Do A-waves correlate with clinical symptoms of Guillain-Barre-Syndrom?

Introduction: The 42-year-old male patient suffered within a week from acute Polyradiculitis with proximal atonic tetraparesis, absence of reflexes and mild distal symmetric sensible deficits. After complete remission (7S-Immunoglobulin-therapy) the symptoms of Guillain-Barre-Syndrom relapsed three times after 4, 24 and 30 months.

Clinical Diagnostics: Examination of cerebro-spinal fluid showed albuminocytologic dissociation (cells 5/3 per µl, protein 58mg/dl, albumin 510mg/l). The initial electrophysical examinations of N. tibialis found prolongations of distal-motoric latency (right 6,7ms; left 6,1ms), absence of F-waves and multiple A-waves. Further examinations at the times of relaps obtained the same results. Remarkably the A-waves were reduced significantly after complete clinical remission. Latency of F-waves were still prolonged (right 68,4ms; left 70,1ms).

Conclusion: In this case the existence of multiple A -waves seem to correlate with the clinical symptoms. One can postulate that A-waves might be appear as a marker of recurrence of acute inflammatory processes in demyelinating neuropathia.