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Tasdemir V, Sirin NG, Cakar A, Culha A, Soysal A, Elmali AD, Gunduz A, Arslan B, Yalcin D, Atakli D, Orhan EK, Sanli E, Tuzun E, Gozke E, Gursoy E, Savrun FK, Uslu FI, Aysal F, Durmus H, Bulbul H, Ertas FI, Uluc K, Tutkavul K, Baysal L, Baslo MB, Kiziltan M, Mercan M, Pazarci N, Uzun N, Akan O, Cokar O, Koytak PK, Sürmeli R, Gunaydin S, Ayas S, Baslo SA, Yayla V, Yilmaz V, Parman Y, Matur Z, Acar ZU, Oge AE. Electrodiagnostic methods to verify Guillain-Barré syndrome subtypes in Istanbul: A prospective multicenter study. J Peripher Nerv Syst 2024; 29:72-81. [PMID: 38291679 DOI: 10.1111/jns.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND AIMS This study aimed to identify the clinical characteristics and electrodiagnostic subtypes of Guillain-Barré syndrome (GBS) in Istanbul. METHODS Patients with GBS were prospectively recruited between April 2019 and March 2022 and two electrodiagnostic examinations were performed on each patient. The criteria of Ho et al., Hadden et al., Rajabally et al., and Uncini et al. were compared for the differentiation of demyelinating and axonal subtypes, and their relations with anti-ganglioside antibodies were analyzed. RESULTS One hundred seventy-seven patients were included, 69 before the coronavirus disease 2019 pandemic (April 2019-February 2020) and 108 during the pandemic (March 2020-March 2022), without substantial changes in monthly frequencies. As compared with the criteria of Uncini et al., demyelinating GBS subtype diagnosis was more frequent according to the Ho et al. and Hadden et al. criteria (95/162, 58.6% vs. 110/174, 63.2% and 121/174, 69.5%, respectively), and less frequent according to Rajabally et al.'s criteria (76/174, 43.7%). Fourteen patients' diagnoses made using Rajabally et al.'s criteria were shifted to the other subtype with the second electrodiagnostic examination. Of the 106 analyzed patients, 22 had immunoglobulin G anti-ganglioside antibodies (14 with the axonal subtype). They had less frequent sensory symptoms (54.5% vs. 83.1%, p = 0.009), a more frequent history of previous gastroenteritis (54.5% vs. 22.9%, p = 0.007), and a more severe disease as compared with those without antibodies. INTERPRETATION Serial electrodiagnostic examinations are more helpful for accurate subtype diagnosis of GBS because of the dynamic pathophysiology of the disease. We observed no significant increase in GBS frequency during the pandemic in this metropolis.
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Affiliation(s)
- Volkan Tasdemir
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Arman Cakar
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Ayla Culha
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Aysun Soysal
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ayse Deniz Elmali
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Beyza Arslan
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Destina Yalcin
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Dilek Atakli
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Elif Sanli
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Erdem Tuzun
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Eren Gozke
- Fatih Sultan Mehmet Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Esra Gursoy
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Feray Karaali Savrun
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ferda Ilgen Uslu
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fikret Aysal
- Faculty of Medicine, Department of Neurology, Medipol University, Istanbul, Turkey
| | - Hacer Durmus
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Hafsa Bulbul
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - F Inci Ertas
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Kayihan Uluc
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kemal Tutkavul
- Haydarpaşa Numune Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Leyla Baysal
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Meral Kiziltan
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Metin Mercan
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Nevin Pazarci
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Nurten Uzun
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Onur Akan
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Cokar
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Pinar Kahraman Koytak
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Reyhan Sürmeli
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Sefer Gunaydin
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Selahattin Ayas
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezin Alpaydin Baslo
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Vildan Yayla
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Vuslat Yilmaz
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Yesim Parman
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Zeliha Matur
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeynep Unlusoy Acar
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ali Emre Oge
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
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Song Y, Zheng X, Fang Y, Liu S, Liu K, Zhu J, Wu X. Current status of Guillain-Barré syndrome (GBS) in China: a 10-year comprehensive overview. Rev Neurosci 2023; 34:869-897. [PMID: 37145885 DOI: 10.1515/revneuro-2023-0024] [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: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy; a disease involving the peripheral nervous system which is the most common cause of acute flaccid paralysis worldwide. So far, it is still lack of a comprehensive overview and understanding of the national epidemiological, clinical characteristics, and the risk factors of GBS in China, as well as differences between China and other countries and regions in these respects. With the global outbreak of the coronavirus disease 2019 (COVID-19), an epidemiological or phenotypic association between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and GBS has attracted great attention. In this review, we outlined the current clinical data of GBS in China by retrieving literature, extracting and synthesizing the data of GBS in China from 2010 to 2021. Besides, we compared the characteristics of epidemiology, preceding events and clinical profiles of GBS between China and other countries and regions. Furthermore, in addition to conventional intravenous immunoglobulin (IVIG) and plasma exchange (PE) therapy, the potential therapeutic effects with novel medications in GBS, such as complement inhibitors, etc., have become the research focus in treatments. We found that epidemiological and clinical findings of GBS in China are approximately consistent with those in the International GBS Outcome Study (IGOS) cohort. We provided an overall picture of the present clinical status of GBS in China and summarized the global research progress of GBS, aiming to further understand the characteristics of GBS and improve the future work of GBS worldwide, especially in countries with the middle and low incomes.
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Affiliation(s)
- Yanna Song
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road 600, 510000 Guangzhou, China
| | - Xiaoxiao Zheng
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Yong Fang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Shan Liu
- The Second Hospital of Jilin University, Jilin University, Ziqiang Street 218, 130022 Changchun, China
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, 17177 Solna, Stockholm, Sweden
| | - Xiujuan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Xinmin Street 1, 130021 Changchun, China
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Guillain-Barré syndrome in children - High occurrence of Miller Fisher syndrome in East Asian region. Brain Dev 2022; 44:715-724. [PMID: 35906115 DOI: 10.1016/j.braindev.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a rare acquired immune-mediated polyneuropathy. Updated population-based data concerning paediatric GBS is needed. METHODS Paediatric patients aged below 18 years diagnosed with GBS between 2009 and 2018 in all 11 paediatric departments in Hong Kong were identified from the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. The collected data from medical health records were reviewed by paediatric neurologist from each department. Estimated incidence of paediatric GBS was calculated. We also compared our findings with other paediatric GBS studies in Asia. RESULTS 63 subjects of paediatric GBS were identified, giving an estimated annual incidence of 0.62 per 100,000 population. Half of the subjects had acute inflammatory demyelinating polyneuropathy (AIDP) (n = 31; 49.2%), one quarter had Miller Fisher Syndrome (MFS) (n = 16; 25.4%), one-fifth had axonal types of GBS (n = 12; 19.0%), and four were unclassified. Paediatric subjects with axonal subtypes of GBS compared to the other 2 subtypes, had significantly higher intensive care unit (ICU) admission rates (p = 0.001) and longest length of stay (p = 0.009). With immunomodulating therapy, complete recovery was highest in those with MFS (100%), followed by AIDP (87.1%) and axonal GBS (75%). Our study also confirms a higher MFS rate for paediatric GBS in East Asia region and our study has the highest MFS rate (25.4%). CONCLUSION Our population-based 10-year paediatric GBS study provides updated evidence on estimated incidence, healthcare burden and motor outcome of each subtype of paediatric GBS and confirmed a higher occurrence of paediatric MFS in East Asia.
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Doets AY, Walgaard C, Lingsma HF, Islam B, Papri N, Yamagishi Y, Kusunoki S, Dimachkie MM, Waheed W, Kolb N, Gorson KC, Jacobs BC. International validation of the Erasmus GBS Respiratory Insufficiency Score. Ann Neurol 2022; 91:521-531. [PMID: 35106830 PMCID: PMC9306880 DOI: 10.1002/ana.26312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/25/2022]
Abstract
Objective This study aimed to validate the Erasmus Guillain–Barré Syndrome Respiratory Insufficiency Score in the International Guillain–Barré Syndrome Outcome Study cohort, and to improve its performance and region‐specificity. Methods We examined data from the first 1,500 included patients, aged ≥6 years and not ventilated prior to study entry. Patients with a clinical variant or mild symptoms were also included. Outcome was mechanical ventilation within the first week from study entry. Model performance was assessed regarding the discriminative ability (area under the receiver operating characteristic curve) and the calibration (observed vs predicted probability of mechanical ventilation), in the full cohort and in Europe/North America and Asia separately. We recalibrated the model to improve its performance and region‐specificity. Results In the group of 1,023 eligible patients (Europe/North America n = 842, Asia n = 104, other n = 77), 104 (10%) required mechanical ventilation within the first week from study entry. Area under the curve values were ≥0.80 for all validation subgroups. Mean observed proportions of mechanical ventilation were lower than predicted risks: full cohort 10% versus 21%, Europe/North America 9% versus 21%, and Asia 17% versus 23%. After recalibration, predicted risks for the full cohort and Europe/North America corresponded to observed proportions. Interpretation This prospective, international cohort study validated the Erasmus Guillain–Barré Syndrome Respiratory Insufficiency Score, and showed that the model can be used in the full spectrum of Guillain–Barré syndrome patients. In addition, a more accurate, region‐specific version of the model was developed for patients from Europe/North America. ANN NEUROL 2022;91:521–531
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Affiliation(s)
- Alex Y Doets
- Department of Neurology, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Christa Walgaard
- Department of Neurology, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Neurology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Badrul Islam
- Laboratory of Gut-Brain Signaling; Laboratory Sciences and Services Division (LSSD), icddr,b, GBP Box 128, 1000, Dhaka, Bangladesh
| | - Nowshin Papri
- Department of Neurology, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Laboratory of Gut-Brain Signaling; Laboratory Sciences and Services Division (LSSD), icddr,b, GBP Box 128, 1000, Dhaka, Bangladesh
| | - Yuko Yamagishi
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Centre, 3599 Rainbow Blvd, Mail Stop 2012, Kansas City, Kansas, 66160, US
| | - Waqar Waheed
- Department of Neurology, University of Vermont Medical Centre, 89 South William Street 05401, Burlington, USA
| | - Noah Kolb
- Department of Neurology, University of Vermont Medical Centre, 89 South William Street 05401, Burlington, USA
| | - Kenneth C Gorson
- Department of Neurology, St. Elizabeth's Medical Centre, Tufts University, School of Medicine, 736 Cambridge Street, 2135, Boston, USA
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Kakumoto T, Kobayashi S, Yuuki H, Kainaga M, Shirota Y, Hamada M, Hashimoto Maeda M, Kubota A, Kawai M, Saito M, Ishiura H, Toda T. Cranial Nerve Involvement and Dysautonomia in Post-COVID-19 Guillain-Barré Syndrome. Intern Med 2021; 60:3477-3480. [PMID: 34433712 PMCID: PMC8627825 DOI: 10.2169/internalmedicine.7355-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The clinical characteristics of Guillain-Barré syndrome (GBS) after coronavirus disease 2019 (COVID-19) remain unclear due to the small number of cases. We herein report a case of a Japanese patient with post-COVID-19 GBS who presented with facial and limb muscle weakness, sensory deficits, and autonomic dysfunction. Nerve conduction studies revealed demyelination. Head magnetic resonance imaging showed contrast enhancement in the bilateral facial nerves. Systemic management, including intubation, intravenous immunoglobulin therapy, and rehabilitation, improved the patient's condition. This was the first Japanese case of acute inflammatory demyelinating polyneuropathy after COVID-19 and was characterized by autonomic dysfunction and facial nerve enhancement.
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Affiliation(s)
- Toshiyuki Kakumoto
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Satoshi Kobayashi
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hayato Yuuki
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mitsuhiro Kainaga
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yuichiro Shirota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Meiko Hashimoto Maeda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mizuho Kawai
- Department of Neurology, Tokyo Kyosai Hospital, Japan
| | - Masaaki Saito
- Department of Neurology, Tokyo Kyosai Hospital, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
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Unclassified subtype of Guillain-Barré syndrome is associated with quick recovery. J Clin Neurosci 2021; 91:313-318. [PMID: 34373045 DOI: 10.1016/j.jocn.2021.07.025] [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: 02/02/2021] [Revised: 06/27/2021] [Accepted: 07/17/2021] [Indexed: 11/21/2022]
Abstract
Electrophysiological classification of Guillain-Barré syndrome (GBS) is important for predicting its clinical course; however, few reports discuss GBS patients who do not conform to the acute inflammatory demyelinating polyneuropathy (AIDP) or acute motor axonal neuropathy (AMAN) classifications. Therefore, the present study assessed the features of unclassified types of GBS and compared them to those of AIDP and AMAN. We compared clinical symptoms, nerve conduction, and laboratory data among patients with AIDP, AMAN, and unclassified subtypes of GBS, according to criteria developed by Rajabally, Hadden, and Ho. According to the Rajabally criteria, the F wave frequency in the upper and lower extremities was higher in the unclassified subgroup than in the AIDP and AMAN subgroups; however, according to the Hadden and Ho criteria, the F wave frequency in only the lower extremities was higher in the unclassified subgroup than in the other subgroups. The unclassified subgroup showed better prognosis using the Rajabally criteria. Classification with the Rajabally criteria is useful for predicting prognosis and determining treatment in patients with GBS. Moreover, unclassified patients exhibit the quickest recovery.
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7
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Alanazy MH, Bakry SS, Alqahtani A, AlAkeel NS, Alazwary N, Osman AM, Mustafa RA, Al-Harbi TM, Abdulmana SO, Amper AC, Aldughaythir Y, Ali AS, Makkawi S, Maglan A, Alamoudi L, Alsulaiman F, Alabdali M, AlShareef AA, Abuzinadah AR, Bamaga AK. Clinical features and outcome of Guillain-Barre syndrome in Saudi Arabia: a multicenter, retrospective study. BMC Neurol 2021; 21:275. [PMID: 34253174 PMCID: PMC8273933 DOI: 10.1186/s12883-021-02314-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/30/2021] [Indexed: 01/16/2023] Open
Abstract
Background Guillain–Barre syndrome (GBS) is an inflammatory polyradiculoneuropathy characterized by rapidly evolving weakness and areflexia, reaching nadir within 4 weeks. Data on the characteristic of GBS in Saudi Arabia are limited. This study aimed to describe the clinical, electrophysiological, and laboratory characteristics and outcome of a multicenter cohort of patients with GBS. Methods This is a retrospective multicenter nationwide study. Patients who had GBS, identified through Brighton Criteria, between January 2015 and December 2019 were included. Data collected included demographics, clinical features, cerebrospinal fluid profile, reported electrophysiological patterns, treatment, and outcome. Reported GBS subtypes were compared using chi-square, Fisher's exact, or Mann–Whitney U tests, as appropriate. Results A total of 156 patients with GBS were included (men, 61.5%), with a median age of 38 (interquartile range, 26.25–53.5) years. The most commonly reported antecedent illnesses were upper respiratory tract infection (39.1%) and diarrhea (27.8%). All but two patients (98.7%) had weakness, 64.1% had sensory symptoms, 43.1% had facial diplegia, 33.8% had oropharyngeal weakness, 12.4% had ophthalmoplegia, and 26.3% needed mechanical ventilation. Cytoalbuminological dissociation was observed in 69.1% of the patients. GBS-specific therapy was administered in 96.8% of the patients, of whom 88.1% had intravenous immunoglobulin, and 11.9% had plasmapheresis. Approximately half of the patients were able to walk independently within 9 months after discharge, and a third regained the ability to walk independently thereafter. Death of one patient was caused by septicemia. Acute inflammatory demyelinating polyradiculoneuropathy was the most commonly reported GBS subtype (37.7%), followed by acute motor axonal neuropathy (29.5%), and acute motor-sensory axonal neuropathy (19.2%). Conclusion The clinical and laboratory characteristics and outcome of GBS in the Arab population of Saudi Arabia are similar to the international cohorts. The overall prognosis is favorable.
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Affiliation(s)
- Mohammed H Alanazy
- Division of Neurology, Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Sawsan S Bakry
- Division of Neurology, Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afnan Alqahtani
- Division of Neurology, Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Norah S AlAkeel
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Naael Alazwary
- Department of Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Afag M Osman
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rania A Mustafa
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Talal M Al-Harbi
- Neurology Department, Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Sameeh O Abdulmana
- Neurology Department, Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Aimee C Amper
- Neurology Department, Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Yousef Aldughaythir
- Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman S Ali
- Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Alaa Maglan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Loujen Alamoudi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Feras Alsulaiman
- Department of Neurology, King Fahad Hospital of the University, Imam Abdulrhman Bin Faisal University, Dammam, Saudi Arabia
| | - Majed Alabdali
- Department of Neurology, King Fahad Hospital of the University, Imam Abdulrhman Bin Faisal University, Dammam, Saudi Arabia
| | - Aysha A AlShareef
- Internal Medicine Department, Neurology Division, Neuromuscular Medicine Unit, Faculty of Medicine and King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad R Abuzinadah
- Internal Medicine Department, Neurology Division, Neuromuscular Medicine Unit, Faculty of Medicine and King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed K Bamaga
- Pediatric department, Neuromuscular Medicine Unit, Faculty of Medicine and King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
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Ismail H, Malek E, Saroufim L, Salameh J. Characteristics of Guillain-Barré syndrome in a Lebanese tertiary care center. Neuromuscul Disord 2021; 31:765-768. [PMID: 34238653 DOI: 10.1016/j.nmd.2021.05.012] [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: 01/29/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
Guillain-Barré Syndrome (GBS) is a group of acute inflammatory disorders that share a clinical presentation of progressive polyradiculo-neuropathy. Data on GBS in the Middle East and Lebanon are scarce; hence, we explored the characteristics of patients presenting with GBS to a tertiary care center in Beirut, Lebanon. This was a single-centered retrospective study over a 12-year period. We reviewed the charts of patients presenting with GBS to the American University of Beirut medical center and examined their presentation, management and outcome. 61 patients were included, with the majority being males. 59% of the patients reported an infection prior to admission. 77% had sensory and motor symptoms and 69% were diagnosed with acute inflammatory demyelinating polyneuropathy (AIDP). 57% of patients had initial symptoms in the lower extremities, 25% experienced cranial neuropathies, and 26% complained of pain. 77% were managed by intravenous immunoglobulin with a median hospital stay of 6.5 days. AIDP was noted to be the most prevalent GBS variant in Lebanon. More than 50% had an unfavorable outcome at discharge, which raises the need for better treatment and management approaches.
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Affiliation(s)
- Helen Ismail
- Department of neurology, American university of Beirut medical center, Hamra, Cairo street, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Elia Malek
- Department of neurology, American university of Beirut medical center, Hamra, Cairo street, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Lea Saroufim
- Faculty of Science, McGill university, Montreal, Quebec H3A 0G4, Canada
| | - Johnny Salameh
- Department of neurology, American university of Beirut medical center, Hamra, Cairo street, P.O. Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
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9
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Song Y, Zhang Y, Yuki N, Wakerley BR, Liu C, Song J, Wang M, Feng X, Hao Y, Wang Y. Guillain-Barré syndrome in Eastern China: A study of 595 patients. Eur J Neurol 2021; 28:2727-2735. [PMID: 33949041 DOI: 10.1111/ene.14898] [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: 01/15/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate geographical differences in the clinical features of Guillain-Barré syndrome (GBS) between patients from our region in Eastern China and patients from other areas. METHODS A total of 595 patients fulfilling the diagnostic criteria for GBS or its variants were included from two large hospitals located in Eastern China. Data collection included demographics, antecedent events, clinical presentation and signs, electrophysiological subtypes, treatment, complications during hospitalization, clinical severity at nadir, and outcome at 12 months, and these data were compared to data from a study conducted in Southern China and the Europe/Americas section of the International GBS Outcome Study. RESULTS The median (interquartile range) age of patients was 50 (36-61) years, the ratio of men to women was 1.2, and 49% of patients had antecedent events. Patients in our region of Eastern China had pure motor predominant GBS (158/340, 46%) and 30% (103/340) had complications during hospitalization. Patients aged over 60 years had a lower frequency of antecedent infections and single, axonal subtypes, but higher disability scores at entry, nadir, and 12 months. When compared with the Europe/Americas data, our patients had a lower frequency of antecedent infection (46% vs. 63%), cranial nerve involvement (43% vs. 49%), sensory deficits (45% vs. 69%), pain (19% vs. 57%) and mechanical ventilation (11% vs. 17%), but a higher frequency of axonal subtype (35% vs. 6%). There was a higher frequency of patients with antecedent gastroenteritis (16% vs. 8%), mechanical ventilation (11% vs. 8%) and axonal subtypes (35% vs. 19%) in our region in Eastern China than in Southern China. CONCLUSIONS Patients with GBS in Eastern China showed significant clinical heterogeneity and differences when compared to other geographic areas.
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Affiliation(s)
- Yan Song
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yong Zhang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Nobuhiro Yuki
- Department of Neurology, Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | | | - Chen Liu
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Jin Song
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Min Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xungang Feng
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yanlei Hao
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China.,Medical Research Centre, Affiliated Hospital of Jining Medical University, Jining, China
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10
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Papri N, Islam Z, Leonhard SE, Mohammad QD, Endtz HP, Jacobs BC. Guillain-Barré syndrome in low-income and middle-income countries: challenges and prospects. Nat Rev Neurol 2021; 17:285-296. [PMID: 33649531 PMCID: PMC7920001 DOI: 10.1038/s41582-021-00467-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
The epidemiology, clinical characteristics, management and outcome of Guillain-Barré syndrome (GBS) differ between low-income and middle-income countries (LMIC) and high-income countries (HIC). At present, limited data are available on GBS in LMIC and the true incidence of GBS in many LMIC remains unknown. Increased understanding of GBS in LMIC is needed because poor hygiene and high exposure to infections render populations in LMIC vulnerable to GBS outbreaks. Furthermore, insufficient diagnostic and health-care facilities in LMIC contribute to delayed diagnosis in patients with severe presentations of GBS. In addition, the lack of national clinical guidelines and absence of affordable, effective treatments contribute to worse outcomes and higher mortality in LMIC than HIC. Systematic population-based surveillance studies, cohort and case-control studies are required to understand the incidence and risk factors for GBS. Novel, targeted and cost-effective treatment strategies need to be developed in the context of health system challenges in LMIC. To ensure integrative rehabilitation services in LMIC, existing prognostic models must be validated, and responsive outcome measures that are cross-culturally applicable must be developed. Therefore, fundamental and applied research to improve the clinical management of GBS in LMIC should become a critical focus of future research programmes.
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Affiliation(s)
- Nowshin Papri
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh ,grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Zhahirul Islam
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sonja E. Leonhard
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Quazi D. Mohammad
- grid.489064.7National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hubert P. Endtz
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.434215.50000 0001 2106 3244Fondation Mérieux, Lyon, France
| | - Bart C. Jacobs
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.5645.2000000040459992XDepartment of Immunology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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11
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Alborzian Deh Sheikh A, Gomaa S, Li X, Routledge M, Saigoh K, Numoto N, Angata T, Hitomi Y, Takematsu H, Tsuiji M, Ito N, Kusunoki S, Tsubata T. A Guillain-Barré syndrome-associated SIGLEC10 rare variant impairs its recognition of gangliosides. J Autoimmun 2020; 116:102571. [PMID: 33223341 DOI: 10.1016/j.jaut.2020.102571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 01/05/2023]
Abstract
Guillain-Barré syndrome (GBS), including its variant Miller Fisher syndrome (MFS), is an acute peripheral neuropathy that involves autoimmune mechanisms leading to the production of autoantibodies to gangliosides; sialic acid-containing glycosphingolipids. Although association with various genetic polymorphisms in the major histocompatibility complex (MHC) is shown in other autoimmune diseases, GBS is an exception, showing no such link. No significant association was found by genome wide association studies, suggesting that GBS is not associated with common variants. To address the involvement of rare variants in GBS, we analyzed Siglec-10, a sialic acid-recognizing inhibitory receptor expressed on B cells. Here we demonstrate that two rare variants encoding R47Q and A108V substitutions in the ligand-binding domain are significantly accumulated in patients with GBS. Because of strong linkage disequilibrium, there was no patient carrying only one of them. Recombinant Siglec-10 protein containing R47Q but not A108V shows impaired binding to gangliosides. Homology modeling revealed that the R47Q substitution causes marked alteration in the ligand-binding site. Thus, GBS is associated with a rare variant of the SIGLEC10 gene that impairs ligand binding of Siglec-10. Because Siglec-10 regulates antibody production to sialylated antigens, our finding suggests that Siglec-10 regulates development of GBS by suppressing antibody production to gangliosides, with defects in its function predisposing to disease.
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Affiliation(s)
- Amin Alborzian Deh Sheikh
- Department of Immunology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soha Gomaa
- Department of Immunology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan; Division of Immunology and Biotechnology, Faculty of Science, Tanta University, Tanta, Egypt
| | - Xuexin Li
- Department of Immunology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Matthew Routledge
- Department of Immunology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazumasa Saigoh
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Nobutaka Numoto
- Department of Structural Biology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Angata
- Institute of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yuki Hitomi
- Department of Microbiology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Tokyo, Japan
| | - Hiromu Takematsu
- Faculty of Medical Technology, Fujita Health University, Toyoake, Aichi, Japan
| | - Makoto Tsuiji
- Department of Microbiology, Hoshi University School of Pharmacy and Pharmaceutical Sciences, Tokyo, Japan
| | - Nobutoshi Ito
- Department of Structural Biology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Kusunoki
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Takeshi Tsubata
- Department of Immunology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
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12
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Yang MC, Liu A. Surge of Miller Fisher variant and Guillain-Barré syndrome in two downtown Los Angeles community teaching hospitals. Clin Case Rep 2020; 8:2245-2250. [PMID: 33235769 PMCID: PMC7669403 DOI: 10.1002/ccr3.3132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022] Open
Abstract
Guillain-Barré syndrome (GBS) and Miller Fisher variant (MFv) cases spiked threefold in Los Angeles, with a high proportion of MFv cases. MFv is underdiagnosed when accompanying neurological symptoms are mild. This report emphasizes the seasonality of GBS and its relation to ganglioside antibodies.
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Affiliation(s)
- Michael C. Yang
- Department of Internal MedicineAdventist Health White MemorialLos AngelesCAUSA
| | - Antonio Liu
- Department of NeurologyAdventist Health White MemorialLos AngelesCAUSA
- Department of NeurologyCalifornia Hospital Medical CenterLos AngelesCAUSA
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13
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Hao Y, Wang W, Jacobs BC, Qiao B, Chen M, Liu D, Feng X, Wang Y. Antecedent infections in Guillain-Barré syndrome: a single-center, prospective study. Ann Clin Transl Neurol 2019; 6:2510-2517. [PMID: 31714025 PMCID: PMC6917331 DOI: 10.1002/acn3.50946] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the spectrum of antecedent infections in Chinese patients with Guillain-Barré syndrome (GBS) and analyze the infections-related clinical phenotypes locally. METHODS A prospective case-control study of 150 patients diagnosed with GBS and age- and sex-matched neurological and healthy controls was performed to investigate recent infections of 14 pathogens serologically and collect the clinical data during a follow-up of 12 months. RESULTS In total, 53% of patients with GBS had a positive serology for recent infection, including Campylobacter jejuni (27%), influenza A (17%) and B (16%), hepatitis A virus (5%), dengue virus (3%), cytomegalovirus (3%), Epstein-Barr virus (3%), Mycoplasma pneumoniae (2%), herpes simplex virus (2%), varicella-zoster virus (1%), and rubella virus (1%). Serology for infections of hepatitis E virus, Haemophilus influenzae, and Zika virus was negative. There was a higher frequency of C. jejuni, influenza A, influenza B, and hepatitis A virus infections in GBS patients than both the neurological and healthy controls. C. jejuni infection was more frequent in younger GBS patients and was associated with antibodies against GM1, GalNAc-GD1a, and GM1:galactocerebroside complex. Influenza B infection was associated with a pure motor form of GBS. INTERPRETATION C. jejuni, influenza A, influenza B, and hepatitis A virus serve as the most common cause of antecedent infections in GBS locally. Influenza B-related GBS may represent a pure motor phenotype. Differences in the infectious spectrum worldwide may contribute to the geographical clinical heterogeneity of GBS.
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Affiliation(s)
- Yanlei Hao
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Weifang Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Baojun Qiao
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Mengshi Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Daiqiang Liu
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Xungang Feng
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China.,Central Laboratory, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
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14
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Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, van Doorn PA, Dourado ME, Hughes RAC, Islam B, Kusunoki S, Pardo CA, Reisin R, Sejvar JJ, Shahrizaila N, Soares C, Umapathi T, Wang Y, Yiu EM, Willison HJ, Jacobs BC. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019; 15:671-683. [PMID: 31541214 PMCID: PMC6821638 DOI: 10.1038/s41582-019-0250-9] [Citation(s) in RCA: 412] [Impact Index Per Article: 82.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Abstract
Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
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Affiliation(s)
- Sonja E Leonhard
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Melissa R Mandarakas
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Francisco A A Gondim
- Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Kathleen Bateman
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Maria L B Ferreira
- Department of Neurology, Hospital da Restauração, Recife, Pernambuco, Brazil
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mario E Dourado
- Department of Integrative Medicine, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Richard A C Hughes
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Badrul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - James J Sejvar
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Cristiane Soares
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | | | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Eppie M Yiu
- Department of Neurology, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
- Neurosciences Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Hugh J Willison
- College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands.
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.
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15
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Doets AY, Verboon C, van den Berg B, Harbo T, Cornblath DR, Willison HJ, Islam Z, Attarian S, Barroso FA, Bateman K, Benedetti L, van den Bergh P, Casasnovas C, Cavaletti G, Chavada G, Claeys KG, Dardiotis E, Davidson A, van Doorn PA, Feasby TE, Galassi G, Gorson KC, Hartung HP, Hsieh ST, Hughes RAC, Illa I, Islam B, Kusunoki S, Kuwabara S, Lehmann HC, Miller JAL, Mohammad QD, Monges S, Nobile Orazio E, Pardo J, Pereon Y, Rinaldi S, Querol L, Reddel SW, Reisin RC, Shahrizaila N, Sindrup SH, Waqar W, Jacobs BC. Regional variation of Guillain-Barré syndrome. Brain 2019; 141:2866-2877. [PMID: 30247567 DOI: 10.1093/brain/awy232] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/23/2018] [Indexed: 12/24/2022] Open
Abstract
Guillain-Barré syndrome is a heterogeneous disorder regarding the clinical presentation, electrophysiological subtype and outcome. Previous single country reports indicate that Guillain-Barré syndrome may differ among regions, but no systematic comparative studies have been conducted. Comparative studies are required to identify factors determining disease susceptibility, variation and prognosis, and to improve diagnostic criteria. The International Guillain-Barré Syndrome Outcome Study is a prospective, observational cohort study including all patients within the diagnostic spectrum, aiming to describe the heterogeneity of Guillain-Barré syndrome worldwide. The current study was based on the first 1000 inclusions with a follow-up of at least 1 year and confirmed the variation in clinical presentation, course and outcome between patients. The full clinical spectrum of Guillain-Barré syndrome was observed in patients from all countries participating in the International Guillain-Barré Syndrome Outcome Study, but the frequency of variants differed between regions. We compared three regions based on geography, income and previous reports of Guillain-Barré syndrome subtypes: 'Europe/Americas', 'Asia' (without Bangladesh), and 'Bangladesh'. We excluded 75 (8%) patients because of alternative diagnoses, protocol violations, or missing data. The predominant clinical variant was sensorimotor in Europe/Americas (n = 387/562, 69%) and Asia (n = 27/63, 43%), and pure motor in Bangladesh (n = 74/107, 69%). Miller Fisher syndrome and Miller Fisher-Guillain-Barré overlap syndrome were more common in Asia (n = 14/63, 22%) than in the other two regions (Europe/Americas: n = 64/562, 11%; Bangladesh: n = 1/107, 1%) (P < 0.001). The predominant electrophysiological subtype was demyelinating in all regions (Europe/Americas: n = 312/573, 55%; Asia: n = 29/65, 45%; Bangladesh: n = 38/94, 40%). The axonal subtype occurred more often in Bangladesh (n = 34/94, 36%) than in Europe/Americas (n = 33/573, 6%) and other Asian countries (n = 4/65, 6%) (P < 0.001). In all regions, patients with the axonal subtype were younger, had fewer sensory deficits, and showed a trend towards poorer recovery compared to patients with the demyelinating subtype. The proportion of patients able to walk unaided after 1 year varied between Asia (n = 31/34, 91%), Europe/Americas (n = 334/404, 83%) and Bangladesh (n = 67/97, 69%) (P = 0.003). A similar variation was seen for mortality, being higher in Bangladesh (n = 19/114, 17%) than in Europe/Americas (n = 23/486, 5%) and Asia (n = 1/45, 2%) (P < 0.001). This study showed that factors related to geography have a major influence on clinical phenotype, disease severity, electrophysiological subtype, and outcome of Guillain-Barré syndrome.
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Affiliation(s)
- Alex Y Doets
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Christine Verboon
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Bianca van den Berg
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Nörrebrogade 44, 8000, Aarhus, Denmark
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University, 733 North Broadway, 21205 MD, Baltimore, USA
| | - Hugh J Willison
- Department of Neurology, University of Glasgow, University Avenue, G12 8QQ, Glasgow, UK
| | - Zhahirul Islam
- Department of Laboratory Sciences and Services Division, The International Centre for Diarrhoeal Disease Research, GBP Box 128, 1000, Dhaka, Bangladesh
| | - Shahram Attarian
- Department of Neurology, CHU Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Fabio A Barroso
- Department of Neurology, Instituto de Investigaciones Neurológicas Raúl Carrea, FLENI, Montañeses 2325, Buenos Aires, Argentina
| | - Kathleen Bateman
- Department of Neurology, Groote Schuur Hospital, University of Cape Town, Main Road, Observatory 7925, Cape Town, South Africa
| | - Luana Benedetti
- Department of Neurology, Ospedale Sant' Andrea La Spezia, Via Vittorio Veneto 197, 19121 SP, La Spezia, Italy
| | - Peter van den Bergh
- Department of Neurology, University Hospital St. Luc, University of Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Carlos Casasnovas
- Department of Neurology, Bellvitge University Hospital, Carrer de la Feixa Llarga 8907, Barcelona, Spain
| | - Guido Cavaletti
- Department of Neurology, University Milano-Bicocca, Via Cadore 48, 20900 MB, Monza, Italy
| | - Govindsinh Chavada
- Department of Neurology, University of Glasgow, University Avenue, G12 8QQ, Glasgow, UK
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, POB 1425, 41110, Larissa, Greece
| | - Amy Davidson
- Department of Neurology, University of Glasgow, University Avenue, G12 8QQ, Glasgow, UK
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Tom E Feasby
- Department of Clinical Neurosciences, University of Calgary, 2500 University Drive NW, T2N 1N4, Calgary, Canada
| | - Giuliana Galassi
- Department of Neurology, University Hospital of Modena, Via P. Giardini 1455, 41126, Modena, Italy
| | - Kenneth C Gorson
- Department of Neurology, Tufts University School of Medicine, 736 Cambridge Street, 2135, Boston, USA
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty and Center of Neurology and Neuropsychiatry, Heinrich-Heine-University Düsseldorf, Moorenstrasse 1, 40225, Düsseldorf, Germany
| | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, 7 Chung-Shan S Road, 10002, Taipei City, Taiwan
| | - Richard A C Hughes
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG, London, UK
| | - Isabel Illa
- Department of Neurology, Hospital de la Santa Creu I Santa Pau, C/Sant Antoni M. Claret 167, 8025, Barcelona, Spain
| | - Badrul Islam
- Department of Laboratory Sciences and Services Division, The International Centre for Diarrhoeal Disease Research, GBP Box 128, 1000, Dhaka, Bangladesh
| | - Susumu Kusunoki
- Department of Neurology, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Chiba University, 1-8-1 Inohana, Chuo-ku, 260-8670, Chiba, Japan
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Kerpenerstrasse 62, 50937, Cologne, Germany
| | - James A L Miller
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, NE1 4LP, Newcastle, UK
| | - Quazi Deen Mohammad
- National Institute of Neuroscience and Hospital, Sher-E-Bangla Nagar, 1207, Dhaka, Bangladesh
| | - Soledad Monges
- Department of Neurology, Hospital de Pediatría J.P. Garrahan, Combate de los Pozos 1881, 1245, Buenos Aires, Argentina
| | - Eduardo Nobile Orazio
- Department of Neurology, Milan University, Via Manzoni 56, 20089, Rozzano, MI, Milan, Italy
| | - Julio Pardo
- Department of Neurology, Hospital Clínico de Santiago, Travesia Choupana, S/N 15706, Santiago de Compostela (A Coruña), Spain
| | - Yann Pereon
- Department of Clinical Neurophysiology, Reference centre for NMD, CHU Nantes, Place Alexis-Ricordeau, 44093, Nantes, France
| | - Simon Rinaldi
- Department of Clinical Neurosciences, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Headly Way, Headington, OX3 9DU, Oxford, UK
| | - Luis Querol
- Department of Neurology, Hospital de la Santa Creu I Santa Pau, C/Sant Antoni M. Claret 167, 8025, Barcelona, Spain
| | - Stephen W Reddel
- Department of Neurology, Concord Hospital, Hospital Road, 2139, Sydney NSW, Australia
| | - Ricardo C Reisin
- Department of Neurology, Hospital Británico, Perdriel 74, 1280, Buenos Aires, Argentina
| | - Nortina Shahrizaila
- Department of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
| | - Soren H Sindrup
- Department of Neurology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Waheed Waqar
- Department of Neurology, University of Vermont, 89 South William Street 5401, Burlington, USA
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Immunology, Erasmus University Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Yamana M, Kuwahara M, Fukumoto Y, Yoshikawa K, Takada K, Kusunoki S. Guillain-Barré syndrome and related diseases after influenza virus infection. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e575. [PMID: 31355311 PMCID: PMC6624088 DOI: 10.1212/nxi.0000000000000575] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/05/2019] [Indexed: 01/01/2023]
Abstract
Objective We examined the clinical and serologic features of Guillain-Barré syndrome (GBS)-related diseases (GBSRDs), including GBS, Fisher syndrome (FS), and Bickerstaff brainstem encephalitis (BBE), after influenza virus infection (GBSRD-I) to reveal potential underlying autoimmune mechanisms. Methods We retrospectively investigated the presence of antiglycolipid antibodies against 11 glycolipids and the clinical features of 63 patients with GBSRD-I. Autoantibody profiles and clinical features were compared with those of 82 patients with GBSRDs after Campylobacter jejuni infection (GBSRD-C). Results The anti-GQ1b seropositivity rate was significantly higher, whereas the GM1 and GD1a seropositivity rates were significantly lower in GBSRD-I compared with GBSRD-C. Anti-GQ1b and anti-GT1a were the most frequently detected antiglycolipid antibodies in GBSRD-I (both 15/63, 24%). Consequently, FS was more frequent in GBSRD-I than GBSRD-C (22% vs 9%, p < 0.05). In addition, as for GBS, cranial nerve deficits, sensory disturbances, and ataxia were more frequent in the cases after influenza infection (GBS-I) than in those after C. jejuni infection (GBS-C) (46% vs 15%, 75% vs 46%, and 29% vs 4%, respectively; all p < 0.01). Nerve conduction studies revealed acute inflammatory demyelinating polyneuropathy (AIDP) in 60% of patients with GBS-I but only 25% of patients with GBS-C (p < 0.01). Conclusions Anti-GQ1b antibodies are the most frequently detected antibodies in GBSRD-I. Compared with GBS-C, GBS-I is characterized by AIDP predominance and frequent presence of cranial nerve involvement and ataxia.
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Affiliation(s)
- Masaki Yamana
- Department of Neurology (M.Y., M.K., Y.F., K.Y., K.T., S.K.), Kindai University Faculty of Medicine; and Department of Neurology (K.T.), Shinjinkai Hospital, Osaka, Japan
| | - Motoi Kuwahara
- Department of Neurology (M.Y., M.K., Y.F., K.Y., K.T., S.K.), Kindai University Faculty of Medicine; and Department of Neurology (K.T.), Shinjinkai Hospital, Osaka, Japan
| | - Yuta Fukumoto
- Department of Neurology (M.Y., M.K., Y.F., K.Y., K.T., S.K.), Kindai University Faculty of Medicine; and Department of Neurology (K.T.), Shinjinkai Hospital, Osaka, Japan
| | - Keisuke Yoshikawa
- Department of Neurology (M.Y., M.K., Y.F., K.Y., K.T., S.K.), Kindai University Faculty of Medicine; and Department of Neurology (K.T.), Shinjinkai Hospital, Osaka, Japan
| | - Kazuo Takada
- Department of Neurology (M.Y., M.K., Y.F., K.Y., K.T., S.K.), Kindai University Faculty of Medicine; and Department of Neurology (K.T.), Shinjinkai Hospital, Osaka, Japan
| | - Susumu Kusunoki
- Department of Neurology (M.Y., M.K., Y.F., K.Y., K.T., S.K.), Kindai University Faculty of Medicine; and Department of Neurology (K.T.), Shinjinkai Hospital, Osaka, Japan
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Kondo A, Yamaguchi H, Ishida Y, Toyoshima D, Azumi M, Akutsu N, Koyama J, Kurosawa H, Kawamura A, Maruyama A. Spontaneous spinal epidural hematoma mimicking Guillain-Barre Syndrome. Brain Dev 2019; 41:392-395. [PMID: 30471873 DOI: 10.1016/j.braindev.2018.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/23/2018] [Accepted: 11/06/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS. CASE REPORT A previously healthy 6-year-old girl presented with a 2-day history of progressive pain in the lower extremities and an inability to walk. On initial evaluation, she was completely paraparetic in the lower extremities. Deep tendon reflexes were absent in the lower extremities, and Babinski reflexes were positive on both sides. She exhibited reduced response to light touch and pinprick with a sensory level below T10, and experienced difficulty during urination. However, the strength, sensation and flexion of upper extremities were normal. Because her presentation and examinations were consistent with GBS, we initiated intravenous immunoglobulin therapy. The next day, she also developed pain and muscle weakness of the right upper extremity. Three days after admission, respiratory depression progressed rapidly. Spinal MRI showed a mass extending from the level of C7-T3, with spinal cord compression. The patient underwent an emergency laminectomy with evacuation of hematoma, and was diagnosed with SSEH. Sixty days after admission, she was transferred to the rehabilitation hospital with severe neurologic sequelae of paralysis in both legs. CONCLUSION SSEH might have severe consequences, including neurologic deficits and risk of death. This case report serves to raise the awareness of SSEH that mimics the initial presentation of GBS.
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Affiliation(s)
- Aya Kondo
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Yamaguchi
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Daisaku Toyoshima
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Mai Azumi
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Nobuyuki Akutsu
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Junji Koyama
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Kurosawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Atushi Kawamura
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
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18
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Gümüşyayla Ş, Vural G, Yurtoğulları Çevik Ş, Akdeniz G, Neselioğlu S, Deniz O, Erel Ö. Dynamic thiol-disulphide homeostasis in patients with Guillain-Barre Syndrome. Neurol Res 2019; 41:413-418. [PMID: 30730791 DOI: 10.1080/01616412.2019.1573955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate dynamic thiol-disulphide homeostasis as a novel oxidative stress parameter in patients with Guillain-Barre syndrome (GBS). METHODS A total of 130 participants were included in this study, 70 of whom were diagnosed with GBS. Total thiol (-SH+-S-S-) and native thiol (-SH) levels in serum were measured in all patients and healthy individuals. Amount of dynamic disulphide bond were calculated from these values. In the GBS patients, disability status was determined by the Hughes and Medical Research Center (MRC) sum scores at the time of admission and 3 months thereafter. RESULTS Total and native thiol levels were significantly lower in patients with GBS compared with healthy individuals. There was no statistically significant difference in the number of dynamic disulphide bonds between groups. There was a negative correlation between total thiol levels in patients with GBS and Hughes scores at month 3. DISCUSSION Oxidative stress is among the molecular changes underlying the pathogenesis of GBS. In this study, we have investigated the dynamic thiol-disulfide homeostasis in patients with epilepsy using a new method in the literature. Also, functional recovery in Guillain-Barré syndrome patients could be promoted by increasing antioxidant activity.
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Affiliation(s)
- Şadiye Gümüşyayla
- a Faculty of Medicine, Department of Neurology , Ankara Yildirim Beyazit University , Ankara , Turkey
| | - Gönül Vural
- a Faculty of Medicine, Department of Neurology , Ankara Yildirim Beyazit University , Ankara , Turkey
| | | | - Gülsüm Akdeniz
- c Faculty of Medicine, Department of Biopysic , Ankara Yildirim Beyazit University , Ankara , Turkey
| | - Salim Neselioğlu
- d Faculty of Medicine, Department of Biochemistry , Ankara Yildirim Beyazit University , Ankara , Turkey
| | - Orhan Deniz
- a Faculty of Medicine, Department of Neurology , Ankara Yildirim Beyazit University , Ankara , Turkey
| | - Özcan Erel
- d Faculty of Medicine, Department of Biochemistry , Ankara Yildirim Beyazit University , Ankara , Turkey
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Park SJ, Kim JK, Kim HH, Yoon BA, Ji DY, Lee CW, Kim HJ, Kim KH, Shin HY, Park SJ, Lee DY. Integrative metabolomics reveals unique metabolic traits in Guillain-Barré Syndrome and its variants. Sci Rep 2019; 9:1077. [PMID: 30705347 PMCID: PMC6355784 DOI: 10.1038/s41598-018-37572-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute fatal progressive disease caused by autoimmune mechanism mainly affecting peripheral nervous system. Although the syndrome is clinically sub-classified into several variants, specific biomarker and exact pathomechanism of each subtypes are not well elucidated yet. In current study, integrative metabolomic and lipidomic profiles were acquisitioned from cerebrospinal fluid samples of 86 GBS from three variants and 20 disease controls. And the data were systematically compared to our previous result on inflammatory demyelination disorders of central nervous system (IDDs) and healthy controls. Primary metabolite profiles revealed unique metabolic traits in which 9 and 7 compounds were specifically changed in GBS and IDD, respectively. Next, the biomarker panel with 10 primary metabolites showed a fairly good discrimination power among 3 GBS subtypes, healthy controls, and disease controls (AUCs ranged 0.849-0.999). The robustness of the biomarker panel was vigorously validated by multi-step statistical evaluation. Subsequent lipidomics revealed GBS variant-specific alteration where the significant elevations of lyso-phosphatidylcholines and sphingomyelins were unique to AIDP (acute inflammatory demyelinating polyneuropathy) and AMAN (acute motor axonal neuropathy), respectively. And metabolome-wide multivariate correlation analysis identified potential clinical association between GBS disability scale (Hughes score) and CSF lipids (monoacylglycerols, and sphingomyelins). Finally, Bayesian network analysis of covarianced structures of primary metabolites and lipids proposed metabolic hub and potential biochemical linkage associated with the pathology.
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Affiliation(s)
- Soo Jin Park
- The Department of Bio and Fermentation Convergence Technology, BK21 PLUS Program, Kookmin University, Seoul, 02707, Republic of Korea
| | - Jong Kuk Kim
- Department of Neurology, Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, 49315, Republic of Korea
| | - Hyun-Hwi Kim
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, 21936, Republic of Korea
| | - Byeol-A Yoon
- Department of Neurology, Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, 49315, Republic of Korea
| | - Dong Yoon Ji
- The Department of Bio and Fermentation Convergence Technology, BK21 PLUS Program, Kookmin University, Seoul, 02707, Republic of Korea
| | - Chang-Wan Lee
- The Department of Bio and Fermentation Convergence Technology, BK21 PLUS Program, Kookmin University, Seoul, 02707, Republic of Korea
| | - Ho Jin Kim
- The Department of Neurology, Research Institute and Hospital of the National Cancer Center, Goyang, Republic of Korea
| | - Kyoung Heon Kim
- The Department of Biotechnology, Graduate School, Korea University, Seoul, Republic of Korea
| | - Ha Young Shin
- Department of Neurology, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jean Park
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, 21936, Republic of Korea.
| | - Do Yup Lee
- The Department of Bio and Fermentation Convergence Technology, BK21 PLUS Program, Kookmin University, Seoul, 02707, Republic of Korea.
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Guillain–Barré syndrome subtypes: A clinical electrophysiological study of 100 patients. Rev Neurol (Paris) 2019; 175:73-80. [DOI: 10.1016/j.neurol.2018.01.379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/22/2022]
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Bazaraa HM, Rady HI, Mohamed SA, Rabie WA, ElAnwar NH. Initial Response and Outcome of Critically Ill Children With Guillain Barre' Syndrome. Front Pediatr 2019; 7:378. [PMID: 31620410 PMCID: PMC6759753 DOI: 10.3389/fped.2019.00378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Guillain-Barre syndrome is the most common cause of acute flaccid paralysis worldwide since the eradication of poliomyelitis. Severe cases may require intensive care and mechanical ventilation. Purpose: was to study pediatric patients with severe GBS requiring intensive care unit (ICU) admission, to assess their course and response to initial treatment modality plasma exchange (PE) or intravenous immunoglobulins (IVIg) and their final outcome. Methods: children with severe GBS who had either actual or impending respiratory failure, bulbar involvement or rapid progression of acute flaccid paralysis with trunk, upper limb and neck involvement within 24 h of the onset of weakness were enrolled. Results: 40 children were included. Following the initial treatment (33 subjects had 5 PE sessions each and IVIg in 7), 16 patients improved (40%), two died and 22 (55%) showed initial treatment failure. Axonal neuropathy, rapid progression and severe motor weakness significantly predicted poor response to therapy. At discharge, favorable outcomes (patient can walk unaided) were present in 22 cases (58%). Conclusion: Despite relatively low mortality, critically ill children with severe GBS have increased prevalence of axonal neuropathy and guarded response to initial therapy with PE or IVIg.
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Affiliation(s)
- Hafez M Bazaraa
- Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanaa I Rady
- Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shereen A Mohamed
- Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Walaa A Rabie
- Clinical and Chemical Pathology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha H ElAnwar
- Department of Pediatrics, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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22
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Abstract
Since the discovery of an acute monophasic paralysis, later coined Guillain-Barré syndrome, almost 100 years ago, and the discovery of chronic, steroid-responsive polyneuropathy 50 years ago, the spectrum of immune-mediated polyneuropathies has broadened, with various subtypes continuing to be identified, including chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN). In general, these disorders are speculated to be caused by autoimmunity to proteins located at the node of Ranvier or components of myelin of peripheral nerves, although disease-associated autoantibodies have not been identified for all disorders. Owing to the numerous subtypes of the immune-mediated neuropathies, making the right diagnosis in daily clinical practice is complicated. Moreover, treating these disorders, particularly their chronic variants, such as CIDP and MMN, poses a challenge. In general, management of these disorders includes immunotherapies, such as corticosteroids, intravenous immunoglobulin or plasma exchange. Improvements in clinical criteria and the emergence of more disease-specific immunotherapies should broaden the therapeutic options for these disabling diseases.
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23
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Zhang Y, Zhao Y, Wang Y. Prognostic factors of Guillain-Barré syndrome: a 111-case retrospective review. Chin Neurosurg J 2018; 4:14. [PMID: 32922875 PMCID: PMC7398209 DOI: 10.1186/s41016-018-0122-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/21/2018] [Indexed: 02/08/2023] Open
Abstract
Background To identify the predictive factors associated with worse prognosis in the Guillain-Barré syndrome (GBS), which can be helpful to fully evaluate the disease progression and provide proper treatments. Methods Clinical data of 111 GBS patients who were diagnosed from 2010 to 2015 were collected and retrospectively analyzed. Results Patients with diabetes (P=0.031), high blood pressure at admission (P=0.034), uroschesis (P=0.028), fever (P<0.001), ventilator support (P<0.001) during hospitalization, disorder of consciousness (p=0.007) and absence of preceding respiratory infection(P=0.016) were associated with worse outcome at discharge, while abnormal sensation, ataxia, weakness and decrease of tendon reflex seemed not correlated with the Medical Research Council(MRC) score at discharge. Compared with the subtype of acute inflammatory demyelinating polyneuropathy, prognosis of Miller-Fisher syndrome (p<0.001) and cranial nerve variant (p<0.038) were better, but prognosis of acute motor axonal neuropathy(AMAN) was worse (p<0.032). Laboratory examinations at admission showed that hyperglycemia (P=0.002), high leukocyte count (P=0.010), hyperfibrinogenemia (P=0.001), hyponatremia (P=0.020), hypoalbuminemia (P=0.005), abnormal hepatic (P=0.048) and renal (P=0.009) functions were associated with poorer prognosis at discharge, while albuminocytologic dissociation in cerebrospinal fluid, GM1 and GQ1b antibody showed no correlation with the MRC score at discharge. γ-Globulin and glucocorticoid therapies showed no difference in the MRC score at the discharge. Conclusions AMAN, diabetes, high blood pressure, uroschesis, high body temperature, ventilator support, consciousness disorder, absence of upper respiratory tract preceding infection, hyperglycemia, hyponatremia, hypoalbuminemia, high leukocyte count, hyperfibrinogenemia, abnormal hepatic and renal function were demonstrated as poor prognostic factors.
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Affiliation(s)
- Yitao Zhang
- Department of neurology, Huashan Hospital affiliated to Fudan University, 12 M.Wulumuqi Rd, Jina'an District Shanghai, People's Republic of China
| | - Yanyin Zhao
- Department of neurology, Huashan Hospital affiliated to Fudan University, 12 M.Wulumuqi Rd, Jina'an District Shanghai, People's Republic of China
| | - Yi Wang
- Department of neurology, Huashan Hospital affiliated to Fudan University, 12 M.Wulumuqi Rd, Jina'an District Shanghai, People's Republic of China
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Purnamawati K, Ong JAH, Deshpande S, Tan WKY, Masurkar N, Low JK, Drum CL. The Importance of Sex Stratification in Autoimmune Disease Biomarker Research: A Systematic Review. Front Immunol 2018; 9:1208. [PMID: 29915581 PMCID: PMC5994590 DOI: 10.3389/fimmu.2018.01208] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022] Open
Abstract
The immune system is highly dynamic and regulated by many baseline characteristic factors. As such, significant variability may exist among different patient groups suffering from the same autoimmune disease (AD). However, contemporary research practices tend to take the reductionist aggregate approach: they do not segment AD patients before embarking on biomarker discovery. This approach has been productive: many novel AD biomarkers have recently been discovered. Yet, subsequent validation studies of these biomarkers tend to suffer from a lack of specificity, sensitivity, and reproducibility which hamper their translation for clinical use. To enhance reproducibility in validation studies, an optimal discovery-phase study design is paramount: one which takes into account different parameters affecting the immune system biology. In this systematic review, we highlight need for stratification in one such parameter, i.e., sex stratification. We will first explore sex differences in immune system biology and AD prevalence, followed by reported sex-bias in the clinical phenotypes of two ADs—one which more commonly affects females: systemic lupus erythematosus, and one which more commonly affects males: ankylosing spondylitis. The practice of sex stratification in biomarker research may not only advance the discovery of sex-specific AD biomarkers but more importantly, promote reproducibility in subsequent validation studies, thus easing the translation of these novel biomarkers from bench to bedside to improve AD diagnosis. In addition, such practice will also promote deeper understanding for differential AD pathophysiology in males and females, which will be useful for the development of more effective interventions for each sex type.
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Affiliation(s)
- Kristy Purnamawati
- Biomedical Institute for Global Health Research and Technology (BIGHEART), National University of Singapore (NUS), Singapore, Singapore
| | | | | | | | | | | | - Chester Lee Drum
- National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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25
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Matsui N, Nodera H, Kuzume D, Iwasa N, Unai Y, Sakai W, Miyazaki Y, Yamazaki H, Osaki Y, Mori A, Furukawa T, Tsukamoto-Miyashiro A, Shimatani Y, Yamasaki M, Izumi Y, Kusunoki S, Arisawa K, Kaji R. Guillain−Barré syndrome in a local area in Japan, 2006-2015: an epidemiological and clinical study of 108 patients. Eur J Neurol 2018; 25:718-724. [DOI: 10.1111/ene.13569] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- N. Matsui
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - H. Nodera
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - D. Kuzume
- Department of Neurology; Chikamori Hospital; Kochi Japan
| | - N. Iwasa
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - Y. Unai
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - W. Sakai
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - Y. Miyazaki
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - H. Yamazaki
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - Y. Osaki
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - A. Mori
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - T. Furukawa
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - A. Tsukamoto-Miyashiro
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - Y. Shimatani
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - M. Yamasaki
- Department of Neurology; Chikamori Hospital; Kochi Japan
| | - Y. Izumi
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
| | - S. Kusunoki
- Department of Neurology; Kindai University; Faculty of Medicine; Osaka Japan
| | - K. Arisawa
- Department of Preventive Medicine; Institute of Biomedical Sciences; Tokushima University Graduate School; Tokushima Japan
| | - R. Kaji
- Department of Clinical Neuroscience; Graduate School of Biomedical Sciences; Tokushima University; Tokushima Japan
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26
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Alterations of plasma concentrations of lipophilic antioxidants are associated with Guillain-Barre syndrome. Clin Chim Acta 2017; 470:75-80. [PMID: 28476374 DOI: 10.1016/j.cca.2017.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/12/2017] [Accepted: 05/01/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy resulting in demyelination in peripheral nervous system. Myelin enriched in lipids is easily oxidized by reactive oxygen species during inflammation. Oxidative stress and lipophilic anti-oxidative capacities in GBS patients have not been fully explored. To evaluate the redox status of GBS patients, we measured malondialdehyde (MDA), myeloperoxidase (MPO), lipophilic antioxidants, and tocopherols concentrations in plasma from GBS patients and age-matched healthy controls. RESULTS Concentrations of γ-tocopherol and δ-tocopherol decreased significantly, and α-carotene significantly increased in GBS patients compared to healthy controls. However, no significant changes in MDA and MPO concentrations were detected. In GBS patients, the γ-tocopherol concentration correlated positively with concentrations of δ-tocopherol, α-tocopherol, lutein, Q10, and γ-CEHC, respectively. Similarly, the δ-tocopherol concentration correlated positively with γ-tocopherol, α-tocopherol, lutein, Q10, δ-CEHC, and γ-CEHC concentrations, respectively. The receiver operating characteristics curve analysis showed that γ-tocopherol may serve as a good predictor for GBS. CONCLUSIONS Diminished lipophilic antioxidant defense, mainly γ-tocopherol and δ-tocopherol, in GBS patients accounting for their lowered resistance to reactive oxygen species is probably associated with pathogenesis of GBS, and potentially useful for the development of therapeutic strategies.
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27
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Fan C, Jin H, Hao H, Gao F, Sun Y, Lu Y, Liu Y, Lv P, Cui W, Teng Y, Huang Y. Anti-ganglioside antibodies in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy in Chinese patients. Muscle Nerve 2016; 55:470-475. [PMID: 27464289 DOI: 10.1002/mus.25266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/17/2016] [Accepted: 07/22/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION In this study we investigated the relationships between anti-ganglioside antibodies and Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS Samples from 48 Chinese patients diagnosed with GBS and 18 patients diagnosed with CIDP were retrospectively reviewed. RESULTS In the GBS patients, 62.5% were classified as having acute inflammatory demyelinating polyneuropathy (AIDP), 27.1% were found to have acute motor axonal neuropathy (AMAN), and 10.4% were unclassified. Serum IgG anti-ganglioside antibodies were detected in 46.2% of the AMAN patients and in 6.7% of the AIDP patients (P < 0.05); 5.6% of the 18 CIDP patients were IgG antibody positive, and 27.8% were IgM antibody positive. Facial palsy and sensory impairment were significantly associated with IgM antibodies. CONCLUSIONS These results suggest that IgG anti-GM1 antibodies are associated with AMAN, but not with AIDP, and that IgM antibodies against GM1, GM2, and GM3 are associated with facial nerve palsy. Muscle Nerve 55: 470-475, 2017.
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Affiliation(s)
- Chenghe Fan
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Feng Gao
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Yuanyuan Lu
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Yuanyuan Liu
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Pu Lv
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Wei Cui
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Yuming Teng
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, China
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Antiganglioside, antiganglioside-complex, and antiglycolipid-complex antibodies in immune-mediated neuropathies. Curr Opin Neurol 2016; 29:572-80. [DOI: 10.1097/wco.0000000000000361] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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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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Magid-Bernstein J, Al-Mufti F, Merkler AE, Roh D, Patel S, May TL, Agarwal S, Claassen J, Park S. Unexpected Rapid Improvement and Neurogenic Stunned Myocardium in a Patient With Acute Motor Axonal Neuropathy: A Case Report and Literature Review. J Clin Neuromuscul Dis 2016; 17:135-141. [PMID: 26905914 DOI: 10.1097/cnd.0000000000000109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Acute Motor Axonal Neuropathy-type Guillain-Barré Syndrome (GBS) is a subset of GBS with either a rapidly improving or protracted course that was first described in China. We describe a 27-year-old previously healthy woman with weakness that progressed to complete tetraplegia and areflexia within 2 weeks after an upper respiratory illness. A lumbar puncture performed 4 days after onset of neurologic symptoms was inconclusive for GBS, and electromyography revealed complete motor axonal neuropathy. The patient had Mycoplasma pneumoniae in her nares and blood, and several antiganglioside antibodies in her blood. She was treated with plasmapheresis, antibiotics, and physical therapy. Her motor function and reflexes improved rapidly with treatment, and she was able to ambulate within 3 weeks. She also experienced cardiomyopathy, which improved with plasmapheresis. We report a rare case of Mycoplasma pneumonia-associated acute motor axonal neuropathy-type GBS presenting with complete tetraplegia, areflexia, and neurogenic stunned myocardium that rapidly improved with plasmapheresis.
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Demyelinating Guillain-Barré syndrome recurs more frequently than axonal subtypes. J Neurol Sci 2016; 365:132-6. [PMID: 27206890 DOI: 10.1016/j.jns.2016.02.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/26/2016] [Accepted: 02/19/2016] [Indexed: 11/23/2022]
Abstract
Guillain-Barré syndrome (GBS) is considered a monophasic disorder yet recurrences occur in up to 6% of patients. We retrospectively studied an Italian-Japanese population of 236 GBS and 73 Miller Fisher syndrome (MFS) patients and searched for factors which may be associated with recurrence. A recurrent patient was defined as having at least two episodes that fulfilled the diagnostic criteria for GBS and MFS with an identifiable recovery after each episode and a minimum of 2months between episodes. Preceding Campylobacter jejuni (C. jejuni) infection and antiganglioside antibodies were also assessed. Seven (3%) recurrent GBS and one (1.4%) recurrent MFS patients were identified. In the individual patient the clinical features during episodes were usually similar varying in severity whereas the preceding infection differed. None of the patients had GBS in one episode and MFS in the recurrence or vice versa. Recurrent GBS patients, compared with monophasic GBS, did not have preceding diarrhea at the first episode and considering the electrophysiological subtypes, acute inflammatory demyelinating polyneuropathies recurred more frequently than axonal GBS (6.5% vs 0.9%, p=0.04). In conclusion in a GBS population with a balanced number of demyelinating and axonal subtypes less frequent diarrhea and demyelination at electrophysiology were associated with recurrence.
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Clinical Features of Miller-Fisher Syndrome in Pregnancy. Case Rep Obstet Gynecol 2015; 2015:840680. [PMID: 26697248 PMCID: PMC4678060 DOI: 10.1155/2015/840680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/19/2015] [Indexed: 12/04/2022] Open
Abstract
Miller-Fisher syndrome (MFS) is recognized as a variant of Guillain-Barré syndrome (GBS). MFS is a rare disorder that is characterized by the acute onset of ophthalmoplegia, ataxia, and areflexia/hyporeflexia. MFS has a higher incidence in Asia, where the incidence is estimated to be 18%–26% of GBS compared with 3%–5% in the West. The differential diagnosis of MFS includes Wernicke's encephalopathy (WE) which is characterized by a clinical triad (nystagmus and ophthalmoplegia, mental status changes, and ataxia), myasthenia gravis, and brainstem stroke. The association between MFS and pregnancy has not been reported previously. Here, we describe the clinical features of a pregnant woman in early pregnancy with MFS. This case highlights the fact that it is necessary to establish an accurate diagnosis based on the details from the patient's history on appropriate complementary testing in a pregnant patient with MFS.
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Abstract
The proportion of different subtypes of Guillain-Barré syndrome (GBS) and their prognosis varied significantly among different regions. This study attempts to investigate the clinical subtypes and outcome of GBS in southwest China. Patients with GBS admitted to The First Affiliated Hospital of Chongqing Medical University from January 2006 to March 2013 were included in our study. Patients were classified into acute inflammatory demyelinating polyneuropathy (AIDP) group, acute motor axonal neuropathy (AMAN) group, Miller-Fisher syndrome (MFS) group, cranial nerve variants(CNV), Bickerstaff's brainstem encephalitis overlaps with GBS (BBE-GBS) group and unclassifiable group based on clinical features and electrophysiological findings. Hughes function grade score (HFGS) was used to assess the prognosis at 3 and 6 months. The prognosis of different subtypes and outcome predictors were analyzed. The most common subtype of GBS was AIDP (57%), followed by AMAN (22%) and MFS (7%). The prognosis of AMAN and BBE-GBS is similar at 3 month(P = 0.0704)and 6 month (P = 0.1614) follow-up. The prognosis of AMAN group was poorer than that of AIDP group at 3 month and 6 month follow-up (P<0.001). Outcome of MFS group and that of CNV group at 6 months were both good(Hughes≤1). Hughes≥3(P<0.0001,OR = 6.650,95%CI = 2.865 to 15.023))and dysautonomia (P = 0.043,OR = 2.820,95%CI = 1.031 to 7.715)) were associated with poor outcome at 6 month follow-up. AIDP is the most common subtype of GBS. Prognosis of AMAN group and BBE-GBS group is poorer than that of AIDP group at 3 month and 6 month follow-up. Hughes≥3 at nadir and dysautonomia are predictors of poor prognosis at 6 month follow-up.
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Affiliation(s)
- Gang Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongrong Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Wei
- Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Junyi Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail:
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Kusunoki S. [111th Scientific Meeting of the Japanese Society of Internal Medicine: Symposium: 1. Immunity and diseases in internal medicine--Frontier of pathophysiology and treatment; 2) Pathogenesis and treatment of immune-mediated neuropathies; the cutting edge]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2014; 103:2105-2110. [PMID: 27522759 DOI: 10.2169/naika.103.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Ngo ST, Steyn FJ, McCombe PA. Gender differences in autoimmune disease. Front Neuroendocrinol 2014; 35:347-69. [PMID: 24793874 DOI: 10.1016/j.yfrne.2014.04.004] [Citation(s) in RCA: 600] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/20/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022]
Abstract
Autoimmune diseases are a range of diseases in which the immune response to self-antigens results in damage or dysfunction of tissues. Autoimmune diseases can be systemic or can affect specific organs or body systems. For most autoimmune diseases there is a clear sex difference in prevalence, whereby females are generally more frequently affected than males. In this review, we consider gender differences in systemic and organ-specific autoimmune diseases, and we summarize human data that outlines the prevalence of common autoimmune diseases specific to adult males and females in countries commonly surveyed. We discuss possible mechanisms for sex specific differences including gender differences in immune response and organ vulnerability, reproductive capacity including pregnancy, sex hormones, genetic predisposition, parental inheritance, and epigenetics. Evidence demonstrates that gender has a significant influence on the development of autoimmune disease. Thus, considerations of gender should be at the forefront of all studies that attempt to define mechanisms that underpin autoimmune disease.
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Affiliation(s)
- S T Ngo
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, Australia; University of Queensland Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
| | - F J Steyn
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - P A McCombe
- University of Queensland Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia; Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
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