Human Physiology

, Volume 44, Issue 8, pp 891–895 | Cite as

Absence of H-Reflex as an Additional Neurophysiological Sign of the Development of Acute Inflammatory Demyelinating Polyneuropathy in Children

  • V. B. VoitenkovEmail author
  • A. V. Klimkin
  • N. V. Skripchenko
  • S. G. GrigoryevEmail author
  • A. I. AksenovaEmail author


Introduction. Early diagnosis of acute inflammatory demyelinating polyneuropathy (AIDP) is of fundamental importance for the timely administration of therapy. At early stages of this condition, conventionally used electrophysiological diagnostic techniques are not sensitive enough. The objective of this work was to study H-reflex as a potential tool for early diagnosis of AIDP in children. Materials and methods. A total of 57 children were examined: 20 healthy children (7–14 years; mean age 12 years) and 37 patients diagnosed with AIDP (8−13 years; mean age 11 years). Electroneuromyography (ENMG) was performed on the 3d–7th day after the first symptoms onset. Nerve conduction velocity for motor fibers, amplitude of M-response during stimulation of n. tibialis, n. ulnaris and n. medianus, as well as latency and threshold of M-response and H-reflex during stimulation of m. soleus, were evaluated. Results. No significant intergroup differences in amplitudes of motor responses and the nerve conduction velocity were recorded, while the residual latency of M-response was significantly higher in the AIDP group. In individuals of the control group, the H-reflex was recorded in 100% of cases, while being recorded only in 2 (5.4%) patients in the AIDP group. In the latter two patients, the study was performed at the earliest stage (3d day) after the onset of the first symptoms. Conclusions. In pediatric patients with AIDP, on the 3d–7th day after the first symptoms onset, H-reflex was absent in 94.6% of cases. Evaluation of the H-reflex at the early stage of AIDP in children can be used as an additional diagnostic criterion.


acute inflammatory demyelinating polyneuropathy electroneuromyography H-reflex pediatric patients 


  1. 1.
    Skripchenko, N.V., Lobzin, Y.V., Ivanova, G.P., et al., Neuroinfectious diseases in children, Det. Infekts., 2014, vol. 13, no. 1, pp. 8–18. 10.22627/2072-8107-2014-13-1-8-18Google Scholar
  2. 2.
    Klimkin, A.V., Voitenkov, V.B., and Skripchen-ko, N.V., Resistance to ischemia of motor axons in children with viral meningitis and Guillain-Barré syndrome, Hum. Physiol., 2015, vol. 41, no. 2, pp. 185–189. doi 10.1134/S0362119715010077CrossRefGoogle Scholar
  3. 3.
    Kimura, J., Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice, Oxford: Oxford Univ. Press, 2013.CrossRefGoogle Scholar
  4. 4.
    Aminoff, M.J., Aminoff’s Electrodiagnosis in Clinical Neurology, Philadelphia: W.B. Saunders, 2012, 6th ed.Google Scholar
  5. 5.
    Suponeva, N.A., Shakaryan, A.K., Rakhteenko, A.V., et al., Clinical and laboratory features, treatment, and prognosis in children with Guillain-Barré syndrome, Det. Infekts., 2015, vol. 14, no. 3, pp. 17–26. http:// Scholar
  6. 6.
    Schnaider, N.A. and Kantimirova, E.A., Guillain-Barré syndrome, Vestn. Novosib. Gos. Univ., 2009, vol. 7, no. 4, pp. 163–169. 2222-8721-2009-5-2-10-15Google Scholar
  7. 7.
    Gusev, E.I. and Gekht, A.B., Klinicheskie rekmendatsii po diagnostike i lecheniyu sindroma Giiena-Barre (Clinical Recommendations for Diagnostics and Treatment of Guillain-Barré Syndrome), Moscow, 2014.Google Scholar
  8. 8.
    Sudulagunta, S.R., Sodalagunta, M.B., Sepehrar, M., et al., Guillain-Barré syndrome: clinical profile and management, Ger. Med. Sci., 2015, vol. 13, pp. 3205–3208. PMID 26421004. doi 10.3205/000220Google Scholar
  9. 9.
    Ye, Y., Zhu, D., Wang, K., et al., Clinical and electrophysiological features of the 2007 Guillain-Barré syndrome epidemic in northeast China, Muscle Nerve, 2010, vol. 42, no. 3, pp. 311–314. PMID 20589890. doi 10.1002/mus.21701CrossRefGoogle Scholar
  10. 10.
    Vucic, S., Cairns, K.D., Black, K.R., et al., Neurophysiologic findings in early acute inflammatory demyelinating polyradiculoneuropathy, Clin. Neurophysiol., 2004, vol. 115, no. 10, pp. 2329–2335. PMID 15351375CrossRefGoogle Scholar
  11. 11.
    Baraba, R., Sruk, A., Sragalj, L., et al., Electrophysiological findings in early Guillain-Barré syndrome, Acta Clin. Croat., 2011, vol. 50, no. 2, pp. 201–207. PMID 22263383Google Scholar
  12. 12.
    Gordon, P.H. and Wilbourn, A.J., Early electrodiagnostic findings in Guillain-Barré syndrome, Arch. Neurol., 2001, vol. 58, no. 6, pp. 913–917. PMID 11405806CrossRefGoogle Scholar
  13. 13.
    Sun, R.D., Fu, B., Li, C., et al., Role of nerve stimulation at Erb point in early diagnosis of Guillain-Barré syndrome in children, Zhongguo Dang Dai Er Ke Za Zhi, 2015, vol. 17, no. 7, pp. 683–686. PMID 26182271Google Scholar
  14. 14.
    Dachy, B., Deltenre, P., Deconinck, N., and Dan, B., The H-reflex as a diagnostic tool for Miller Fisher syndrome in pediatric patients, J. Clin. Neurosci., 2010, vol. 17, pp. 410–411. PMID 20071180. doi 10.1016/j.jocn.2009.06.014CrossRefGoogle Scholar
  15. 15.
    Skripchenko, N.V. and Komantsev, V.N., Infektsionnye zabolevaniya perifericheskoi nervnoi sistemy u detei (Infectious Diseases of the Peripheral Nervous System in Children), Moscow: Meditsina, 2006.Google Scholar

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© Pleiades Publishing, Inc. 2018

Authors and Affiliations

  1. 1.Pediatric Research and Clinical Center for Infectious DiseasesSt. PetersburgRussia

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