The electrodiagnostic features of acute childhood Guillain-Barré syndrome (GBS) have not been distinguished from those in the adult. We report nerve conduction and electromyographic data from 23 children. Sixty-one percent (14 of 23) fulfilled strict electrodiagnostic criteria for a demyelinating neuropathy, and the remainder demonstrated demyelination in at least one nerve. Reduced compound muscle action potential (CMAP) amplitude was the most common finding overall. Children less than 10 years old demonstrated significantly greater slowing of motor CV than children greater than 10 years old. Electrodiagnostic criteria associated with poor outcome (low mean CMAP and fibrillation potentials) in previous studies, primarily of adult patients, occurred in 39% (9 of 23 children). All patients on whom follow-up data were obtained recovered without residual disability. We conclude that electrodiagnostic prognostic indicators identified in general series of GBS may not apply to children.

Motor unit number estimation (MUNE) attempts to directly assess the number of functioning motor units present in a muscle. It is an important addition to the electrodiagnostic evaluation; however, both intrasubject and intersubject reliability must be minimized for this technique to be clinically useful. A number of MUNE techniques have been developed. We propose a change in the way of calculating the MUNE, using the statistical technique described by Daube, and show that this modification reduces intersubject variability and improves test–retest reliability in normal subjects. © 1999 John Wiley & Sons, Inc. Muscle Nerve 22: 1457–1460, 1999

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Guillain-Barré syndrome is an acute, autoimmune polyradiculoneuropathy that improves with immune-modulating treatment if instituted early in the illness. Preliminary diagnosis relies on the clinician's recognition of the typical symptoms and signs as supporting evidence of the illness, such as nerve conduction studies, which may not be available emergently. We report eight children with Guillain-Barré syndrome in whom the initial presentation was atypical and suggested a primary central nervous system illness. In these patients, the predominant clinical symptoms included drowsiness, headache, irritability, and meningismus, although the classic features of Guillain-Barré syndrome (weakness, hyporeflexia) were also present. The atypical presentation caused delay in diagnosis in some cases. It is important to recognize this variant of pediatric Guillain-Barré syndrome to ensure expeditious diagnosis and treatment.

Objective To analyze the impact of interview date on the applicant rank for Neurology residencies in the United States. Methods A multi‐institutional retrospective review of interview dates and applicant rank list data for the National Resident Matching Program (NRMP) was conducted for five Neurology programs, totaling 1932 interviewed applicants over a combined total of 31 interview years. For each candidate, the interview date and applicant rank were abstracted along with the total number of interviews for that season. Statistical analyses were completed on the cumulative institution data set as well for each individual institution to assess for a possible relationship between interview date and applicant rank. Results The cumulative institutional analysis showed that the mean applicant rank decreased as the interview season progressed. Applicants who interviewed on the first day of the interview season were ranked 11.4% higher than those who interviewed on the last interview day. Additionally, applicants interviewed on the first interview day more likely to be ranked higher when compared to all other interview dates. Independent analysis of each program's data identified comparable, statistically significant, differences in mean applicant rank and interview position at three out of the five institutions. Conclusions This study evaluated the impact of interview order on the ranking of applicants by Neurology residency programs, noting a temporal relationship with applicant rank and interview date. The primacy bias appreciated in our data merits further evaluation in other medical specialties. Strategies to minimize the impact of this bias should be employed by residency programs who use medical matching services.