الفهرس 
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Abstract
Guillain–Barré syndrome is an acute inflammatory polyneuropathy characterized by progressive symmetric ascending muscle weakness, and hyporeflexia with or without sensory or autonomic symptoms.(25) It is a rapidly progressive syndrome and can be potentially fatal if early diagnosis is not made for appropriate interventions.
Nerve conduction studies and EMG are important investigations to establish the diagnosis of GBS, identify the GBS subtype and help to exclude mimic disorders. Electrophysiological tests to detect proprioceptive involvement in GBS is lacking in literature.
The aim of this work was to study the proprioceptive and sympathetic fibers affection in patients with GBS. This was done by recording SSR of hand and foot, and the study of the proprioceptive Ia afferent CV of median and posterior tibial nerves by recording short latency electrically induced reflex activity (R1) respectively. The study of proprioceptive Ia afferent fibers by recording (R1) has not been employed previously to study GBS patients. Twenty patients fulfilling the criteria for diagnosis of GBS were enrolled in this study. All patients went through clinical evaluation including neurological examination followed by a thorough electrophysiological evaluation. Twenty healthy individuals matching age and sex with patients’group were enrolled as a control group for the electrophysiologic tests to calculate reference values.
Clinical evaluation of studied patients revealed that muscle weakness was the most frequent manifestation followed by sensory abnormalities and cranial nerve involvement.
The electrophysiological assessment included nerve conduction study to the following: Motor conduction study for median nerve, ulnar nerve, common peroneal nerve and posterior tibial nerve, sensory conduction study for the median and sural nerves, SSR of hand and foot, and a study of the proprioceptive Ia afferent CV of median and posterior tibial nerves by recording short latency electrically induced reflex activity (R1).
The majority of patients (14 cases, 70%) presented with demyelinating variant (AIDP). Six patients (30%) presented with axonal motor variant (AMAN), while only 1 patient (5%) presented with axonal sensory variant (AMSAN) of GBS.
It was found that there was a statistical significant difference in most of the measured motor and sensory parameters in patients when compared to control group.
There was statistical significant decrease in the amplitude of SSR of the hand and foot in patients’ group in comparison to control group. Sympathetic skin response latency of hand and foot showed no statistical significant difference between both groups.
There was statistical significant slowing in CV of the Ia afferent fibers of the median and posterior tibial nerves in patients in comparison to control group.
Nine patients (45%) showed absent response of SSR of the hand, while 12 patients (60%) showed absent response of SSR of the foot. Twenty-seven percent of patients (3 out of 11) showed delayed latency of the SSR of the hand and 37 % of patients (3 out of 8) showed delayed latency of the SSR of the foot. A decrease in the amplitude of the SSR of the hand was found in 3 out of 11 patients (27 %) while only 1 out of 8 patients (12.5%) showed a decrease in the amplitude of the SSR of the foot.
As regards the proprioceptive Ia afferent fibers, 9 patients (45%) showed absent response for the median nerve, while 10 patients (50%) showed absent response for the posterior tibial nerve. Nine out of 11 patients (81.8 %) showed a slowing of CV of the proprioceptive Ia afferent fiber of the median nerve. However, 9 out of 10 patients (90 %) showed a slowing of CV of the proprioceptive Ia afferent fiber of the posterior tibial nerve.
The conduction parameters of the studied motor and sensory nerves showed no significant correlation with SSR parameters of hand and foot in patients’ group.
There was significant positive linear correlation between posterior tibial and common peroneal MCV and Ia afferent fibers CV of posterior tibial nerve. However, there was no significant correlation between the median and ulnar nerves sensory and motor CVs and Ia afferent fibers CV of the median nerve. Similarly, there was no significant correlation between the Ia afferent fibers CV of the posterior tibial nerve and the sural nerve CV.
No significant correlation was found between motor distal latency of the median nerve and its Ia afferent fibers CV. However, a significant negative linear correlation was found between the motor distal latency of the posterior tibial nerve and its Ia afferent fibers CV.
There was no statistical significant association between SSR parameters and Ia afferent fibers CV. Also, each of them showed no statistical association with different electrophysiological types of GBS among studied patients.