ID 79 – The usefulness of miotatic electronic reflex (T-reflex) in early stages of Guillain Barre syndrome. A case report

Objective Guillain-Barre Syndrome (GBS) diagnosis in its early stages remains a clinical challenge and thus new diagnostic techniques need to be incorporated. The aim of this work is to evaluate the usefulness of miotatic electronic reflex (T-reflex) in initial phases of GBS. Methods A 46-year-old woman was admitted with 7 days of distal paresthesias and intense interscapular pain. Serial electrodiagnostic studies (EDX) on 7th & 33rd day following clinical onset included motor and sensory nerve conduction, somatosensory evoked potentials (SEP) and T-reflex. Results First study showed minimal abnormalities in proximal motor nerve conduction (appearance of A waves and inconsistent F waves) and abolition of Achilles T-reflex bilaterally. Central and peripheral sensory nerve studies were normal. Second study (3 weeks after immunoglobulin treatment) showed disappearance of abnormalities detected in proximal motor nerve conduction and “ad integrum” recovery of Achilles T-reflex. Conclusions T-reflex provides a complete study of the miotatic reflex including 1A sensory fibers unexplored by conventional EDX. Therefore, this test can contribute to GBS diagnosis in its early stages and, as in this case, suggests the presence of dorsal roots conduction block. Thus, it would be desirable to incorporate T-reflex in GBS studies.