article: 42

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rowid	title	DOI	URL	created	subject	references-count	is-referenced-by-count	ISSN	container-title	abstract	author_number	orcids	names	award_numbers	funder_names	funder_dois
42	["Hyper-reflexia in Guillain-Barr\u00e9 syndrome: systematic review"]	10.1136/jnnp-2019-321890	http://dx.doi.org/10.1136/jnnp-2019-321890	2020-01-14T22:33:50Z	["Surgery", "Psychiatry and Mental health", "Clinical Neurology"]	43	1	["0022-3050", "1468-330X"]	Journal of Neurology, Neurosurgery & Psychiatry	<jats:p>Areflexia or hyporeflexia is a mandatory clinical criterion for the diagnosis of Guillain-Barré syndrome (GBS). A systematic review of the literature from 1 January 1993 to 30 August 2019 revealed 44 sufficiently detailed patients with GBS and hyper-reflexia, along with one we describe. 73.3% of patients were from Japan, 6.7% from the USA, 6.7% from India, 4.4% from Italy, 4.4% from Turkey, 2.2% from Switzerland and 2.2% from Slovenia, suggesting a considerable geographical variation. Hyper-reflexia was more frequently associated with antecedent diarrhoea (56%) than upper respiratory tract infection (22.2%) and the electrodiagnosis of acute motor axonal neuropathy (56%) than acute inflammatory demyelinating polyneuropathy (4.4%). Antiganglioside antibodies were positive in 89.7% of patients. Hyper-reflexia was generalised in 90.7% of patients and associated with reflex spread in half; it was present from the early progressive phase in 86.7% and disappeared in a few weeks or persisted until 18 months. Ankle clonus or Babinski signs were rarely reported (6.7%); spasticity never developed. 53.3% of patients could walk unaided at nadir, none needed mechanical ventilation or died. 92.9% of patients with limb weakness were able to walk unaided within 6 months. Electrophysiological studies showed high soleus maximal H-reflex amplitude to maximal compound muscle action potential amplitude ratio, suggestive of spinal motoneuron hyperexcitability, and increased central conduction time, suggestive of corticospinal tract involvement, although a structural damage was never demonstrated by MRI. Hyper-reflexia is not inconsistent with the GBS diagnosis and should not delay treatment. All GBS variants and subtypes can present with hyper-reflexia, and this eventuality should be mentioned in future diagnostic criteria for GBS.</jats:p>	3	["http://orcid.org/0000-0002-8131-8912", "http://orcid.org/0000-0002-4716-8578"]	["Antonino Uncini", "Francesca Notturno", "Satoshi Kuwabara"]	[""]	[""]	[""]