Assessment Of T-Reflex In Adult Patients With Early Guillain-Barré Syndrome At Groote Schuur Hospital

Abstract

Guillain-Barré Syndrome (GBS) is a polyneuropathy involving both proximal (spinal root) and peripheral nerves, and is characterised clinically by acute progressive weakness associated with reduced or absent deep tendon reflexes. Electromyographically recording the deep tendon reflex (T-reflex) has proven to be useful when confirming the diagnosis of many peripheral neuropathies. However, research on the T-reflex in GBS remains limited. The primary aim of this study was to describe the T-reflex in patients with GBS compared with healthy subjects. This is a prospective, controlled, non-blinded, cohort study. Adults with GBS (GBS cohort) and healthy subjects (Control cohort) were recruited concurrently. During all electrophysiological evaluations, both T-reflexes and conventional NCS (including F-responses), were performed on all subjects. The T-reflex was successfully recorded in 28 subjects (14 GBS- and 14 control cohort). In patients with GBS, T-reflex responses had significantly prolonged latencies, slowed conduction velocities and increased duration. Furthermore, T-reflex responses were abnormal in all subjects with GBS manifesting the clinical presentation, CSF features and abnormalities on conventional nerve conductions studies consistent with this diagnosis. In contrast to normal control patients, the T-reflex response had indistinct onset and offset and polyphasic rather than biphasic or triphasic morphology. However, no significant differences in the T-reflex were identified between the various subtypes of GBS. Significantly, the T-reflex was more often recordable than the more widely utilised conventional F-response. Thus, the results of this study strongly suggest that the T-reflex is sensitive to the electrophysiological changes associated with GBS, but that it is not specific for the subtype of GBS. Given that the T-reflex is painless and easy to perform, the results of this study suggest that it should be more widely utilised, together with conventional nerve conduction studies, in the assessment of patients with GBS.