Serial electrophysiological studies in a Guillain–Barré subtype with bilateral facial neuropathy

Abstract

ObjectiveBifacial weakness with paraesthesias subtype of Guillain–Barré syndrome (GBS) is thought to be demyelinating in nature but the evolution of serial nerve conduction study (NCS) findings has not been studied. We retrospectively analyzed the changes on serial NCS of patients with bilateral facial neuropathy. MethodsWe described the clinical features, serial blink reflex, facial nerve and limb NCS of such patients. ResultsFive patients fulfilled our study criteria. Patients 1 and 2 were diagnosed clinically to have bilateral Bell’s palsy, patients 3 and 4 as bifacial GBS subtype and patient 5 as facial palsy associated with acute HIV infection. In all, the initial neurophysiological tests showed absent blink response and normal facial NCS. Patient 1’s repeat tests were normal. Patient 2’s repeat blink reflex showed mildly prolonged latency. Repeat blink reflex latency of patients 3, 4 and 5 were in the demyelinating range. Patient 3 also had prolonged facial nerve latency. Patients 3 and 4 had serial limb NCS showing progressively prolonged latency. ConclusionSerial NCS suggests that the bifacial GBS subtype is demyelinating in nature. SignificanceThis study provides further evidence for a bifacial subtype of GBS with a demyelinating pathophysiology.