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Kim JK, Hong SK, Bae JS, Yoon BA, Park HT, Huh SY, Kim SJ, Kim JE, Kim DS. Ophthalmoplegic Guillain-Barré syndrome: An independent entity or a transitional spectrum? J Clin Neurosci 2016; 32:19-23. [PMID: 27436763 DOI: 10.1016/j.jocn.2015.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/05/2015] [Accepted: 11/29/2015] [Indexed: 12/28/2022]
Abstract
Ophthalmoplegia can occur in both Miller Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS) with typical limb involvement. However, ophthalmoplegic GBS (OGBS) has been poorly defined. We aimed to characterize OGBS and clarify the pathophysiological implications across the overall GBS spectrum. Twenty GBS and seven MFS patients from three university based teaching hospitals in Korea were enrolled and analyzed. Six GBS patients who were classified as OGBS commonly also had facial diplegia (50%) and bulbar palsy (50%), while only a small portion of non-ophthalmoplegic GBS (NOGBS) patients had facial diplegia (21%). None of the patients had bulbar palsy in the NOGBS or MFS groups. The most frequent anti-ganglioside antibody in OGBS was the IgG anti-GT1a antibody (50%). The IgG anti-GM1 antibody was found mainly in NOGBS (57%) with high concordance with the pure motor type classification on electrophysiology. IgG anti-GQ1b antibody was positive uniquely in MFS (100%), although some patients were also positive for anti-GT1a antibody (71%). OGBS had distinct clinical features, including bulbar palsy, as well as ophthalmoplegia and limb weakness for both GBS and MFS. Relevant immunological factors were anti-GT1a antibody. Whether OGBS is an independent entity or a transitional spectrum remains to be established and further study will be needed.
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Affiliation(s)
- Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, South Korea
| | - Seuk Kyung Hong
- Department of Neurology, Dong-A University College of Medicine, Busan, South Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Byeol-A Yoon
- Department of Neurology, Dong-A University College of Medicine, Busan, South Korea
| | - Hwan Tae Park
- Department of Physiology, Dong-A University College of Medicine, Busan, South Korea
| | - So Young Huh
- Department of Neurology, Kosin University College of Medicine, Busan, South Korea
| | - Sang-Jin Kim
- Department of Neurology, Inje University College of Medicine, Busan, South Korea
| | - Jong-Eun Kim
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University, Gyeongsangnam-do, South Korea.
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Kim JK, Bae JS, Kim DS, Kusunoki S, Kim JE, Kim JS, Park YE, Park KJ, Song HS, Kim SY, Lim JG, Kim NH, Suh BC, Nam TS, Park MS, Choi YC, Sohn EH, Na SJ, Huh SY, Kwon O, Lee SY, Lee SH, Oh SY, Jeong SH, Lee TK, Kim DU. Prevalence of anti-ganglioside antibodies and their clinical correlates with guillain-barré syndrome in Korea: a nationwide multicenter study. J Clin Neurol 2014; 10:94-100. [PMID: 24829594 PMCID: PMC4017025 DOI: 10.3988/jcn.2014.10.2.94] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/05/2013] [Accepted: 10/16/2013] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose No previous studies have investigated the relationship between various anti-ganglioside antibodies and the clinical characteristics of Guillain-Barré syndrome (GBS) in Korea. The aim of this study was to determine the prevalence and types of anti-ganglioside antibodies in Korean GBS patients, and to identify their clinical significance. Methods Serum was collected from patients during the acute phase of GBS at 20 university-based hospitals in Korea. The clinical and laboratory findings were reviewed and compared with the detected types of anti-ganglioside antibody. Results Among 119 patients, 60 were positive for immunoglobulin G (IgG) or immunoglobulin M antibodies against any type of ganglioside (50%). The most frequent type was IgG anti-GM1 antibody (47%), followed by IgG anti-GT1a (38%), IgG anti-GD1a (25%), and IgG anti-GQ1b (8%) antibodies. Anti-GM1-antibody positivity was strongly correlated with the presence of preceding gastrointestinal infection, absence of sensory symptoms or signs, and absence of cranial nerve involvement. Patients with anti-GD1a antibody were younger, predominantly male, and had more facial nerve involvement than the antibody-negative group. Anti-GT1a-antibody positivity was more frequently associated with bulbar weakness and was highly associated with ophthalmoplegia when coupled with the coexisting anti-GQ1b antibody. Despite the presence of clinical features of acute motor axonal neuropathy (AMAN), 68% of anti-GM1- or anti-GD1a-antibody-positive cases of GBS were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) by a single electrophysiological study. Conclusions Anti-ganglioside antibodies were frequently found in the serum of Korean GBS patients, and each antibody was correlated strongly with the various clinical manifestations. Nevertheless, without an anti-ganglioside antibody assay, in Korea AMAN is frequently misdiagnosed as AIDP by single electrophysiological studies.
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Affiliation(s)
- Jong Kuk Kim
- Department of Neurology, College of Medicine, Dong-A University, Busan, Korea
| | - Jong Seok Bae
- Department of Neurology, College of Medicine, Hallym University, Seoul, Korea
| | - Dae-Seong Kim
- Department of Neurology, School of Medicine, Pusan National University, Busan, Korea
| | - Susumu Kusunoki
- Department of Neurology, School of Medicine, Kinki University, Osaka, Japan
| | - Jong Eun Kim
- Department of Industrial and Occupational Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ji Soo Kim
- Department of Neurology, College of Medicine, Seoul National University, Seoul, Korea
| | - Young-Eun Park
- Department of Neurology, School of Medicine, Pusan National University, Busan, Korea
| | - Ki-Jong Park
- Department of Neurology, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Hyun Seok Song
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sun Young Kim
- Department of Neurology, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Jeong-Geun Lim
- Department of Neurology, School of Medicine, Keimyung University, Daegu, Korea
| | - Nam-Hee Kim
- Department of Neurology, College of Medicine, Dongguk University, Seoul, Korea
| | - Bum Chun Suh
- Department of Neurology, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Min Su Park
- Department of Neurology, School of Medicine, Yeungnam University, Daegu, Korea
| | - Young-Chul Choi
- Department of Neurology, College of Medicine, Yonsei University, Seoul, Korea
| | - Eun Hee Sohn
- Department of Neurology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Sang-Jun Na
- Department of Neurology, College of Medicine, Konyang University, Daejeon, Korea
| | - So Young Huh
- Department of Neurology, College of Medicine, Kosin University, Busan, Korea
| | - Ohyun Kwon
- Department of Neurology, School of Medicine, Eulji University, Seoul, Korea
| | - Su-Yun Lee
- Department of Neurology, College of Medicine, Dong-A University, Busan, Korea
| | - Sung-Hoon Lee
- Department of Neurology, College of Medicine, Hallym University, Seoul, Korea
| | - Sun-Young Oh
- Department of Neurology, School of Medicine, Chonbuk National University, Jeonju, Korea
| | - Seong-Hae Jeong
- Department of Neurology, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Tae-Kyeong Lee
- Department of Neurology, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Dong Uk Kim
- Department of Neurology, School of Medicine, Chosun University, Gwangju, Korea
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