I wanted to know what it meant when my latest testing results showed both CMAP & SNAP declined slightly. I found these definitions:

[I]Glossary: NCV & EMG “jargon”

Latency: Time interval between stimulus and the response; motor latency is usually measured to the onset of the CMAP and sensory latency to the peak of SNAP. Latency is measured in milliseconds. The same nerve may be stimulated distally and proximally and conduction time is designated as distal latency and proximal latency respectively.

Amplitude: Size of the response, measured in millivolts (for motor) or microvolts (for sensory); the measurement may be from baseline to negative peak or peak to peak.

CMAP: The term stands for compound muscle action potential; response recorded over the muscle, when its motor nerve is stimulated.

SNAP: The term stands for sensory nerve action potential; response recorded over sensory nerve; the nerve may be stimulated distally with recoding electrode placed proximally (orthodromic) or vice versa (antidromic).

Fibrillations: Biphsic waves of 200-500 uV detected by needle EMG; signifies denervation of muscle fibers

Positive Waves: Monophasic positive waves, detected by needle EMG; signifies denervation

Fasciculations: Biphsic or triphasic potentials of 0.5-5 mV detected by needle EMG; seen in chronic denervation of motor units.

Motor unit potentials (MUP): Summated electric activity of several muscle fibers of one motor unit in the vicinity of the needle electrode; usually bi or triphasic, 0.5-5 mV. When 4 or more phases are present, the term polyphasic unit is used; denotes altered motor units from reinnervation or myopathic changes.

Recruitment pattern: During volitional contrction motor units are recruited according to the force of contraction; thev rate of firing of each unit increases before more units are recruited and with full force individual units cannot be distinguished leading to full interference pattern.[/I]

link- http://www.cmki.org/LMHS/Chapters/33-electrophysiological.htm

It’s a study of the hand. Still the info makes interesting reading.

Hi guys,

Quick question regarding wearing AFO’s and winter boots. This is my first winter wearing an AFO and I’m almost positive I’ll need ankle boots. I’m also concerned about getting boots with fleece inside as I have a hinged AFO and wouldn’t want anything to get caught in the hinges.

The type of boots I need would have to be something I could wear all day at work as changing into shoes would be a bit too much. Any suggestions would be greatly appreciated.

Have a wonderful day!!

[B]Ten Medical Facilities Designated “Centers of Excellence” for the diagnosis and management of inflammatory neuropathy by the GBS/CIDP Foundation International[/B]

(Narberth, PA.) The GBS/CIDP Foundation International today announced the designation of ten initial “Centers of Excellence” for the diagnosis and treatment of Guillain-Barré syndrome (GBS) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and variants.

The centers will form a network of healthcare facilities to provide expert diagnosis and management of inflammatory neuropathies for patients who are unable to consult with medical experts in the field in their own communities.

“This is the first round of designations,” said Patricia A. Bryant, executive director of the foundation. “We will be accepting and evaluating applications from other interested institutions in the future in our efforts to better serve patients with these debilitating diseases,” she said.

The designated facilities are:

California Pacific Medical Center–San Francisco, California
Heinrich-Heine University Department of Neurology,–Duesseldorf, Germany
Phoenix Neurological Associates/Banner Good Samaritan Medical Center,–Phoenix, Arizona
St. Elizabeth’s Medical Center–Boston, Massachusetts
The Johns Hopkins University School of Medicine–Baltimore, Maryland
King’s College Hospital–London, United Kingdom
University of Kansas Medical Center–Kansas City, Kansas
The University of California, Los Angeles Dept. of Neurology–Los Angeles, California
University of Texas Health Science Center–Houston, Texas
Wayne State University School of Medicine–Detroit Medical Center, Michigan

For additional information on these centers please visit our website at http://www.gbs-cidp.org.

North Dakota Agriculture Commissioner Doug Goehring is being treated in a Bismarck hospital for a recurrence of Guillain-Barré Syndrome (GBS) which he first experienced 18 years ago.

http://www.farmandranchguide.com/articles/2009/10/26/ag_news/regional_news/news15.txt

Wow, unusual to get GBS again after that long of time.

Today I finally ventured out of the house (a bout of depression kept me close to home). I had a nice time and enjoyed the car show with my kids and taking some photos. I wanted a couple of last minute shots…we were not there very long…and I started walking down a slight embankment to the creek for some photos. My left leg gave out on me several times! It freaked me out and scared me. No reason that I could find, the incline was not steep and I have walked it before. I wasnt there long enough to walk very much, did squat for photos in some instances, but for the most part I took it easy. This incident scared me and confused me. I recall when I first got sick that my leg did the same thing. I will keep a check on things and will not hesitate to call the dr. He may not know a hell of a lot about this, but he is willing to help and has a neuro backing him up. I have even taken a week off from the Y to rest and let things recoup because I dont want to over do anything and end up relapsing. It is just so frightening to have something pop up out of the blue. I am taking extra B12, drinking Acai and lots of water that is electrolyte balanced. I am off of my “anti inflammatory” supplements because of cost and I can tell the difference…constant tingling and aching, muscles are quick to fatigue and definitely let me know. Also got a bout of depression going on but dr knows I react poorly to meds for it so he isnt suggesting anything right now. I did get my xanax increased which has helped the past few days quiet things so I can relax. Anyhow, not sure what the whole leg thing was all about, any ideas?? Should I be concerned or just keep a check on it?

The other day I thought I would try the treck to the end of the driveway to get the mail. Not far, but a journey for most of us with bad feet.
At the back porch I had my choice of footwear. The rather large shoes of my son and half the kids in the neighborhood, (13/14 yr old boys have big feet), my own shoes that would require me to sit down and tie them up, or I could slip on my husbands flips flops.
These things are made by Adidas and have “fit foams” written on the sole. They are amazing! There is about an inch of foam on the sole and it must be the way they are constructed because they are the most comfortable thing I have worn since I was discharged. Today I ironed for almost half an hour at a stretch.
I have bought a few new pairs of shoes trying to find ones that are the most comfortable and will give me the most time walking. I have tried a much bigger size, thinner soles that will allow my feet to move, and digging out my oldest shoes to feel if they would help. These flip flops are the best.
Unfortunately, they are ugly, about eight sizes too big, and look really stupid on my feet.

So if anybody knows of really good shoes for us with feet residuals, let me know. Ladies please, I know I am not at my feminine best in my hubby’s footwear.

Thanks.

In May of this year I had a brain tumor removed. Three days in the hospital, released and feeling right as rain. One week latter I just started violently throwing up. It was uncontrollable. Having been warned, “If something, anything happens, go directly to the hospital, after brain surgery going to your doctor won’t help”, my husband took me to the hospital.

I remember getting to the emergency room at the hospital where they had done the original surgery. I cannot remember the next three days, and thankfully only vaguely remember the next three weeks. The brain is a marvelous thing! I believe that because I was in so much pain, my brain says I do not need to remember that, and I cannot remember what was my most painful period.

Because it was brain surgery the first thing they suspected was bleeding or something to do with the surgery, both the neurologist and the surgeon were consulted, within the first few hours. They had done a CT scan and a MRI but nothing could be seen.

By now it was about 8 hours into it. I had only been given something for the nausea, as they were afraid that painkillers would mask the new symptoms. The paralysis started. They moved me to the intensive care unit. By this time my husband was dealing with a half of dozen doctors with a half a dozen different opinions. Eventually they discussed the possibility that it could be Gillian Barre. They did a lumbar puncture, which confirmed the GBS. Over day 6 and 7 they administered immunoglobulin therapy, and I was on my way to recovery.

This is where I start to remember things. There was a lot of hammering on my knees and elbows to test what was left of my reflexes, there was a lot of don’t touch me to the nurses, and a lot, a lot of drugs to keep me sedated. By now I tubes inserted into every orifice on my body! Feeding tube, breathing apparatus, catheter, intravenous and a pick-line. They also had a very fine tube that went into my arm vein, traveled up to within an inch of my heart: this monitored my blood pressure as accurately as possible. One of my sisters happened to be in the room when my heart rate dropped to 43!

I was two weeks in the ICU when they were able to move me to the critical care unit. I had already regain use of my hands and arms. While in the CCU they did a tracheotomy. That was the worst ten days of my life! I could only communicate by writing on a white board, or using an ABC chart. I didn’t even have the dexterity to type! I could not imagine living in a world without communication.

Apparently I forget to breathe when I have morphine. So, no more morphine for me.

26 days from onset of symptoms they remove the trach, take out all the tubes and I got to eat something. I don’t think hospital food was ever more appreciated. My upper body was fully recovered, except for some “fizzyness” in the tips of my fingers. I was able to get into a wheelchair. 49 days from onset I was transferred to a rehab ward, and on day 50 I stood for the first time in the parallel bars. On day 67 I was released from the hospital, the only remaining issue is the fact that my feet are numb from the balls of my feet to my toes. Of course I still have to continue my exercises to strengthen the muscles in my legs, but on the whole I feel amazing!!!!

During the first week the doctors told my family to be prepared for me to be in the hospital for months and rehab after that and not be home for a year. I told them that I would be walking home for Christmas. Now I am at home doing most of what I was doing before, occasionally hit by fatigue, making things work. My thirteen year old hovers around me like a mother hen. None of my cloths fit me anymore. And I still kind of walk like a duck.

Since my experience, I am surprised how many people have come up to me to say “my sister or brother or somebody had GBS”. I see now that they mention it on ads for some inoculations.

I was happy to find this site, heartbroken to read some of the stories, and inspired to share mine. I look forward to reading more on this forum.

i would like to share my thoughts, about the next months, vaccination programmes about the flue H1N1. the countries prepared for vaccinations ,some for all people,some for the kids.they dont know for sure ,the last days of august will deside.the last time that try to vaccinate massive number of people in 1976-usa, the numbers of patients about Guillain Barré was increase hight.
my son had Guillain Barré this year and i worry about that untested 100% vaccine that coming.

George
(Greece)

hello
here is my story,for my 6yo son alex.
at the begining of february alex have tonsillitis with fever .that was kept about 6 days.everything was going to normal, but i was wrong.suddenly he start complaning that he cannot move legs and hands.it was not possible to get up from the bed, but he could walk ,not very easy.the next 2 days we trying find out what is going on with our son.we did blood test for everything that our doctor ask ,and everything was perfect.the third day -as everything was about the same,and not better-.We visit a hospital that in head was the european professor of pediatrics.(why i say that i tell you later.)we get in the hospital and start doing 5 examinations.first was FUNDUS EXAMINATION in eyes,to see the reflection of brain.everything was ok.the second was neurologist exam.third was some more blood test,everything was good.the next one ,spinal fluid is withdrawn from the lumbar region of the spinal column.
The results: Guillain Barré Syndrome at the early start.
that was a sok for us,we have never something like that.
he took antibodies for 2 days.the next days was very very difficult for a child of 6.finally we stay 10 days at the hospital.every day was better after the antibodies.he had to sleep for 25 days.he had illusions every 40 min at night.we did also a magnetic tomography to check the brain .
now we are home,20 days after we leave the hospital.alex getting better every day.he can run ,as every child.he’s tired fast but is normal.he needs time and rest.
about the professor i told you before, is VERY IMPORTANT
to take your child to doctors how know ,and just do it FAST.dont wait.we were lucky says the professor ,that we brought our child at the begining of Guillain Barré Syndrome.
that was my story that take place in athens-greece.sorry for my english.
i hope that my story could help people and childrens to face that syndrome FAST . kouts73@yahoo.gr is my mail to anyone how needs more info.
“enjoy the life you have in front of you ,as good as you can”
that is what i learn.
thanks for listening
George

IrishTimes.com
Saturday, August 30, 2008

Guillain-Barré syndrome: what is it?

Living with a creeping paralysisGBS or Guillain-Barré syndrome is an acute disease of the peripheral nervous system which causes damage to the myelin sheath around the nerves, causing them to stop working, resulting in loss of sensation and limb paralysis, sometimes accompanied by pain.

Some patients have a similar but longer-lasting illness called CIDP (chronic inflammatory demyelinating polyneuropathy).

There are about 100-120 cases of GBS a year in Ireland. The first symptoms are usually tingling and numbness in the fingers and toes, with progressive weakness in the arms and legs over a few days.

In the milder cases, this weakness may stop and cause only moderate difficulty in walking, requiring sticks, crutches or a walking frame.

In some cases the weakness progresses and leads to complete paralysis of the legs. The arms may also be affected.

In a quarter of cases, the paralysis progresses up the chest and face and the patient is unable to breathe on his or her own and needs to rely on a ventilator and a feeding tube.

GBS improves spontaneously. However, certain factors can assist recovery, according to the GBS Support Group.

These include good nursing and medical care, physiotherapy and hydrotherapy, therapies that relieve discomfort and prevent stiffness, immunoglobulin infusion of immunoglobulin, plasmapheresis and counselling – because a high proportion of patients get depressed during the gruelling recovery phase.

Association between Campylobacter Infection and Guillain-Barré Syndrome
Ban Mishu Allos

Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee

Guillain-Barré syndrome (GBS), a neurologic disease that produces ascending paralysis, affects people all over the world. Acute infectious illnesses precede 50%-75% of the GBS cases. Although many infectious agents have been associated with GBS, the strongest documented association is with Campylobacter infection. The first line of evidence supporting Campylobacter infection as a trigger of GBS is anecdotal reports. The second line of evidence is serologic surveys, which have demonstrated that sera from GBS patients contain anti-Campylobacter jejuni antibodies, consistent with recent infection. Finally, culture studies have proven that a high proportion of GBS patients have C. jejuni in their stools at the time of onset of neurologic symptoms. Neurologic symptoms are more severe and more likely to be irreversible when GBS is preceded by C. jejuni infection. One of every 1058 Campylobacter infections results in GBS, and 1 of 158 Campylobacter type O:19 infections results in GBS.

US FDA, CDC back Merck’s Gardasil shot as safe
26th July 2008, 09:02 am

Tue Jul 22 20:20:58 PDT 2008

(Recasts; adds details, background on sales, Merck comment)

WASHINGTON, July 22 (Reuters) – Merck & Co’s Gardasil vaccine remains safe and effective for protecting women and girls from a virus that causes cervical cancer, U.S. officials said on Tuesday after reviewing thousands of reports of health problems.

Consumers, doctors and others have raised questions about Gardasil’s safety but the Food and Drug Administration and the Centers for Disease Control and Prevention said the most serious adverse events did not appear linked to the vaccine.

“Based on the review of available information by FDA and CDC, Gardasil continues to be safe and effective, and its benefits continue to outweigh its risks,” a statement said.

The agencies said they reviewed more than 9,700 reports of health problems following Gardasil injections.

Six percent of the cases were deemed serious events. They included 20 deaths reported as of June 30.

“There was not a common pattern to the deaths that would suggest they were caused by the vaccine,” the FDA and CDC statement said.

In cases where autopsy or other records were available, “the cause of death was explained by factors other than the vaccine,” the agencies said.

Other serious problems that were reported included a rare neurological disorder called Guillain-Barre Syndrome. Data “do not currently suggest an association” between Gardasil and the condition, the FDA and CDC said.

Gardasil targets four strains of the human papillomavirus (HPV), a common sexually transmitted virus that causes genital warts and most cases of cervical cancer. It is approved for women and girls ages 9 to 26.

The vaccine is one of Merck’s top-selling products but its sales have been under pressure. On Monday, Merck projected 2008 Gardasil sales of between $1.4 billion and $1.6 billion. That was down from its prior view of $1.9 billion to $2.1 billion.

The lowered forecast was due in part to Merck’s failure earlier this year to win U.S. approval to market the vaccine to an older group of women.

Merck has distributed more than 16 million Gardasil doses in the United States.

Merck spokeswoman Amy Rose referred to a July 8 statement in which the company said it was confident of Gardasil’s safety.

(Reporting by Lisa Richwine; editing by Brian Moss and Tim Dobbyn)

Provided by Reuters

© Reuters 2008 All rights reserved

Category: Healthcare & Pharmaceuticals | Comment (RSS) | Trackback

Differential Dx on Peripheral Nerve Dysfunction

cut and paste the following link.

http://botulismtoolkit.com/?p=328

Jean Alexandre Barré (May 25, 1880 – April 26, 1967), French neurologist, worked in 1916 on the identification of the Guillain-Barré syndrome.

He is also credited with the Barré test, which may identify “pyramidal drift”. This test is performed by making the patient stretch out his hands with the palms to the top, and requesting him to close his eyes. If one hand drops involuntarily, the test indicates damage to the pyramidal tract.