Immunology of Guillain-Barré syndrome

Herpes virus infection of the peripheral nervous system

Among the human herpes viruses, three are neurotropic and capable of producing severe neurological abnormalities: herpes simplex virus type 1 and 2 (HSV-1 and HSV-2) and varicella-zoster virus (VZV). Both the acute, primary infection and the reactivation from the site of latent infection, the dorsal sensory ganglia, are associated with severe human morbidity and mortality. The peripheral nervous system is one of the major loci affected by these viruses. The present review details the virology and molecular biology underlying the human infection. This is followed by detailed description of the symtomatology, clinical presentation, diagnosis, course, therapy, and prognosis of disorders of the peripheral nervous system caused by these viruses.

Neurological abnormalities associated with celiac disease

BACKGROUND

Celiac disease (CD) is a gluten-sensitive enteropathy in genetically susceptible individuals. Anecdotal reports suggest that the nervous system might be affected in the disorder, but the severity and prevalence of such an involvement have not been systematically evaluated.

MATERIALS AND METHODS

Analysis of files of CD patients diagnosed between 1980 and 1999 for neurological abnormalities. Diagnosis of CD was based on the modified criteria of the European Society for Pediatric Gastroenterology and Nutrition.

RESULTS

Of 148 CD patients, 18 (12%) had 21 neurological disorders that could not be attributed to any other condition including muscle abnormality (3), epilepsy (3), psychiatric disease (4), peripheral neuropathy (3), cerebrovascular disease (1), myelopathy (1) and Down syndrome (2). Other disorders probably unrelated to CD were present in 8 patients.

CONCLUSION

If this association is not coincidental, both the central and the peripheral nervous systems may be affected in CD by a spectrum of neurological disorders that are either the outcome of CD or share the same pathogenesis with the enteropathy.

Human herpes viruses latent infection in the nervous system

The neurotropic herpes viruses, HSV-1, HSV-2 and VZV, colonize and establish latent infection in human peripheral sensory ganglia. Recurrent diseases due to reactivation of these viral pathogens can take place despite an effective immune response. Molecular, cellular, physiological and immune mechanisms work in concert to enable the establishment of latency, the maintenance of the latent state for the entire life of the host, and the reactivation infection. Although all three viruses belong to the same family and establish latent infection in the same tissue, the clinical pattern of their reactivation is quite different. This review covers current knowledge of the basis of these infections, and offers a theory explaining the basis of HSV-1 latent infection and the differences of the disorders caused by HSV-1 and VZV reactivation in humans.

Herpes simplex virus specific antibody determined by immunoblotting in cerebrospinal fluid of a patient with the Guillain-Barré syndrome

The Guillain-Barré syndrome is often preceded by a herpes virus infection. Herpes simplex virus, however, has rarely been observed as the causative agent. A patient is described with a herpes simplex virus infection followed by a Guillain-Barré syndrome. Immunoblotting was used to detect herpes simplex virus-specific antibodies in serum and cerebrospinal fluid.

Anti-myelin antibodies in cerebrospinal fluid and serum of patients with meningopolyneuritis Garin-Bujadoux-Bannwarth and other neurological diseases

Anti-myelin antibodies (AMA) of IgG, IgM, and IgA class were investigated by ELISA in CSF and serum from patients with meningopolyneuritis Garin-Bujadoux-Bannwarth (GBB), other inflammatory diseases of the nervous system (ID) comprising meningoencephalitis (ME), multiple sclerosis (MS), and Guillain-Barré syndrome (GBS), and various noninflammatory neurological diseases (NID). Anti-Borrelia antibodies (ABA) were determined by ELISA in GBB patients. In CSF, a high incidence of IgG-AMA, IgM-AMA, and IgA-AMA was found in GBB as compared with ID and NID. On average, positive AMA titers were higher in GBB than in ID and NID, IgM-AMA titers in GBB being most prominent. In serum, AMA were found in all but 2 patients investigated. On average, IgM-AMA titers were higher in GBB and MS than in other diseases; IgG-AMA titers in GBB and ME were relatively low. Antibody indices, calculated from titer values and Ig concentrations in CSF and serum, indicate intrathecal synthesis mainly of IgG- and IgA-AMA, and of IgG- and IgM-ABA. Participation of AMA in the pathogenesis of GBB may be envisaged, but needs further confirmation.

Appearance of Guillain-Barré syndrome in patients during corticosteroid treatment

Three patients developed acute Guillain-Barré syndrome while on steroid treatment. The first patient suffered from ulcerative colitis and developed Guillain-Barré syndrome when the steroid dosage was being tapered. Another patient with long-standing multiple sclerosis received steroids during relapse and the Guillain-Barré syndrome appeared while treatment was reduced. The third patient, with aqueductal stenosis and ventriculoatrial shunt, who received steroids when malfunction of the shunt was suspected, developed Guillain-Barré syndrome while steroids were being tapered. Based on the putative immune pathogenesis of inflammatory demyelinating polyneuropathy, the occurrence of the syndrome in these patients could have been due to a selective effect of low-dose steroids on a specific, maybe suppressor lymphocyte subpopulation.