الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hepatitis C virus is considered as a major health problem in Egypt. The prevalence of infection increases steadily with age, and high rates of infection are observed among persons in all age groups.
A spectrum of neuromuscular disorders has been associated with untreated, chronic HCV infection with degrees of certainity ranging from strong or proven neuropathy, provisional to mild (inflammatory myopathies) and questionable MG.
The aim is to study the pattern of peripheral neuromuscular changes among patients with chronic HCV infection.
This study included 30 patients with chronic HCV infection which were selected randomly from university hospitals, Internal medicine department, Faculty of medicine, Alexandria University. Fifteen healthy individuals were enrolled as a control group for the electrophysiologic tests to calculate reference values. All cases and controls were evaluated clinically and were subjected to the electrophysiological measurements.
Electrodiagnostic techniques included complete neurography of upper and lower limbs. Also SSR latency and Amp of the hand were assessed. Needle EMG was done in cases where abnormalities of peripheral conduction were observed.
All the electrodiagnostic procedures were done in room temperature in the Department of Physical Medicine, Rheumatology and Rehabilitation using the “Neuropack2”.
Results were tabulated and statistically evaluated. Eighteen patients were proved to have PN, 8 were axonal type, and 10 patients were mixed type. None of PN patients were primary demeylinating type. All of them were sensory motor PN. In only 5 patients the neuropathy was limited to lower limbs only and 13 patients with affection of both upper and lower limbs.
Autonomic neuropathy and MG were assessed electrophysiologically using SSR and RNS respectively. Twenty eight patients were diagnosed electrophysiologically as AN only 4 patients were subclinical and 24 patients were clinically manifested. No patients found to have myopathy. MG was diagnosed electrophysiologically in only 3 patients and all were subclinical without any clinical manifestations
There was no statistical correlation between PN pathology and history of IFN. There was a statistical correlation between PN and sensory and motor deficit in neurological examination
A statistical significant difference between both groups was found as regard DL and SNAP Amp of superficial radial, median and ulnar nerves. Also there was statistically significant difference between both groups regarding NCV in median, ulnar and sural nerves. But in motor conduction study there was statistically significant difference between both groups regarding DL, CMAP Amp and CV of median, ulnar and posterior tibial nerves and there was statistically significant difference between both groups as regard CMAP Amp and CV of peroneal nerve.
There was a statistical significant correlation between PN and superficial radial nerve latency and SNAP Amp, sensory ulnar nerve SNAP Amp, sensory median nerve SNAP Amp and all parameters of sural nerve.
There was a statistical significant correlation between PN and motor median nerve CMAP Amp and CV, motor ulnar nerve CMAP Amp, all parameters of deep peroneal nerve and posterior tibial CMAP Amp and CV.
As regard late responses, there was a statistical significant difference between both groups as regard median and ulnar F wave latencies and H reflex.
There was a high statistically significant difference between both groups as regard the SSR latency and Amp. There was a statistical correlation between AN and SSR latency but there was no statistical correlation between AN and SSR Amp.
There was no statistical correlation between AN or PN and severity of liver disease. There was a statistical correlation between sensory and motor complaints and PN. There was no statistical correlation between PN or AN and history of IFN.
In conclusion, PN exists in high prevalence among Egyptian HCV patients clinically and electrophysiologically and it is the most common neuromuscular complication occurs in chronic HCV patients. PN is mostly of mixed pathology and always lower limbs are more and firstly affected before upper limbs.
Autonomic neuropathy also occurs in high prevalence in hepatitis C patients. Both myopathy and MG are not common complication in hepatitis C.