0353 The sural nerve biopsy and nerve conduction study in polyneuropathy: The 3-year retrospective, clinical, electrophysiological, and neuro-pathological study

Poster Abstracts Method: 42 patients (male 33, Female 9) mean age 44.2 with a diagnosis of GBS were treated with IVIG 0a:31) Plasmapheresis (n:8) and both (n:3) at Sri Ramakrishna Hospital between January 1996 and November 2004. The results were reviewed retrospectively and improvement in functional status was assessed by GBS functional grading scale (0 -- normal, 1 - minor deficit, 2 - able to walk > 10 M independent, 3 -- able to walk > 10M with help, 4 -- wheel chair or bedridden, 5 - needs respiratory assistance, 6 - dead) at two, four, eight weeks and also after six months of treatment. Results: All the patients had a functional grading score o f 3 or more before treatment. The average time to improve by one functional grade was 21 days. 24 patients (with IVIG treatment) improved one functional grade after two weeks of therapy. Improvement by atleast one functional grade was achieved in 16 patients (IVIG 8 + Plasmapheresis 8) after 4 weeks of treatement. 2 patients were treated with both IVIG and plasmapheresis and one functional grade was ackieved only 16 weeks after treatment. One patient died. 32 patients able to walk independently after 8 weeks, the mmximum improvement was observed between the second and fourth weeks. About 7 patients required venrilatory support (2 IVIG, 2 plasmapheresis, 3 combined). Recurrence o f symptoms in 2 patients who were treated again with WIG, no side effect was observed. Conclusion: IVIG and Plasmapheresis both are safe and effective methods and complementary to each other in the management of GBS. 0352 Peripheral Neuropathy in anti HIV-positive patients, Chiang Mai Utfiversity Thailand Kongsaengdao, S 1, Chankrachang, S 1, Sa-ngnanmitra, p 1 Komolchan, S ~, Sittinoy, M 1. 1Division of Neurology, Department of Medicine,

Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand Background: Peripheral neuropathy in Anti HIV positive patients may be presented with A I D P / C I D P in asymp tomatic or mildly symptomatic stage, Mononeuritis multiplex/Herpes Zoster neuropathy in early symptomatic, stage, and Distal symmetric polyneuropathy, toxic neuropathy, tumor and Progressive polyradiculopathy in advance AIDS patients. In northern Thailand, 1996-2001, most of the patients have no opportunity to treat with anti-retrovirus therapy. The spectrum of peripheral neuropathy seem to be different from developed country. Objective: To characterize the peripheral neuropathy in anti HIVpositive patients who not receiving anti-retroviral therapy in Chiang Mai University, Thailand. Methods: Twenty three anti HIV-positive patients were examined in electrophysiologic laboratory in Chiang Mai University, Thailand. The studies included conventional neurography (NCV, H reflex, F-response) and skin sympathetic response (SSR). Findings: The neurological symptoms of anti HIV-positive patients were weakness, numbness, dysaesthesia and bowel-bladder abnormalities. Electrophysiologic studies revealed polyradiculopathy in 19 patients (182.6"/o), sensorimotor polyneuropathy in 19 patients (82.6%), demyelinating polyneuropattry in 15 patients (165.2"/o), axonopathy polyneuropathy in 12 patients (52.1"/o), small fiber neuropathy in 8 patients (34.7%), pure sensory polyneuropathy in 3 patients (13.0%), polyneuropathy in 2 patients (8.7%), pure motor polyneuropathy in 1 patient (4.3%), radiculopathy in 1 patient (4.3"/o) and mononeuropathy in 1 patient (4.3%). Conclusion: The electrophysiologic studies in anti HIV-positive patients who not receiving anti-retroviral therapy showed both large fiber neuropathy and small fiber neuropathy. Most common types of peripheral neuropathy were polyradiculopathy (182.6%) and sensorimotor polyneuropathy (82.6%). Key wolds: peripheral neuropathy, polyradiculopathy, polyneuropathy, small fiber neuropathy, mononeuritis nmltiplex, human inmmnodeficiency syndrome, Acquired immune deficiency syndrome, AIDS.

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0353 The sural nerve biopsy and nerve conduction study in Polyneuropathy: The 3-year retrospeclive, clitfical, eleclroptlysiological, and neuxo-pathologieal study Subsai Kongsaengdao 1, Siwaporn Chankrachang 1, Kanoksri Sarmntarapunya 1, Suchart Phudhichareonrat ~, Sumalee Siriaunkgn 1~, Songkiet Suwansirikul 3, Helen Ling ~. 1Neurology unit, Department of

Medicine, Faculty of Medicine, Chiang Mai University/:Department of Pathology, Prasat Neurological Institute, Ministry of Public Health, Bangkok; 3Department of Pathology, Faculty of Medicine, Chiang Mai University, Thailand. Background: Nerve conduction studies are non-nivasive investigations which help in the diagnosis o f peripheral nervous disease whereas nerve biopsies are more invasive but give the definitive pathological diagnosis. However, nerve biopsy makes irreversible deficit along the distribution o f the nerve. Objective: We entire to characterize the association between nerve conduction studies and sural nerve biopsy in the patients with polyneuropathy. Method" We conducted a 3 years retrospective study fi'om September 2000 to September 2003. The patients underwent both motor and sensory nerve conduction study followed by nerve biopsy witlfin 2 weeks. The sural nerves were exanfined both under light and electron microscope. The characteristic, of either axonopathy or demyelniafion / dysmyelniafion were used to correlate with ipsilateral sural nerve conduction study and overall nerve conduction studies. Results- There were 23 patients reviewed. Among the 11 cases of axonopathy, sural nerve biopsy revealed 5 vascullfic mononeuritis multiplex, 1 amyloid neuropathy, and 5 unknown etiology. Among the 12 cases of demyelinarion / dysmyelniafion sural nerve biopsy revealed 8 chronic.inflammatory demyelniating polyneuropathy, I acute demyellnation polyneuropathy, 1 relapsing-remitting acute inflanmmtory demyelinating polyneuropathy and 1 vasculitic neuropathy and 1 unknown etiology. The sensitivity of ipsilateral sural nerve conduction study was 91.3% whereas the sensitivity o f overall nerve conduction studies was over better (100%). Conclusion: The association between nerve conduction study and sural nerve biopsy was very good. The two methods of investigations in combination will allow a better yield of definitive diagnosis of peripheral neuropathy to be achieved. 0354 Abnormal Sensory Nerve Excitability Underlying the Development of Uraemic Neuropathy Arun V. K~ishnan~;z, Richard KS Phoon 3, Bruce A. Pussell 3, John A. Charlesworth 3, Hugh Bostock 4, Matthew C. Kiernan 1'2. 1Institute of

Neurological Sciences, Prince of Wales Hospital, Australia; 2Prince of Wales Medical Research Institute and Prince of Wales Clinical School, University of New South Wales, Australia; 3 Department of Nephrology, Prince of g~les Hospital, Randwielc, Sydney, Australia; 4Sobell Department of Neurophysiology, Institute of Neurology, Queen Square, London, United f£ingdom Background" Peripheral neuropathy is present in 65"/0 of patients with chronic renal failure (CRF) commencing dialysis. Although multiple toxins have been implicated in the development of uraemic neuropathy, no causative agent has been identified. Nerve excitability techniques, wkich provide information about membrane potential and axonal ion channel function, may provide further insights into the pathophysiology of uraemic neuropathy. Objective: To follow changes in the excitability properties of median sensory axons in patients with CRF treated with hemodialysis and correlate changes in excitability with serum levels o f potential neu rotoxins. Method: Sensory nerve action potentials were recorded from the second digit following stimulation of the median nerve in 10 CRF