Absence of H-Reflex as an Additional Neurophysiological Sign of the Development of Acute Inflammatory Demyelinating Polyneuropathy in Children

Abstract

Introduction. Early diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP) is of fundamental importance for the timely administration of therapy. At early stages of this condition, conventionally used electrophysiological diagnostic techniques are not sensitive enough. The objective of this work was to study H-reflex as a potential tool for early diagnosis of AIDP in children. Materials and methods. A total of 57 children were examined: 20 healthy children (7–14 years; mean age 12 years) and 37 patients diagnosed with AIDP (8−13 years; mean age 11 years). Electroneuromyography (ENMG) was performed on the 3d–7th day after the first symptoms onset. Nerve conduction velocity for motor fibers, amplitude of M-response during stimulation of n. tibialis, n. ulnaris and n. medianus, as well as latency and threshold of M-response and H-reflex during stimulation of m. soleus, were evaluated. Results. No significant intergroup differences in amplitudes of motor responses and the nerve conduction velocity were recorded, while the residual latency of M-response was significantly higher in the AIDP group. In individuals of the control group, the H-reflex was recorded in 100% of cases, while being recorded only in 2 (5.4%) patients in the AIDP group. In the latter two patients, the study was performed at the earliest stage (3d day) after the onset of the first symptoms. Conclusions. In pediatric patients with AIDP, on the 3d–7th day after the first symptoms onset, H-reflex was absent in 94.6% of cases. Evaluation of the H-reflex at the early stage of AIDP in children can be used as an additional diagnostic criterion.