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Fan Z, Liu B, Zhang Y, Li M, Lu T. The effectiveness and safety of acupuncture therapy for Guillain-Barré syndrome: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2020; 99:e18619. [PMID: 31914040 PMCID: PMC6959897 DOI: 10.1097/md.0000000000018619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is the most common acute paralytic neuropathy. Many clinical trials indicate acupuncture provides a good effect as a complementary therapy of Western medicine for GBS. The objective of this systematic review protocol is to provide the evidence to evaluate the effectiveness and safety of acupuncture on the treatment of GBS. METHODS We will search relevant randomized controlled trials investigating the effect of acupuncture for GBS in following databases from start to October 2019: PubMed, Embase, the Cochrane Library, CINAHL Complete, National Digital Science Library, China National Knowledge Infrastructure, and Wanfang Database without language restriction. For articles that meet our inclusion criteria, 2 researchers will extract the data information independently, and assess the risk of bias and trial quality by the Cochrane collaboration's tool. All data will be analyzed by RevMan V.5.3.3 statistical software. RESULTS According to the Barthel index of Activities of Daily Living (ADL) and the Medical Research Council (MRC) muscle scale, the efficacy and safety of acupuncture for GBS will be determined in this study. CONCLUSION This systemic review will provide high quality evidence to judging whether acupuncture provides benefits to treat GBS.Prospero registration number: CRD42019158710.
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Affiliation(s)
| | | | - Yili Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Man Li
- School of Medicine, University of St Andrews, Scotland, UK
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2
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Esposito S, Longo MR. Guillain–Barré syndrome. Autoimmun Rev 2017; 16:96-101. [DOI: 10.1016/j.autrev.2016.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
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Ding VA, Zhu Z, Mantz AA, Xiao H, Wakefield MR, Bai Q, Fang Y. The Role of IL-37 in Non-Cancerous Diseases. Pathol Oncol Res 2016; 23:463-470. [DOI: 10.1007/s12253-016-0137-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/12/2016] [Indexed: 11/24/2022]
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Dash S, Pai AR, Kamath U, Rao P. Pathophysiology and diagnosis of Guillain-Barré syndrome - challenges and needs. Int J Neurosci 2014; 125:235-40. [PMID: 24731000 DOI: 10.3109/00207454.2014.913588] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy which presents with acute onset and rapid progression of flaccid, hyporeflexi quadriparesis. Both sensory and autonomic nerve involvement is seen. GBS has various subtypes that vary in their pathophysiology. The pathogenesis involves an immune response triggered by a preceding event which may be an infection, immunisation or surgical procedure. Clinical diagnosis has been largely the primary diagnosing criterion for GBS along with electrodiagnosis, which has several pitfalls and is supported by ancillary testing of cerebrospinal fluid (CSF) analysis and Nerve Conduction Studies. Measurement of anti-ganglioside antibodies is also an effective tool in its diagnosis. Further understanding of pathophysiology and better diagnostic methods are required for better management of GBS.
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Affiliation(s)
- Sambit Dash
- 1Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus)
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Li C, Zhao P, Sun X, Che Y, Jiang Y. Elevated levels of cerebrospinal fluid and plasma interleukin-37 in patients with Guillain-Barré syndrome. Mediators Inflamm 2013; 2013:639712. [PMID: 24174711 PMCID: PMC3793588 DOI: 10.1155/2013/639712] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/10/2013] [Accepted: 08/19/2013] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED AIMS. Interleukin-37 (IL-37) is an anti-inflammatory cytokine. This study aims to investigate the concentrations of plasma and cerebrospinal fluid (CSF) IL-37 in patients with Guillain-Barré Syndrome (GBS). METHODS The levels of plasma and CSF IL-37, IL-17A, IFN- γ , and TNF- α in 25 GBS patients and 20 healthy controls (HC) were determined by enzyme-linked immunoabsorbent assay and flow cytometric bead array assay, respectively. The values of clinical parameters in the patients were also measured. RESULTS The concentrations of plasma IL-37, IL-17A, IFN- γ , and TNF- α and CSF IL-37 and IL-17A in patients at the acute phase of GBS were significantly higher than those in the HC. The levels of plasma IL-37, IL-17A, IFN- γ , and TNF- α were positively correlated in those patients, and the levels of CSF IL-37 and IL-17A as well as the levels of plasma TNF- α were correlated positively with the GBS disability scale scores (GDSs) in those patients. Treatment with intravenous immunoglobulin significantly reduced the levels of plasma IL-37, IL-17A, IFN- γ , and TNF- α in the drug-responding patients. CONCLUSIONS Our findings indicate higher levels of plasma and CSF IL-37 and IL-17A and other proinflammatory cytokines in patients with GBS.
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Affiliation(s)
- Cong Li
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, The Second Part of First Hospital, Jilin University, Changchun 130032, China
| | - Pingwei Zhao
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, The Second Part of First Hospital, Jilin University, Changchun 130032, China
| | - Xiguang Sun
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, The Second Part of First Hospital, Jilin University, Changchun 130032, China
| | - Yuanyuan Che
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, The Second Part of First Hospital, Jilin University, Changchun 130032, China
| | - Yanfang Jiang
- Key Laboratory of Zoonosis Research, Ministry of Education, Institute of Zoonosis, The Second Part of First Hospital, Jilin University, Changchun 130032, China
- *Yanfang Jiang:
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Neurologic symptoms associated with raising poultry and swine among participants in the Agricultural Health Study. J Occup Environ Med 2011; 53:190-5. [PMID: 21270654 DOI: 10.1097/jom.0b013e31820805d5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Guillain-Barré Syndrome (GBS) is the leading cause of acute peripheral neuropathy worldwide, often associated with recent foodborne infection with Campylobacter jejuni. In this cross-sectional analysis of data from the Agricultural Health Study, we tested whether swine and poultry exposure were associated with increased prevalence of GBS-like neurologic symptoms. METHODS Using multivariate analysis, we tested the symptoms such as numbness and weakness, relevant to inflammatory peripheral neuropathies, among farmers with self-reported occupational poultry or swine exposure compared with farmers who reported no occupational animal exposure. RESULTS Among swine farmers/workers, prevalence of weakness and numbness were increased (P < 0.05). Among poultry farmers/workers, prevalence of weakness and numbness were increased, but increased prevalence of weakness was not statistically significant. CONCLUSIONS Occupational contact with live poultry or swine, potentially related to C. jejuni exposure, was associated with increased reporting of GBS-like symptoms.
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Pithadia AB, Kakadia N. Guillain-Barré syndrome (GBS). Pharmacol Rep 2010; 62:220-32. [PMID: 20508277 DOI: 10.1016/s1734-1140(10)70261-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 10/20/2009] [Indexed: 10/25/2022]
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10
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Cerebral vein thrombosis and Guillain-Barre syndrome: a challenging association. Am J Emerg Med 2009; 27:758.e3-4. [DOI: 10.1016/j.ajem.2008.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 10/18/2008] [Indexed: 11/24/2022] Open
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Markoula S, Giannopoulos S, Sarmas I, Tzavidi S, Kyritsis AP, Lagos G. Guillain-Barré syndrome in northwest Greece. Acta Neurol Scand 2007; 115:167-73. [PMID: 17295711 DOI: 10.1111/j.1600-0404.2006.00731.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We present the epidemiological and clinical-laboratory features of Guillain-Barré syndrome (GBS) in northwest Greece over a 9.5-year period. MATERIALS AND METHODS We studied all the patients with GBS who were admitted to our neurology inpatient service from January 1996 to May 2005 and compared them with previously published series. RESULTS Forty-six patients were hospitalized during this period. The average crude incidence rate was 1.22/100,000 populations per year, and males were more susceptible than females. There was a spring clustering, as 52.17% presented the syndrome during spring. The axonal type of GBS was recorded in 13.04% of the patients. The most frequent presenting symptom was dysesthetic numbness (52.17%). A large number of patients (56.52%) had up to three times the elevation of liver function values that resolved in a few weeks. Most patients had an excellent recovery and no deaths were recorded. CONCLUSIONS In our series, there was no difference in the incidence rate and subtypes of GBS but there was a significant seasonality with spring clustering. A transient elevation of transaminases of undetermined etiology was noted in more than a half of our patients. Although seven patients (15.21%) had significant neurologic sequelae, no deaths occurred.
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Affiliation(s)
- S Markoula
- Department of Neurology, University of Ioannina, Medical School, Ioannina, Greece.
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Taylor BV, Williamson J, Luck J, Coleman D, Jones D, McGregor A. Sensitivity and specificity of serology in determining recent acute Campylobacter infection. Intern Med J 2004; 34:250-8. [PMID: 15151671 DOI: 10.1111/j.1444-0903.2004.00517.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The measurement of serum antibodies to Campylobacter spp. has been used to investigate links between prior Campylobacter infections and the development of Guillain-Barre syndrome and its variants. Little is known of the serum antibody response to acute infections in the short- or long-term. AIMS The aims of the present study were to investigate the normal serum response to an acute Campylobacter infection and the sensitivity and specificity of anti-Campylobacter antibodies in determining recent Campylobacter infection. METHODS An enzyme-linked immunosorbent assay (ELISA) method was used to measure serum anti-Campylobacter immunoglobulin G (IgG), IgA and IgM antibodies. Controls consisted of 420 blood donors without recent gastroenteritis, 25 patients with other gastrointestinal infections, 24 patients with neurological conditions not affecting the peripheral nerves and 19 patients with autoimmune disorders. Three patient groups were assessed: 99 patients with acute Campylobacter infections, all of whom were tested 3 weeks post-infection; 69 of these patients tested 3-6 months later; and 74 additional patients tested >20 months post-infection. Western blot analysis was performed on controls and patients with high titre anti-Campylobacter antibodies to assess for cross-reactivity and specificity. RESULTS Following acute infections, all antibody classes rose in the majority of but not in all patients, followed by decreasing titres that did not return to baseline levels. Sixteen per cent of enteritis cases did not demonstrate a rise in titres and 9% of cases had significant levels of antibodies >20 months post-infection. The ELISA used was shown to be highly specific for the detection of Campylobacter antibodies. CONCLUSION The use of Campylobacter-specific antibody levels as the sole marker of prior infection is an unreliable method of determining the association between Campylobacter infection and neurological disease.
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Affiliation(s)
- B V Taylor
- Department of Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia.
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Chroni E, Papapetropoulos S, Gioldasis G, Ellul J, Diamadopoulos N, Papapetropoulos T. Guillain-Barre syndrome in Greece: seasonality and other clinico-epidemiological features. Eur J Neurol 2004; 11:383-8. [PMID: 15171734 DOI: 10.1111/j.1468-1331.2004.00799.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The epidemiologic and clinical features of Guillain-Barré syndrome (GBS) during a 13-year period in a region of south-western Greece with an average population of 819 009 inhabitants are described. Clinical records of all patients between 1 January 1989 and 31 December 2001 who were admitted in the two referring hospitals of the above district and fulfilled the criteria for idiopathic GBS were reviewed. Overall 105 patients were identified. The age adjusted to European population incidence rate per 100 000 person-years was 1.02 (95% CI: 0.84-1.24) and a male preponderance was found. The highest number of cases (35; 33.3%) occurred in spring and the lowest (17; 16.2%) in autumn, although this tendency did not reach a significant level. Cases with and without preceding illness were similarly distributed in the seasons. Electrophysiologic abnormalities of axonal type were found in 6.1% of patients. The mortality rate was 2.8% and the long-term outcome 5%. The incidence of GBS was relatively low and the prognosis was close to the best reported. Spring clustering has also been observed in other countries with mild climate.
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Affiliation(s)
- E Chroni
- Department of Neurology, School of Medicine, University Hospital of Patras, Greece.
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Rocha CT, Escolar DM. Update on diagnosis and treatment of hereditary and acquired polyneuropathies in childhood. SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2004; 57:255-71. [PMID: 16106624 DOI: 10.1016/s1567-424x(09)70362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Carolina Tesi Rocha
- Department of Neurology, Research Center for Genetic Medicine, MDA Clinic, Children's National Medical Center, George Washington University, Washington, DC 20010, USA
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Piliero PJ, Fish DG, Preston S, Cunningham D, Kinchelow T, Salgo M, Qian J, Drusano GL. Guillain-Barré syndrome associated with immune reconstitution. Clin Infect Dis 2003; 36:e111-4. [PMID: 12715328 DOI: 10.1086/368311] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2002] [Accepted: 12/25/2002] [Indexed: 11/03/2022] Open
Abstract
We report a case of acute Guillain-Barré syndrome (GBS) associated with a prompt and vigorous immune reconstitution and decrease in the virus load noted during treatment with a potent regimen of highly active antiretroviral therapy. We hypothesize that GBS may have been due to an aberrant immune response or an adverse drug reaction in association with preexisting peripheral neurologic disease.
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Abstract
PURPOSE OF THE REVIEW Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating poly(radiculo)neuropathy (CIDP) and multifocal motor neuropathy (MMN) are potentially treatable disorders. The use of appropriate assessment scales to evaluate the effects of treatment is essential. Recent therapeutic trials and the question of whether patients with mild disease or other variants of these disorders need to be treated are discussed. RECENT FINDINGS Recent clinical trials and Cochrane reviews give new information on the effect of various treatments in patients with GBS, CIDP and MMN. Intravenous immunoglobulin remains the only treatment proven to be effective in MMN. Combinations of treatment may be even more effective in GBS. Studies on prognostic factors related to improvement have been reported. Whether patients with Miller-Fisher syndrome or those with mild GBS should also be treated is still debated. New assessment scales at the disability and handicap level have now been evaluated for GBS and CIDP, and are ready for use. Results of studies in experimental models contribute to our understanding of the mechanism of action of intravenous immunoglobulin. SUMMARY Recent new information on the use of intravenous immunoglobulin and steroids indicates that the former should remain the cornerstone of treatment for GBS and MMN, and probably also for CIDP. Whether steroids not only suppress disease activity in CIDP but also eradicate the disease remains to be established. Some GBS patients have secondary deterioration or finally turn out to have CIDP; additional information in this group of patients may lead to more appropriate disease management. Most patients with CIDP and those with MMN need long-term treatment. New treatment strategies should now focus also on the effect and the costs of treatment over long-term follow up.
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Affiliation(s)
- Pieter A Van Doorn
- Department of Neurology, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
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Kanbayashi T, Ishiguro H, Aizawa R, Saito Y, Ogawa Y, Abe M, Hirota K, Nishino S, Shimizu T. Hypocretin-1 (orexin-A) concentrations in cerebrospinal fluid are low in patients with Guillain-Barré syndrome. Psychiatry Clin Neurosci 2002; 56:273-4. [PMID: 12047592 DOI: 10.1046/j.1440-1819.2002.00974.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is reported that cerebrospinal fluid (CSF) hypocretin-1 (orexin-A) concentrations in patients with narcolepsy are significantly low. Human narcolepsy is also known to be closely associated with a specific human histocompatibility leukocyte antigen (HLA), suggesting that autoimmunity is involved in the pathophysiology of the disease. Thus, it is important to know whether hypocretin changes are found in definite neuroimmunological diseases such as multiple sclerosis and Guillain-Barré syndrome (GBS). The results of the present study indicate that some patients with GBS have lower levels of CSF hypocretin-1.
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Affiliation(s)
- Takashi Kanbayashi
- Department of Neuropsychiatry, Akita University School of Medicine, Japan.
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De Angelis MV, Di Muzio A, Lupo S, Gambi D, Uncini A, Lugaresi A. Anti-GD1a antibodies from an acute motor axonal neuropathy patient selectively bind to motor nerve fiber nodes of Ranvier. J Neuroimmunol 2001; 121:79-82. [PMID: 11730943 DOI: 10.1016/s0165-5728(01)00434-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute motor axonal neuropathy (AMAN) is associated with high titer anti-GD1a antibodies. We have found that very high titer IgG anti-GD1a antibodies (Ab) from one AMAN patient selectively bind to motor, but not sensory, nerve nodes of Ranvier. Binding is abolished by preadsorption with GD1a. Sera negative for Ab do not immunostain motor and sensory nerve roots. We have also found that botulinum toxin A (BTA), which binds to GD1a, stains both motor and sensory nerve nodes of Ranvier. Our results strongly support the pathogenetic role of anti-GD1a antibodies in AMAN. Why BTA also binds to sensory fibers still remains to be elucidated, although the different size of BTA and its specificity to other gangliosides present in sensory axons might represent important factors.
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Affiliation(s)
- M V De Angelis
- Center for Neuromuscular Diseases, University "Gabriele d'Annunzio", Via dei Vestini, I-66013, Chieti, Italy
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Calza L, Manfredi R, Marinacci G, Briganti E, Giuliani R, Talo S, Chiodo F. Role of gancyclovir and HAART administration in the treatment of a rare complication of HIV disease: cytomegalovirus-associated Guillain-Barré syndrome. J Chemother 2001; 13:575-7. [PMID: 11760224 DOI: 10.1179/joc.2001.13.5.575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Peripheral nerve disorders are very common in patients with HIV infection, including inflammatory demyelinating polyneuropathies, such as Guillain-Barré syndrome. Causes of these neuropathies are probably multiple, and often dictated by the stage of the underlying HIV disease. Acute demyelinating polyneuropathy is usually preceded by infections, generally sustained by cytomegalovirus or Campylobacter jejuni, and a co-infection with HIV may represent the initial etiopathogenetic event leading to the neurological disorder. An extraordinary case report of a cytomegalovirus-associated Guillain-Barré syndrome occurred in one of our patients with advanced HIV infection, who was cured by gancyclovir and HAART administration, and gives us the opportunity to briefly discuss the intriguing pathogenetic and clinical correlations among HIV disease, cytomegalovirus infection, this neurological syndrome, and its specific treatment.
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Affiliation(s)
- L Calza
- Department of Clinical and Experimental Medicine, University of Bologna, S. Orsola Hospital, Italy.
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Kiefer R, Kieseier BC, Stoll G, Hartung HP. The role of macrophages in immune-mediated damage to the peripheral nervous system. Prog Neurobiol 2001; 64:109-27. [PMID: 11240209 DOI: 10.1016/s0301-0082(00)00060-5] [Citation(s) in RCA: 213] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Macrophage-mediated segmental demyelination is the pathological hallmark of autoimmune demyelinating polyneuropathies, including the demyelinating form of Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Macrophages serve a multitude of functions throughout the entire pathogenetic process of autoimmune neuropathy. Resident endoneurial macrophages are likely to act as local antigen-presenting cells by their capability to express major histocompatibility complex antigens and costimulatory B7-molecules, and may thus be critical in triggering the autoimmune process. Hematogenous infiltrating macrophages then find their way into the peripheral nerve together with T-cells by the concerted action of adhesion molecules, matrix metalloproteases and chemotactic signals. Within the nerve, macrophages regulate inflammation by secreting several pro-inflammatory cytokines including IL-1, IL-6, IL-12 and TNF-alpha. Autoantibodies are likely to guide macrophages towards their myelin or primarily axonal targets, which then attack in a complement-dependent and receptor-mediated manner. In addition, non-specific tissue damage occurs through the secretion of toxic mediators and cytokines. Later, macrophages contribute to the termination of inflammation by promoting T-cell apoptosis and expressing anti-inflammatory cytokines including TGF-beta1 and IL-10. During recovery, they are tightly involved in allowing Schwann cell proliferation, remyelination and axonal regeneration to proceed. Macrophages, thus, play dual roles in autoimmune neuropathy, being detrimental in attacking nervous tissue but also salutary, when aiding in the termination of the inflammatory process and the promotion of recovery.
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Affiliation(s)
- R Kiefer
- Department of Neurology, Westfälische Wilhelms-Universität, Albert-Schweitzer-Strasse 33, D-48129 Münster, Germany.
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Síndrome de Guillain-Barré como manifestación inicial de una leucemia mielomonocítica crónica. Med Clin (Barc) 2001. [DOI: 10.1016/s0025-7753(01)71988-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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