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Coly M, Adams D, Attarian S, Bouhour F, Camdessanché JP, Carey G, Cauquil C, Chanson JB, Chrétien P, Créange A, Delmont E, Fargeot G, Frachet S, Gendre T, Kuntzer T, Labeyrie C, Maisonobe T, Michaud M, Moulin M, Nicolas G, Noury JB, Péréon Y, Puma A, Sole G, Taithe F, Tard C, Théaudin M, Timsit S, Venditti L, Echaniz-Laguna A. Clinical, paraclinical and outcome features of 166 patients with acute anti-GQ1b antibody syndrome. J Neurol 2024; 271:4982-4990. [PMID: 38767661 DOI: 10.1007/s00415-024-12410-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND & PURPOSE In this retrospective study, we aimed at defining the clinical, paraclinical and outcome features of acute neurological syndromes associated with anti-GQ1b antibodies. RESULTS We identified 166 patients with neurological symptoms appearing in less than 1 month and anti-GQ1b antibodies in serum between 2012 and 2022. Half were female (51%), mean age was 50 years (4-90), and the most frequent clinical features were areflexia (80% of patients), distal upper and lower limbs sensory symptoms (78%), ophthalmoplegia (68%), sensory ataxia (67%), limb muscle weakness (45%) and bulbar weakness (45%). Fifty-three patients (32%) presented with complete (21%) and incomplete (11%) Miller Fisher syndrome (MFS), thirty-six (22%) with Guillain-Barre syndrome (GBS), one (0.6%) with Bickerstaff encephalitis (BE), and seventy-three (44%) with mixed MFS, GBS & BE clinical features. Nerve conduction studies were normal in 46% of cases, showed demyelination in 28%, and axonal loss in 23%. Anti-GT1a antibodies were found in 56% of cases, increased cerebrospinal fluid protein content in 24%, and Campylobacter jejuni infection in 7%. Most patients (83%) were treated with intravenous immunoglobulins, and neurological recovery was complete in 69% of cases at 1 year follow-up. One patient died, and 15% of patients relapsed. Age > 70 years, initial Intensive Care Unit (ICU) admission, and absent anti-GQ1b IgG antibodies were predictors of incomplete recovery at 12 months. No predictors of relapse were identified. CONCLUSION This study from Western Europe shows acute anti-GQ1b antibody syndrome presents with a large clinical phenotype, a good outcome in 2/3 of cases, and frequent relapses.
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Affiliation(s)
- Martin Coly
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
- Sorbonne University, 75013, Paris, France
| | - David Adams
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France
| | - Shahram Attarian
- Reference Centre for Neuromuscular Diseases PACA RARE, Filnemus, EURO-NMD, CHU Timone, 13005, Marseille, France
| | - Françoise Bouhour
- Reference Centre for Neuromuscular Diseases PACA RARE, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Bron Cedex, France
| | | | - Guillaume Carey
- Centre de Référence Des Maladies Neuromusculaires Nord/Est/Ile-de-France, Neurology Department, U1172, CHU Lille, 59000, Lille, France
| | - Cécile Cauquil
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France
| | - Jean-Baptiste Chanson
- Department of Neurology, Reference Center for Neuromuscular Disorders NEIDF, European Reference Network for Neuromuscular Diseases EURO-NMD, University Hospital of Strasbourg, 67098, Strasbourg, France
| | - Pascale Chrétien
- Clinical Immunology Laboratory, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- Paris University, CNRS, INSERM, UTCBS, Paris, France
- Pathology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
| | - Alain Créange
- Neurology Department, Créteil University Hospital, UPEC, 94010, Créteil, France
| | - Emilien Delmont
- Reference Centre for Neuromuscular Diseases PACA RARE, Filnemus, EURO-NMD, CHU Timone, 13005, Marseille, France
| | - Guillaume Fargeot
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
| | - Simon Frachet
- Neurology Department, Limoges University Hospital, 87042, Limoges, France
| | - Thierry Gendre
- Neurology Department, Créteil University Hospital, UPEC, 94010, Créteil, France
| | - Thierry Kuntzer
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland
| | - Céline Labeyrie
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France
| | - Thierry Maisonobe
- Department of Clinical Neurophysiology, Pitié-Salpêtrière University Hospital, 75013, Paris, France
| | - Maud Michaud
- Neurology Department, NEIDF Reference Center, Nancy University Hospital, 54000, Nancy, France
| | - Maximilien Moulin
- Neurology Department, Reims University Hospital, 51092, Reims, France
| | - Guillaume Nicolas
- Nord-Est/Ile-de-France Neuromuscular Reference Center, Neurology Department, Raymond Poincaré Hospital, UVSQ Paris-Saclay University, Garches, France
| | - Jean-Baptiste Noury
- Centre de Référence Des Maladies Neuromusculaires AOC, INSERM, LBAI, UMR1227, CHRU de Brest, Brest, France
| | - Yann Péréon
- Reference Centre for Neuromuscular Disorders AOC Filnemus, Euro-NMD, Hôtel-Dieu, CHU Nantes, 44000, Nantes, France
| | - Angela Puma
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, Pasteur 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Guilhem Sole
- Reference Centre for Neuromuscular Diseases AOC, Filnemus, Euro-NMD, Neurology and Neuromuscular Diseases Department, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux, France
| | - Frédéric Taithe
- Neurology Department, Clermont-Ferrand University Hospital, 63058, Clermont-Ferrand, France
| | - Céline Tard
- Centre de Référence Des Maladies Neuromusculaires Nord/Est/Ile-de-France, Neurology Department, U1172, CHU Lille, 59000, Lille, France
| | - Marie Théaudin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland
| | - Serge Timsit
- Centre de Référence Des Maladies Neuromusculaires AOC, INSERM, LBAI, UMR1227, CHRU de Brest, Brest, France
| | - Laura Venditti
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
| | - Andoni Echaniz-Laguna
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France.
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France.
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France.
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Poyraz T. Miller Fisher Syndrome Associated With COVID-19: A History of Molecular Mimicry and an Up-to-Date Review of the Literature. Cureus 2023; 15:e43111. [PMID: 37692684 PMCID: PMC10484161 DOI: 10.7759/cureus.43111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Miller Fisher syndrome (MFS) was first recognized by Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. In 1956, three cases with this triad were published by Miller Fisher as a limited variant of Guillian-Barré syndrome (GBS), and the disease started to be called by his name. Since the beginning of the SARS-CoV-2 pandemic, there have been many reports of peripheral and central nervous system involvement. Until December 2022, a total of 24 cases, including four children associated with MFS, had been reported. This current review aimed to present the basic clinical and laboratory characteristics of patients with MFS and coronavirus disease-2019 (COVID-19). Since 2020, cases with different age and gender characteristics have been reported from eight different countries. Most cases were reported from Europe. SARS-CoV-2 infection was confirmed in seven of the cases. The youngest case reported was a 6-year-old boy from Turkey, while the oldest case was a 70-year-old female from Spain. All these reported cases and our past medical knowledge of MFS suggest that molecular mimicry is the main immunological mechanism. Despite all these data, more case reports, cohorts, and case-control studies will be needed to clarify the relationship between MFS and COVID-19.
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Affiliation(s)
- Turan Poyraz
- Department of Elderly Care, Izmir University of Economics, İzmir, TUR
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Lee SU, Baek SH, Kim HJ, Choi JY, Kim BJ, Kim JS. Acute comitant strabismus in anti-GQ1b antibody syndrome. J Neurol 2023; 270:486-492. [PMID: 36175671 DOI: 10.1007/s00415-022-11394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023]
Abstract
Ophthalmoplegia is the diagnostic hallmark of anti-GQ1b antibody syndrome. This study aimed to define the patterns of acute comitant strabismus in patients with anti-GQ1b antibody syndromes. We retrospectively analyzed the ocular motor findings in 84 patients with anti-GQ1b antibody-associated ophthalmoplegia during the acute phases. Of the 84 patients, 11 (13%) showed acute comitant strabismus. Compared to those without, patients with acute comitant strabismus frequently showed abnormal ocular motor findings that included gaze-evoked (n = 8), spontaneous (n = 4) and positional nystagmus (n = 4), saccadic hypermetria (n = 3), head-shaking nystagmus (n = 2), pulse-step mismatch (n = 1), and impaired visual cancellation of the vestibulo-ocular reflex (n = 1, p < 0.001). On the contrary, iridoplegia (p = 0.029) and ptosis (p = 0.001) were more commonly observed in patients with paralytic (incomitant) strabismus than in those with acute comitant strabismus. Comitant strabismus can manifest during the acute phase of anti-GQ1b antibody syndromes in association with other central ocular motor abnormalities. These findings implicate that the cerebellum and/or brainstem can be the primary target of the anti-GQ1b antibodies.
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Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea.,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.,BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea. .,Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Tan CY, Razali SNO, Goh KJ, Shahrizaila N. Determining the Utility of the Guillain-Barré Syndrome Classification Criteria. J Clin Neurol 2021; 17:273-282. [PMID: 33835749 PMCID: PMC8053556 DOI: 10.3988/jcn.2021.17.2.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose Several variants of Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) exist, but their frequencies vary in different populations and do not always meet the inclusion criteria of the existing diagnostic criteria. However, the GBS classification criteria by Wakerley and colleagues recognize and define the clinical characteristics of each variant. We applied these criteria to a GBS and MFS cohort with the aim of determining their utility. Methods Consecutive GBS and MFS patients presenting to our center between 2010 and 2020 were analyzed. The clinical characteristics, electrophysiological data, and antiganglioside antibody profiles of the patients were utilized in determining the clinical classification. Results This study classified 132 patients with GBS and its related disorders according to the new classification criteria as follows: 64 (48.5%) as classic GBS, 2 (1.5%) as pharyngeal-cervical-brachial (PCB) variant, 7 (5.3%) as paraparetic GBS, 29 (22%) as classic MFS, 3 (2.3%) as acute ophthalmoparesis, 2 (1.5%) as acute ataxic neuropathy, 2 (1.5%) as Bickerstaff brainstem encephalitis (BBE), 17 (12.9%) as GBS/MFS overlap, 4 (3%) as GBS/BBE overlap, 1 (0.8%) as MFS/PCB overlap, and 1 (0.8%) as polyneuritis cranialis. The electrodiagnosis was demyelinating in 55% of classic GBS patients but unclassified in 79% of classic MFS patients. Anti-GM1, anti-GD1a, anti-GalNAc-GD1a, and anti-GD1b IgG ganglioside antibodies were more commonly detected in the axonal GBS subtype, whereas the anti-GQ1b and anti-GT1a IgG ganglioside antibodies were more common in classic MFS and its subtypes. Conclusions Most of the patients in the present cohort met the criteria of either classic GBS or MFS, but variants were seen in one-third of patients. These findings support the need to recognize variants of both syndromes in order to achieve a more-complete case ascertainment in GBS.
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Affiliation(s)
- Cheng Yin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Siti Nur Omaira Razali
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean Jin Goh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Freiha J, Zoghaib R, Makhoul K, Maalouf N, Riachi N, Chalah MA, Ayache SS, Ahdab R. The value of sensory nerve conduction studies in the diagnosis of Guillain-Barré syndrome. Clin Neurophysiol 2021; 132:1157-1162. [PMID: 33780722 DOI: 10.1016/j.clinph.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
Electrophysiology plays a determinant role in Guillain-Barré syndrome (GBS) diagnosis, classification, and prognostication. However, traditional electrodiagnostic (EDX) criteria for GBS rely on motor nerve conduction studies (NCS) and are suboptimal early in the course of the disease or in the setting of GBS variants. Sensory nerve conduction studies, including the sural-sparing pattern and the sensory ratio are not yet included in EDX criteria despite their well-established role in GBS diagnosis. The aim of this review is to discuss the diagnostic value of sensory NCS in GBS, their role in establishing the diagnosis and predicting the outcome according to the various subtypes of the disease.
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Affiliation(s)
- Joumana Freiha
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Romy Zoghaib
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Karim Makhoul
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Nancy Maalouf
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Naji Riachi
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Moussa A Chalah
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France; EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
| | - Samar S Ayache
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France; EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
| | - Rechdi Ahdab
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon; Hamidy Medical Center, Tripoli 1300, Lebanon.
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Tan CY, Razali SNO, Goh KJ, Shahrizaila N. Diagnosis of Guillain-Barré syndrome and validation of the Brighton criteria in Malaysia. J Peripher Nerv Syst 2020; 25:256-264. [PMID: 32511817 DOI: 10.1111/jns.12398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 01/12/2023]
Abstract
We aimed to evaluate the key diagnostic features of Guillain-Barré syndrome (GBS) in Malaysian patients and validate the Brighton criteria. This was a retrospective study of patients presenting with GBS and Miller Fisher syndrome (MFS) between 2010 and 2019. The sensitivity of the Brighton criteria was evaluated. A total of 128 patients (95 GBS, 33 MFS) were included. In the GBS cohort, 92 (97%) patients presented with symmetrical limb weakness. Reflexes were depressed or absent in 90 (95%) patients. Almost all patients (94, 99%) followed a monophasic disease course, with 5 (5%) patients experiencing treatment-related fluctuations. Cerebrospinal fluid (CSF) albuminocytological dissociation was seen in 62/84 (73%) patients. Nerve conduction study (NCS) revealed neuropathy in 90/94 (96%) patients. In GBS patients with complete dataset (84), 56 (67%) patients reached level 1 of the Brighton criteria, 21 (25%) reached level 2, 3 (4%) reached level 3, and 4 (5%) reached level 4. In MFS, the clinical triad was present in 25 (76%) patients. All patients had a monophasic course. CSF albuminocytological dissociation was present in 10/25 (40%) patients. NCS was normal or showed sensory neuropathy in 25/33 (76%) patients. In MFS patients with complete dataset (25), 5 (20%) patients reached level 1 of the Brighton criteria, 14 (56%) reached level 2, 2 (8%) reached level 3, and 4 (16%) reached level 4. Inclusion of antiganglioside antibodies improved the sensitivity of the Brighton criteria in both cohorts. In the Malaysian cohort, the Brighton criteria showed a moderate to high sensitivity in reaching the highest diagnostic certainty of GBS, but the sensitivity was lower in MFS.
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Affiliation(s)
- Cheng-Yin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Nur Omaira Razali
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean-Jin Goh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Umapathi T, Lim CSJ, Ng BCJ, Goh EJH, Ohnmar O. A Simplified, Graded, Electrodiagnostic Criterion for Guillain-Barré Syndrome That Incorporates Sensory Nerve Conduction Studies. Sci Rep 2019; 9:7724. [PMID: 31118437 PMCID: PMC6531437 DOI: 10.1038/s41598-019-44090-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/09/2019] [Indexed: 11/09/2022] Open
Abstract
Traditional electrodiagnostic (EDX) criteria for Guillain-Barré Syndrome (GBS), e.g. those delineated by Ho et al. and Hadden et al., rely on motor nerve conduction studies (NCS), and focus on differentiating GBS subtypes instead of the accurate diagnosis of GBS. Sensory studies, including the sural-sparing pattern, are not routinely used in GBS EDX. We studied the utility of a simplified criterion that utilizes sensory NCS. Motor and sensory NCS abnormalities were defined by comparing against age and height adjusted norms derived from 245 controls. We considered the sural-sparing pattern a positive diagnostic feature. We analyzed 109 prospectively validated GBS patients and graded them as "Definite", "Probable" and "Possible" based on the number of motor and sensory abnormalities detected. Using proposed EDX criteria, 35.8%, 43.1%, 11.9% of all GBS patients were considered "Definite", "Probable" or "Possible" respectively; whereas traditional EDX criteria only diagnosed 49.5% of cases. 27.5%, 35.3% and 21.6% of patients with the Miller-Fisher Syndrome (MFS) subtype of GBS were considered "Definite", "Probable" or "Possible" respectively. In comparison, traditional criteria only detected 15.7% of cases. Our proposed EDX criterion, that includes sensory NCS, improves and grades the diagnostic certainty of GBS, especially MFS.
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Affiliation(s)
| | | | - Brandon Chin Jie Ng
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Eunice Jin Hui Goh
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - O Ohnmar
- Yangon General Hospital, Yangon, Myanmar
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Bowley MP, Chad DA. Clinical neurophysiology of demyelinating polyneuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:241-268. [DOI: 10.1016/b978-0-444-64142-7.00052-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Hiew FL, Ramlan R, Viswanathan S, Puvanarajah S. Guillain-Barré Syndrome, variants & forms fruste: Reclassification with new criteria. Clin Neurol Neurosurg 2017; 158:114-118. [PMID: 28514704 DOI: 10.1016/j.clineuro.2017.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/15/2017] [Accepted: 05/03/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical and electrophysiological characteristics of various distinctive classical and localised Guillain-Barré syndrome (GBS) subtypes. PATIENTS AND METHODS Clinical characteristics and electrophysiological data of sixty-one consecutive patients admitted between 2012 and 2015 were systematically analysed and reclassified according to the new GBS clinical classification. Neurophysiology was evaluated with Hadden et al.'s vs recently proposed Rajabally et al.'s criteria. Functional severity and clinical outcome of various GBS subtypes were ascertained. RESULTS All patients initially identified as GBS or related disorders can be sub-classified into having classical GBS (41, 67%), classic Miller-Fisher Syndrome (MFS) (6, 10%), Pharyngeal-cervical-brachial (PCB) (3, 5%), paraparetic GBS (4, 7%), bifacial weakness with paresthesia (3, 5%), acute ophthalmoparesis (AO) (1, 2%) and overlap syndrome (3, 5%): one (2%) with GBS/Bickerstaff brainstem encephalitis overlap and 2 (3%) with GBS/MFS overlap. Greater proportion of axonal classical GBS (67% vs 55%, p=0.372) seen with Rajabally et al.'s criteria and a predominantly axonal form of paraparetic variant (75%) independent of electrodiagnostic criteria were more representative of Asian GBS cohort. Classical GBS patients had lowest admission and discharge Medical Research Council Sum Score (MRCSS), greater functional disability and longest length of in-patient stay. Twenty (20/21, 95%) patients who needed mechanical ventilation had classical GBS. Patients required repeated dose of intravenous immunoglobulin (5/6, 3%) or plasma exchange (4/4, 100%) more frequently had axonal form of classical GBS. CONCLUSION Phenotype recognition based on new GBS clinical classification, supported by electrodiagnostic study permits more precise clinical subtypes determination and outcome prognostication.
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Affiliation(s)
- Fu Liong Hiew
- Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
| | - Rahmansah Ramlan
- Neurophysiology Unit, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
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Chan Y, Punzalan‐Sotelo AM, Kannan TA, Shahrizaila N, Umapathi T, Goh EJ, Fukami Y, Wilder‐Smith E, Yuki N. Electrodiagnosis of reversible conduction failure in Guillain–Barré syndrome. Muscle Nerve 2017; 56:919-924. [DOI: 10.1002/mus.25577] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Yee‐Cheun Chan
- Department of MedicineYong Loo Lin School of Medicine, National University of Singapore Singapore
- Division of NeurologyUniversity Medicine Cluster, National University HospitalNUHS Tower Block, Level 10, 119228 Singapore
| | | | - Therimadasamy A. Kannan
- Division of NeurologyUniversity Medicine Cluster, National University HospitalNUHS Tower Block, Level 10, 119228 Singapore
| | | | | | - Eunice J.H. Goh
- Department of MedicineYong Loo Lin School of Medicine, National University of Singapore Singapore
| | - Yuki Fukami
- Department of MedicineYong Loo Lin School of Medicine, National University of Singapore Singapore
| | - Einar Wilder‐Smith
- Department of MedicineYong Loo Lin School of Medicine, National University of Singapore Singapore
| | - Nobuhiro Yuki
- Department of MedicineYong Loo Lin School of Medicine, National University of Singapore Singapore
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Salehi N, Choi ED, Garrison RC. A Case of Miller Fisher Syndrome, Thromboembolic Disease, and Angioedema: Association or Coincidence? AMERICAN JOURNAL OF CASE REPORTS 2017; 18:52-59. [PMID: 28090073 PMCID: PMC5260666 DOI: 10.12659/ajcr.901940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Miller Fisher Syndrome is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia, and is considered to be a variant of Guillain-Barre Syndrome. Miller Fisher Syndrome is observed in approximately 1-5% of all Guillain-Barre cases in Western countries. Patients with Miller Fisher Syndrome usually have good recovery without residual deficits. Venous thromboembolism is a common complication of Guillain-Barre Syndrome and has also been reported in Miller Fisher Syndrome, but it has generally been reported in the presence of at least one prothrombotic risk factor such as immobility. A direct correlation between venous thromboembolism and Miller Fisher Syndrome or Guillain-Barre Syndrome has not been previously described. CASE REPORT We report the case of a 32-year-old Hispanic male who presented with acute, severe thromboembolic disease and concurrently demonstrated characteristic clinical features of Miller Fisher Syndrome including ophthalmoplegia, ataxia, and areflexia. Past medical and family history were negative for thromboembolic disease, and subsequent hypercoagulability workup was unremarkable. During the course of hospitalization, the patient also developed angioedema. CONCLUSIONS We describe a possible association between Miller Fisher Syndrome, thromboembolic disease, and angioedema.
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Affiliation(s)
- Nooshin Salehi
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA
| | - Eric D Choi
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Roger C Garrison
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA.,School of Medicine, Loma Linda University, Loma Linda, CA, USA
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12
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Wakerley BR, Kokubun N, Funakoshi K, Nagashima T, Hirata K, Yuki N. Clinical classification of 103 Japanese patients with Guillain-Barré syndrome. J Neurol Sci 2016; 369:43-47. [PMID: 27653863 DOI: 10.1016/j.jns.2016.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/17/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022]
Abstract
Guillain-Barré syndrome (GBS) is the commonest cause of flaccid paralysis worldwide. Miller Fisher syndrome (MFS) is a variant of GBS characterized by ophthalmoplegia and ataxia. Together GBS and MFS form a continuum of discrete and overlapping subtypes, the frequency of which remains unknown. We retrospectively analysed the clinical features (antecedent symptoms, pattern of neurological weakness or ataxia, presence of hypersomnolence) of 103 patients at a single hospital in Japan. Patients were then classified according to new diagnostic criteria (Wakerley et al., 2014). Laboratory data (neurophysiology and anti-ganglioside antibody profiles) were also analysed. According to the new diagnostic criteria, the 103 patients could be classified as follows: classic GBS 73 (71%), pharyngeal-cervical-brachial weakness 2 (2%), acute pharyngeal weakness 0 (0%), paraparetic GBS 1 (1%), bifacial weakness with paraesthesias 1 (1%), polyneuritis cranialis 0 (0%), classic MFS 18 (17%), acute ophthalmoparesis 1 (1%), acute ptosis 0 (0%), acute mydriasis 0 (0%), acute ataxic neuropathy 1 (1%), Bickerstaff brainstem encephalitis 3 (3%), acute ataxic hypersomnolence 0 (0%), GBS and MFS overlap 1 (1%), GBS and Bickerstaff brainstem encephalitis overlap 1 (1%), MFS and pharyngeal-cervical-brachial weakness overlap 1 (1%). Application of the new clinical diagnostic criteria allowed accurate retrospective diagnosis and classification of GBS and MFS subtypes.
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Affiliation(s)
- Benjamin R Wakerley
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester GL13NN, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - N Kokubun
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - K Funakoshi
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - T Nagashima
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - K Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - N Yuki
- Department of Neurology, Mishima Hospital, Niigata, Japan.
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Ishii J, Yuki N, Kawamoto M, Yoshimura H, Kusunoki S, Kohara N. Recurrent Guillain-Barré syndrome, Miller Fisher syndrome and Bickerstaff brainstem encephalitis. J Neurol Sci 2016; 364:59-64. [PMID: 27084218 DOI: 10.1016/j.jns.2016.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Guillain-Barré syndrome (GBS), Miller Fisher syndrome (MFS), and Bickerstaff brainstem encephalitis (BBE) are usually monophasic, but some patients experience recurrences after long asymptomatic intervals. We aimed to investigate clinical features of recurrent GBS, MFS, and BBE at a single hospital. METHODS Records from 97 consecutive patients with GBS, MFS or BBE who were admitted to a tertiary hospital between 2001 and 2013 were reviewed. Clinical and laboratory features of patients with recurrent GBS, MFS, or BBE were investigated. RESULTS Patients included 55 (32 males) with GBS, 34 (22 males) with MFS, and 8 (6 males) with BBE. Recurrent cases occurred in 2 (4%) of the 55 patients with GBS, 4 (12%) of the 34 patients with MFS, and 2 (25%) of the 8 patients with BBE. Patients with recurrent MFS had a tendency to be younger at the first episode than patients with non-recurrent MFS (median, 22 versus 37years old). Symptoms and signs were less severe during relapses than during the initial episode in recurrent patients. CONCLUSIONS Recurrences occurred more frequently in patients with MFS or BBE compared with those with GBS. Patients with recurrent MFS might be younger than those with non-recurrent MFS.
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Affiliation(s)
- Junko Ishii
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.
| | - Nobuhiro Yuki
- Brain and Mind Centre, University of Sydney, Australia.
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.
| | - Hajime Yoshimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.
| | - Susumu Kusunoki
- Department of Neurology, Kinki University School of Medicine, Japan.
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan.
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14
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Tan CY, Yuki N, Shahrizaila N. Delayed facial palsy in Miller Fisher syndrome. J Neurol Sci 2015; 358:409-12. [PMID: 26277343 DOI: 10.1016/j.jns.2015.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/15/2015] [Accepted: 08/05/2015] [Indexed: 12/11/2022]
Abstract
Miller Fisher syndrome is characterised by the triad of ophthalmoplegia, ataxia and areflexia. However, facial palsy can occur during the course of the illness although development of facial palsy when other cardinal signs of Miller Fisher syndrome have reached nadir or improving, is unusual. This delayed appearance of facial palsy can be easily overlooked by the treating clinician. Here, we report four patients with Miller Fisher syndrome and delayed-onset facial palsy. We discuss the possible underlying reasons behind the delay in facial palsy.
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Affiliation(s)
- Cheng-Yin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia.
| | - Nobuhiro Yuki
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Brain and Mind Research Institute, University of Sydney, Australia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Malaysia
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Kim JK, Kim BJ, Shin HY, Shin KJ, Nam TS, Seok JI, Suh BC, Oh J, Kim YJ, Bae JS. Does delayed facial involvement implicate a pattern of “descending reversible paralysis” in Fisher syndrome? Clin Neurol Neurosurg 2015; 135:1-5. [DOI: 10.1016/j.clineuro.2015.04.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 12/01/2022]
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16
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Wong AHY, Yuki N. Guillain-Barré syndrome: advances in pathogenic understanding and diagnostic improvements. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1043266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Tatsumoto M, Misawa S, Kokubun N, Sekiguchi Y, Hirata K, Kuwabara S, Yuki N. Delayed facial weakness in Guillain-Barré and Miller Fisher syndromes. Muscle Nerve 2015; 51:811-4. [PMID: 25287079 DOI: 10.1002/mus.24475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/24/2014] [Accepted: 09/30/2014] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Dr. C. Miller Fisher described the appearance of unilateral facial palsy after resolution of ataxia in a patient with the eponymic Miller Fisher syndrome (MFS). However, there have been very few reports of delayed appearance of facial weakness in Guillain-Barré syndrome (GBS) and MFS when the other neurological signs reached nadir or started improving. METHODS In this study we reviewed the clinical and laboratory findings of consecutive patients with GBS (n=195) and MFS (n=68). RESULTS Delayed facial weakness occurred in 12 (6%) GBS and 4 (6%) MFS patients and was unilateral in 5 (42%) GBS and 2 (50%) MFS patients. In those patients with delayed facial weakness, neither limb weakness nor ataxia progressed, and facial weakness disappeared without immunotherapy. CONCLUSIONS Because facial weakness can lead to further morbidity, it would be prudent for clinicians to warn patients of this possibility, although additional immunotherapy is usually not required.
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Affiliation(s)
- Muneto Tatsumoto
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Norito Kokubun
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Yukari Sekiguchi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhiro Yuki
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Medicine, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Unit 09-01, 14 Medical Drive, 117599, Singapore
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18
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Yi Wong AH, Yuki N. Miller Fisher syndrome is a nodo-paranodopathy, but not a myelinopathy. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.14.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Miller Fisher syndrome, characterized by ophthalmoplegia, ataxia and areflexia, is a variant of Guillain–Barré syndrome. There have been controversies over the electrophysiological studies of Miller Fisher syndrome, as both demyelinating and axonal changes have been reported. In recent years, reversible conduction failure has been reported in patients with Miller Fisher syndrome with the use of serial nerve conduction studies. The similarity between Miller Fisher syndrome and axonal Guillain–Barré syndrome has led to the suggestion of a common autoimmune mechanism at the nodes and paranodes.
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Affiliation(s)
- Anna Hiu Yi Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nobuhiro Yuki
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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