hafiz, Dow University of Health Sciences, Pakistan.
(2) Albert C. Cuetter, Texas Tech University Health Sciences Center, USA.
(3) Yi Pan, Saint Louis University, USA.
Complete Peer review History: http://www.sciencedomain.org/review-history/27123
Aims: The aim of this study was to test the utility of blink reflex in detecting sub-cranial neuropathy in the early course of Guillain Barre syndrome (GBS).
Study Design: The study was a case control study with 5 clinically diagnosed patients of GBS and 5 age and sex matched healthy controls.
Place and Duration of Study: Department of Physiology, Pt. B.D. Sharma, Rohtak, Haryana, India. The duration was six months.
Methodology: A total of 5 patients (4 men, 1 women; age range 9-70 years) clinically diagnosed patients of GBS in 1st week of illness, sent for electro-diagnostic evaluation to the department of Physiology from the department of Medicine were included. Motor conduction studies (median, ulnar, tibial & peroneal), sensory conduction studies (median & sural nerves), F wave studies and blink reflex analysis were carried out on both cases and 5 healthy controls.
Results: Out of the Five patients, four had decreased conduction velocity (CV) & amplitude for median & ulnar nerves while 1 patient had normal CV & amplitude. Three patients had a decrease in CV & amplitude for tibial & peroneal nerves; one patient had decreased CV & amplitude for tibial nerve while one had conduction block for both nerves. Decreased sensory CV was seen in all 5 patients in the upper limb; while 3 had normal sural nerve CV. Two patients had decreased sural nerve velocity. F wave was completely absent (prolonged F wave latency) in 3 patients in the upper limb; in 2 cases it was decreased. In the lower limb, f wave was completely absent. A statistically significant increase in R1 latency of blink reflex was seen in all 5 patients on both right & left sides. Increased latency of R2 (ipsilateral) & R2 (contralateral) were also seen.
Conclusion: The abnormalities of blink reflex most likely represent demyelination in either the facial and/or the trigeminal nerves reflecting the multifocal nature of demyelination in GBS. So blink Reflex can be a useful tool for detection of clinically silent cranial neuropathy in GBS.
Blink reflex; demyelination; Gullain Barre syndrome; facial nerve.
DOI : 10.9734/INDJ/2018/44318Review History Comments