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Traub R, Chaudhry V. Neuroprognostication: Guillain-Barré Syndrome. Semin Neurol 2023; 43:791-798. [PMID: 37788681 DOI: 10.1055/s-0043-1775750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Guillain-Barré syndrome is an immune-mediated disease of the peripheral nerves characterized by rapidly progressing symmetric weakness, areflexia, and albuminocytological dissociation. Most patients reach their nadir within 2 weeks. Disease severity can be mild to severe, with 20% of patients requiring mechanical ventilation. Intravenous immunoglobulin and plasma exchange are equally effective treatments. Monitoring strength, respiratory function, blood pressure, and heart rate, as well as pain management and rehabilitative therapy are important aspects of management. About 20% of patients require assistance to walk at 6 months. Older age, preceding diarrhea, and lower Medical Research Council (MRC) sum scores predict poor outcome. Death from cardiovascular and respiratory complications can occur in the acute or recovery phases of the illness in 3 to 7% of the patients. Risk factors for mortality include advanced age and disease severity at onset. Neuropathic pain, weakness, and fatigue can be residual symptoms; risk factors for these include axonal loss, sensory involvement, and severity of illness.
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Affiliation(s)
- Rebecca Traub
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Vinay Chaudhry
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
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2
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Wen PY, Chen XW, Zhang M, Chu WZ, Wu HL, Ren C. Guillain-Barre syndrome after myocardial infarction: a case report and literature review. BMC Cardiovasc Disord 2023; 23:226. [PMID: 37127573 PMCID: PMC10150548 DOI: 10.1186/s12872-023-03261-4] [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: 09/14/2022] [Accepted: 04/25/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Guillain-Barre syndrome after myocardial infarction occurs infrequently, and its occurrence following percutaneous coronary intervention is extremely rare. Due to the high mortality rate of myocardial infarction and the disability of Guillain-Barre syndrome, early identification of Guillain-Barre syndrome after myocardial infarction and early intervention can decrease the mortality rate, lead to early recovery, and provide a better outcome. CASE PRESENTATION Herein, we reported a rare case of Guillain-Barre syndrome after myocardial infarction treated with percutaneous coronary intervention. The patient was a 75-year-old woman from China who was admitted to hospital due to sudden loss of consciousness. Electrocardiography showed acute myocardial infarction in the right ventricle and inferior and posterior walls. The patient underwent emergency percutaneous intervention of the posterior collateral artery of the right coronary artery. Soon after, her condition worsened resulting in limb weakness and numbness. Unfortunately, she continued to develop respiratory failure, and treated with intravenous immunoglobulin and ventilator-assisted breathing. A physical examination showed hypotonia of all four limbs, complete quadriplegia, bulbar palsy, dysarthria, and tendon areflexia. Serum immunoglobulin (Ig) G anti-ganglioside antibody analysis was positive with anti-GT1a antibodies (+ +), anti-GM1 antibodies ( +), anti-GM2 antibodies ( +), and anti-GM4 antibodies ( +), and he was diagnosed with Guillain-Barre syndrome after myocardial infarction. She was discharged due to poor response to treatment. The patient died two days after being discharged. CONCLUSIONS Myocardial infarction and/or percutaneous coronary intervention may activate immune-mediated response and cause severe complications. Clinician should be alert to Guillain-Barre syndrome after myocardial infarction and/or percutaneous coronary intervention.
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Affiliation(s)
- Pu-Yuan Wen
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shangdong, 264000, China
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230000, China
| | - Xian-Wen Chen
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shangdong, 264000, China
| | - Min Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230000, China
| | - Wen-Zheng Chu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230000, China
| | - Hong-Liang Wu
- Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shangdong, 264000, China
| | - Chao Ren
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230000, China.
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Khedr EM, Mohamed MZ, Shehab MMM. The early clinical and laboratory predictors of GBS outcome: hospital-based study, Assiut University, Upper Egypt. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Abstract
Background
This study was designed to identify factors that influence outcomes in a large group of well-defined Guillain–Barré syndrome (GBS) patients with a 3-month follow-up period. Sixty-two cases of GBS with a mean age of 37.15 ± 17.60 years (33 males and 29 females) were recruited in the first 2 weeks after onset. Clinical history, examination, and a variety of rating scales including Medial Research Council sum score (MRC), Erasmus Guillain-Barré respiratory insufficiency score (EGRIS), at admission and 10 days later were performed. Follow-up investigations at 3 months included the Hughes Disability Scale (HDS), and Overall Neuropathy Limitation Scale (ONLS).
Results
64.5% of participants had cranial nerve deficits, 45% had neck muscle weakness, 30.6% had dysautonomia, and 8.1% were mechanically ventilated. C-reactive protein was elevated in 38.7%, and hyponatremia was recorded in 30.6% of patients. Older age, antecedent events particularly diarrhea, neck muscles weakness, low MRC sum score, impaired cough reflex, dysautonomia, and hyponatremia, were all significantly associated with poor outcomes at 3 months using HDS and ONLS. Regression analysis with dependent variables of HDS outcome showed that the presence of an antecedent event particularly diarrhea, neck muscle weakness, hyponatremia and the presence cytoalbuminous dissociation of CSF at onset, and low MRC sum score at 10th day after treatment, were predictors of poor outcome.
Conclusion
Clinical and laboratory predictors of poor outcome were older age, the presence of an antecedent event particularly diarrhea, low MRC sum score at the 10th day, elevated CRP, hyponatremia and the presence cytoalbuminous dissociation.
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Murakami K, Kajimoto Y, Ito H. Acute Oropharyngeal Palsy Following Bilateral Adie's Tonic Pupils Associated with Anti-GT1a and GQ1b IgG Antibodies. Intern Med 2022; 61:3121-3124. [PMID: 35370231 PMCID: PMC9646358 DOI: 10.2169/internalmedicine.8416-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A 36-year-old man was admitted to our hospital with complaints of dysphagia and photophobia. A neurological examination showed oropharyngeal palsy and bilateral mydriasis with loss of light reflexes in the absence of external ophthalmoplegia. Bilateral pupils were supersensitive to pilocarpine 0.1%, which was compatible with Adie's tonic pupils. Serum IgG reacted with GQ1b, GT1a, GalNAc-GD1a, and GD3. Intravenous high-dose immunoglobulin therapy improved his neurological symptoms within three weeks. To our knowledge, there is no medical literature describing acute oropharyngeal palsy with Adie's tonic pupils. We recommend evaluating antiganglioside antibodies to clarify the cause of oropharyngeal palsy and Adie's tonic pupils.
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Affiliation(s)
- Keishu Murakami
- Department of Neurology, Wakayama Medical University, Japan
- Department of Neurology, Wakayama Rosai Hospital, Japan
| | - Yoshinori Kajimoto
- Department of Internal Medicine, Wakayama Medical University Kihoku Hospital, Japan
| | - Hidefumi Ito
- Department of Neurology, Wakayama Medical University, Japan
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Nanatsue K, Takahashi M, Itaya S, Abe K, Inaba A. A case of Miller Fisher syndrome with delayed onset peripheral facial nerve palsy after COVID-19 vaccination: a case report. BMC Neurol 2022; 22:309. [PMID: 35996074 PMCID: PMC9395791 DOI: 10.1186/s12883-022-02838-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/14/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To prevent the spread of the novel coronavirus disease 2019 (COVID-19) infection, various vaccines have been developed and used in a large number of people worldwide. One of the most commonly used vaccines is the mRNA vaccine developed by Moderna. Although several studies have shown this vaccine to be safe, the full extent of its side effects has not yet been known. Miller-Fisher syndrome (MFS) is a rare condition that manifests ophthalmoplegia, ataxia, and loss of tendon reflexes. It is a subtype of Guillain-Barré syndrome and an immune-mediated disease related to serum IgG anti-GQ1b antibodies. Several vaccines including those for COVID-19 have been reported to induce MFS. However, there have been no reports of MFS following Moderna COVID-19 vaccine administration. CASE PRESENTATION A 70-year-old man was referred to our hospital due to diplopia that manifested 1 week after receiving the second Moderna vaccine dose. The patient presented with restricted abduction of both eyes, mild ataxia, and loss of tendon reflexes. He was diagnosed with MFS based on his neurological findings and detection of serum anti-GQ1b antibodies. The patient was administered intravenous immunoglobulin, and his symptoms gradually improved. Five days after admission, the patient showed peripheral facial paralysis on the right side. This symptom was suggested to be a delayed onset of peripheral facial nerve palsy following MFS that gradually improved by administration of steroids and antiviral drugs. CONCLUSION There have been no previous reports of MFS after Moderna COVID-19 vaccination. This case may provide new information about the possible neurological side effects of COVID-19 vaccines.
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Affiliation(s)
- Kentaro Nanatsue
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Makoto Takahashi
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan.
| | - Sakiko Itaya
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Keisuke Abe
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
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Siddiqi AR, Khan T, Tahir MJ, Asghar MS, Islam MS, Yousaf Z. Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature. Medicine (Baltimore) 2022; 101:e29333. [PMID: 35608434 PMCID: PMC9276158 DOI: 10.1097/md.0000000000029333] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically diagnosed based on the clinical triad of ataxia, areflexia, and ophthalmoplegia. MFS is usually preceded by viral infections and febrile illness; however, only a few cases have been reported after vaccinations. PATIENT CONCERNS A 53-year-old hypertensive male presented with a 2-day history of progressive ascending paralysis of the lower limbs along with diplopia and ataxia, 8 days after the first dose of the Sinovac-Coronavac coronavirus disease 2019 (COVID-19) vaccination, with no prior history of any predisposing infections or triggers. DIAGNOSES Physical examination showed moderate motor and sensory loss with areflexia in the lower limbs bilaterally. Routine blood investigations and radiological investigations were unremarkable. Cerebrospinal fluid analysis showed albuminocytologic dissociation and nerve conduction studies revealed prolonged latencies with reduced conduction velocities. The diagnosis of MFS was established based on the findings of physical examination, cerebrospinal fluid analysis, and nerve conduction studies. INTERVENTIONS A management plan was devised based on intravenous immunoglobulins, pregabalin, and physiotherapy. However, due to certain socioeconomic factors, the patient was managed conservatively with regular physiotherapy sessions. OUTCOMES Follow-up after 6 weeks showed remarkable improvement, with complete resolution of symptoms 10 weeks after the discharge. LESSONS This case suggests that MFS is a rare adverse effect after COVID-19 vaccination and additional research is required to substantiate a temporal association. Further studies are needed to understand the pathophysiology behind such complications to enhance the safety of COVID-19 vaccinations in the future.
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Affiliation(s)
- Ahsun Rizwan Siddiqi
- Wah Medical College, Affiliated with University of Health Sciences, Wah, Pakistan
| | - Tehrim Khan
- Wah Medical College, Affiliated with University of Health Sciences, Wah, Pakistan
| | | | | | - Md. Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka-1342, Bangladesh
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Nishiguchi Y, Matsuyama H, Maeda K, Shindo A, Tomimoto H. Miller Fisher syndrome following BNT162b2 mRNA coronavirus 2019 vaccination. BMC Neurol 2021; 21:452. [PMID: 34789193 PMCID: PMC8598937 DOI: 10.1186/s12883-021-02489-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in late 2019. One of the vaccines approved against COVID-19 is the BNT162b2 mRNA COVID-19 vaccine (Pfizer/BioNTech). Case presentation We present the case of a 71-year-old man with no history of the SARS-CoV-2 infection or any recent viral or bacterial illnesses who presented with bilateral oculomotor palsy and limb ataxia after BNT162b2 mRNA COVID-19 vaccination. The diagnosis of Miller Fisher syndrome (MFS) was established based on physical examination, brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis (CSF), and positron emission tomography (PET). There was no evidence of other predisposing infectious or autoimmune factors, and the period from COVID-19 vaccination to the appearance of neurological symptoms was similar to that of other vaccines and preceding events, such as infection. Conclusion Guillain–Barré syndrome (GBS) and its variants after COVID-19 vaccination are extremely rare. Note that more research is needed to establish an association between MFS and COVID-19 vaccines. In our opinion, the benefits of COVID-19 vaccination largely outweigh its risks.
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Affiliation(s)
- Yamato Nishiguchi
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan.
| | - Hirofumi Matsuyama
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan
| | - Kuniko Maeda
- Department of Ophthalmology, Mie Prefectural Shima Hospital, Shima, Mie, 517-0595, Japan
| | - Akihiro Shindo
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Graduate School of Medicine, Mie University, Tsu, Mie, 514-8507, Japan
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Fisher syndrome as an immune-related adverse event after using pembrolizumab but not nivolumab. Acta Neurol Belg 2021; 121:1381-1382. [PMID: 33641036 DOI: 10.1007/s13760-021-01623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
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Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune neuropathy that can cause motor, sensory, and autonomic symptoms. Although GBS primarily is a neuropathic disorder, multiple organ systems can be affected during the disease course, and older patients may be more vulnerable to systemic complications. Close clinical monitoring and early interventions using pharmacologic and nonpharmacological treatments may lead to an improved long-term outcome.
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Affiliation(s)
- Justin Kwan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 1D45, MSC 1140, 10 Center Drive, Bethesda, MD 20814, USA.
| | - Suur Biliciler
- Department of Neurology, The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin Street MSE#466, Houston, TX 77030, USA
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Natsui H, Takahashi M, Nanatsue K, Itaya S, Abe K, Inaba A, Orimo S. Mother and son cases of Bickerstaff's brainstem encephalitis and fisher syndrome with serum anti-GQ1b IgG antibodies: a case report. BMC Neurol 2021; 21:130. [PMID: 33743625 PMCID: PMC7980323 DOI: 10.1186/s12883-021-02159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Bickerstaff’s brainstem encephalitis (BBE) and Fisher syndrome (FS) are immune-mediated diseases associated with anti-ganglioside antibodies, specifically the anti-GQ1b IgG antibody. These two diseases potentially lie on a continuous spectrum with Guillain-Barré Syndrome (GBS). There are some reports of family cases of GBS and fewer of FS. However, there are no reports of family cases of BBE and FS. Case presentation We report a familial case of an 18-year-old son who had BBE and his 52-year-old mother diagnosed with FS within 10 days. The son showed impaired consciousness 1 week after presenting with upper respiratory symptoms and was brought to our hospital by his mother. He showed decreased tendon reflexes, limb ataxia, albuminocytologic dissociation in his spinal fluid, and positive serum anti-GQ1b antibodies. Haemophilus influenzae was cultured from his sputum. He was diagnosed with BBE and treated with intravenous immunoglobulin (IVIg) therapy, which led to an improvement in symptoms. The mother presented with upper respiratory symptoms 3 days after her son was hospitalized. Seven days later, she was admitted to the hospital with diplopia due to limited abduction of the left eye. She showed mild ataxia and decreased tendon reflexes. Her blood was positive for anti-GQ1b antibodies. She was diagnosed with FS and treated with IVIg, which also led to symptomatic improvement. Conclusions There are no previous reports of familial cases of BBE and FS; therefore, this valuable case may contribute to the elucidation of the relationship between genetic predisposition and the pathogenesis of BBE and FS.
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Affiliation(s)
- Hirokazu Natsui
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Makoto Takahashi
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan.
| | - Kentaro Nanatsue
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Sakiko Itaya
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Keisuke Abe
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, 6-25-1 Kami-Yoga, Setagaya-ku, Tokyo, 158-8531, Japan
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Classic and overlapping Miller-Fisher syndrome: clinical and electrophysiological features in Mexican adults. Neurol Sci 2021; 42:4225-4229. [PMID: 33594537 DOI: 10.1007/s10072-020-05029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
Classic and overlapping Miller-Fisher syndrome (MFS) have divergent clinical courses. Few studies have addressed the electrophysiological evaluation of MFS patients, most of them carried out in Asia. This work describes and compares their clinical and neurophysiological characteristics. From a Guillain-Barré syndrome (GBS) patient cohort, we made a selection of twenty MFS cases. We defined classic and overlapping MFS, as stated by Wakerley et al. (Nat Rev Neurol 10(9):537-544, 2014). We describe and compare clinical, biochemical, and electrodiagnostic parameters between groups. Seventy-five percent were men, mean age was 42.2 ± 13.6 years, and 45% had a Hughes score ≥ 3. MFS/GBS was the most frequent clinical subtype with 50%. Almost one-third had unaltered electrophysiological studies. Comparative analysis between groups showed statistically significant differences in length of stay, dysautonomia presence, and treatment type. Kaplan-Meier survival analysis showed that 100% of the patients had an independent walk at 3 months. This study reports Mexican MFS patient's characteristics and represents the most extensive case series in Latin America. We observed a high proportion of overlapping syndromes, a good recovery profile, and no significant severe complications.
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Mayer JE, McNamara CA, Mayer J. Miller Fisher syndrome and Guillain-Barré syndrome: dual intervention rehabilitation of a complex patient case. Physiother Theory Pract 2020; 38:245-254. [DOI: 10.1080/09593985.2020.1736221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jill E. Mayer
- Department of Physical Therapy, Ithaca College, Ithaca, NY, USA
| | | | - John Mayer
- Inpatient Therapy Department, Cayuga Medical Center, Ithaca, NY, USA
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13
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RNA Sequencing Data Sets Identifying Differentially Expressed Transcripts during Campylobacter jejuni Biofilm Formation. Microbiol Resour Announc 2020; 9:9/1/e00982-19. [PMID: 31896623 PMCID: PMC6940275 DOI: 10.1128/mra.00982-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Campylobacter jejuni is a foodborne pathogen and an important contributor to gastroenteritis in humans. C. jejuni readily forms biofilms which may play a role in the transmission of the pathogen from animals to humans. Herein, we present RNA sequencing data investigating differential gene expression in biofilm and planktonic C. jejuni These data provide insight into pathways which may be important to biofilm formation in this organism.
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Brusa R, Faravelli I, Gagliardi D, Magri F, Cogiamanian F, Saccomanno D, Cinnante C, Mauri E, Abati E, Bresolin N, Corti S, Comi GP. Ophthalmoplegia Due to Miller Fisher Syndrome in a Patient With Myasthenia Gravis. Front Neurol 2019; 10:823. [PMID: 31456730 PMCID: PMC6700242 DOI: 10.3389/fneur.2019.00823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Here, we describe a 79-year-old man, admitted to our unit for worsening diplopia and fatigue, started a few weeks after an episode of bronchitis and flu vaccination. Past medical history includes myasthenia gravis (MG), well-controlled by Pyridostigmine, Azathioprine, and Prednisone. During the first days, the patient developed progressive ocular movement abnormalities up to complete external ophthalmoplegia, severe limb and gait ataxia, and mild dysarthria. Deep tendon reflexes were absent in lower limbs. Since not all the symptoms were explainable with the previous diagnosis of myasthenia gravis, other etiologies were investigated. Brain MRI and cerebrospinal fluid analysis were normal. Electromyography showed a pattern of predominantly sensory multiple radiculoneuritis. Suspecting Miller Fisher syndrome (MFS), the patient was treated with plasmapheresis with subsequent clinical improvement. Antibodies against GQ1b turned out to be positive. MFS is an immune-mediated neuropathy presenting with ophthalmoplegia, ataxia, and areflexia. Even if only a few cases of MFS overlapping with MG have been described so far, the coexistence of two different autoimmune disorders can occur. It is always important to evaluate possible differential diagnosis even in case of known compatible diseases, especially when some clinical features seem atypical.
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Affiliation(s)
- Roberta Brusa
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Faravelli
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Delia Gagliardi
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesca Magri
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Cogiamanian
- Neuropathophysiology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenica Saccomanno
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Cinnante
- Neuroradiology Unit, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Mauri
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elena Abati
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nereo Bresolin
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefania Corti
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giacomo Pietro Comi
- Neurology Unit, Department of Pathophysiology and Transplantation, Dino Ferrari Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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15
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Bigaut K, Kremer L, Hacquard A, Collongues N, De Seze J. Miller Fisher syndrome mimicking botulism: Clinical and pathophysiological discussion of a case. Rev Neurol (Paris) 2019; 175:403-405. [PMID: 31047688 DOI: 10.1016/j.neurol.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
Affiliation(s)
- K Bigaut
- Service de neurologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
| | - L Kremer
- Service de neurologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Inserm U1434, centre d'investigation clinique, 67000 Strasbourg, France
| | - A Hacquard
- Service de neurologie, groupe hospitalier de la région Mulhouse sud-Alsace, 68100 Mulhouse, France
| | - N Collongues
- Service de neurologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Inserm U1434, centre d'investigation clinique, 67000 Strasbourg, France; Inserm U1119, biopathologie de la myéline, neuroprotection et stratégies thérapeutiques, fédération de médecine translationnelle de Strasbourg, 67000 Strasbourg, France
| | - J De Seze
- Service de neurologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Inserm U1434, centre d'investigation clinique, 67000 Strasbourg, France; Inserm U1119, biopathologie de la myéline, neuroprotection et stratégies thérapeutiques, fédération de médecine translationnelle de Strasbourg, 67000 Strasbourg, France
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16
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Abstract
PURPOSE OF REVIEW The clinical presentation of Guillain-Barré syndrome (GBS) is highly variable, which can make the diagnosis challenging. Intravenous immunoglobulin (IVIg) and plasma exchange are the cornerstones of treatment since decades. But despite these treatments, 25% initially progress in muscle weakness, 25% require artificial ventilation, 20% is still not able to walk independently after 6 months, and 2-5% die, emphasizing the need for better treatment. We summarize new developments regarding the diagnosis, prognosis, and management of GBS. RECENT FINDINGS GBS is a clinical diagnosis that can be supported by cerebrospinal fluid examination and nerve conduction studies. Nerve ultrasound and MRI are potentially useful techniques to diagnose inflammatory neuropathies. Several novel infections have recently been associated to GBS. Evidence from experimental studies and recent phase 2 clinical trials suggests that complement inhibition combined with IVIg might improve outcome in GBS, but further studies are warranted. Prognostic models could guide the selection of patients with a relatively poor prognosis that might benefit most from additional IVIg or otherwise intensified treatment. SUMMARY New diagnostic tools may help to have early and accurate diagnosis in difficult GBS cases. Increased knowledge on the pathophysiology of GBS forms the basis for development of new, targeted, and personalized treatments that hopefully improve outcome.
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17
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Wang JW, Robbins SL, Moster ML. One-sided triangle: A case of double vision. Surv Ophthalmol 2018; 63:880-883. [PMID: 29920248 DOI: 10.1016/j.survophthal.2018.06.004] [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: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022]
Abstract
A 51-year-old woman presented with acute diplopia and was found to have ptosis and complete bilateral external and internal ophthalmoplegia. She had normal reflexes and gait. Serological testing showed elevated levels of GQ1b ganglioside autoantibodies, making the diagnosis of Miller Fisher syndrome. This case illustrates an atypical presentation of the Miller Fisher variant of Guillain-Barre syndrome, which should be considered in all patients presenting with bilateral ophthalmoplegia.
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Affiliation(s)
- Jeffrey W Wang
- Department of Ophthalmology, University of California, San Diego, San Diego, California, USA
| | - Shira L Robbins
- Ratner Children's Eye Center at the Shiley Eye Institute, University of California, San Diego, San Diego, California, USA.
| | - Mark L Moster
- Department of Neuro-Ophthalmology, Wills Eye Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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18
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Jacobs BC, van den Berg B, Verboon C, Chavada G, Cornblath DR, Gorson KC, Harbo T, Hartung HP, Hughes RAC, Kusunoki S, van Doorn PA, Willison HJ. International Guillain-Barré Syndrome Outcome Study: protocol of a prospective observational cohort study on clinical and biological predictors of disease course and outcome in Guillain-Barré syndrome. J Peripher Nerv Syst 2018; 22:68-76. [PMID: 28406555 DOI: 10.1111/jns.12209] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/06/2017] [Indexed: 01/10/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy with a highly variable clinical presentation, course, and outcome. The factors that determine the clinical variation of GBS are poorly understood which complicates the care and treatment of individual patients. The protocol of the ongoing International GBS Outcome Study (IGOS), a prospective, observational, multicenter cohort study that aims to identify the clinical and biological determinants and predictors of disease onset, subtype, course and outcome of GBS is presented here. Patients fulfilling the diagnostic criteria for GBS, regardless of age, disease severity, variant forms, or treatment, can participate if included within 2 weeks after onset of weakness. Information about demography, preceding infections, clinical features, diagnostic findings, treatment, course, and outcome is collected. In addition, cerebrospinal fluid and serial blood samples for serum and DNA is collected at standard time points. The original aim was to include at least 1,000 patients with a follow-up of 1-3 years. Data are collected via a web-based data entry system and stored anonymously. IGOS started in May 2012 and by January 2017 included more than 1,400 participants from 143 active centers in 19 countries across 5 continents. The IGOS data/biobank is available for research projects conducted by expertise groups focusing on specific topics including epidemiology, diagnostic criteria, clinimetrics, electrophysiology, antecedent events, antibodies, genetics, prognostic modeling, treatment effects, and long-term outcome of GBS. The IGOS will help to standardize the international collection of data and biosamples for future research of GBS.
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Affiliation(s)
- Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Bianca van den Berg
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Christine Verboon
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - David R Cornblath
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth C Gorson
- Department of Neurology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Richard A C Hughes
- Department of Neurology, Institute of Neurology, University College, London, UK
| | - Susumu Kusunoki
- Department of Neurology, Kinki University School of Medicine, Osaka, Japan
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hugh J Willison
- Department of Neurology, University of Glasgow, Glasgow, Scotland, UK
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19
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Kulkantrakorn K, Sukphulloprat P. Outcome of Guillain-Barré Syndrome in Tertiary Care Centers in Thailand. J Clin Neuromuscul Dis 2017; 19:51-56. [PMID: 29189549 DOI: 10.1097/cnd.0000000000000176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS), a common acute polyneuropathy, is seen worldwide with significant morbidity and mortality. GBS consists of a number of subtypes. OBJECTIVE The aim of this study is to identify clinical characteristics, electrophysiologic changes, clinical course, treatment, and outcome of GBS in Thailand. MATERIAL AND METHODS Retrospective study of GBS patients aged 15 years or older, admitted to Thammasat University Hospital and Bangkok Hospital Medical Center between January 1, 2009 and November 30, 2014. RESULTS Thirty patients were found. Demographic characteristics were collected and described as follows; 60% male sex; average age 54 years; Asian 60%, European 20%, and others 10%. Disease subtypes consist of acute inflammatory demyelinating polyneuropathy 66.7%, acute motor axonal neuropathy 10%, and others 23.3%. Average GBS disability score at admission was 2.9. Immunotherapy was intravenous immunoglobulin 83.3%, plasma exchange 3.3%, and steroid 3.3%. Average length of stay was 14.2 days; assisted ventilation rate was 13.3%. After the average of 1-year follow-up, average GBS disability score was 1.8, good outcome (score <3) was 63.3% and no death. CONCLUSIONS Our study suggests that most GBS patients in Thailand are acute inflammatory demyelinating polyradiculoneuropathy (AIDP) subtype and have a good outcome. Predictors of severe disability are older age, previous diarrhea, autonomic disturbances, severe limb or bulbar weakness at admission, or onset of treatment.
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Affiliation(s)
- Kongkiat Kulkantrakorn
- Neurology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University Rangsit Campus, Klongluang, Pathumthani, Thailand
- Neuroscience Center, Bangkok Hospital Medical Center, Bangkok Hospital Group, Bangkok, Thailand
| | - Puchit Sukphulloprat
- Neurology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University Rangsit Campus, Klongluang, Pathumthani, Thailand
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20
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Aldag M, Albeyoglu S, Ciloglu U, Kutlu H, Ceylan L. Miller-Fisher syndrome after coronary artery bypass surgery. Cardiovasc J Afr 2017; 28:e4-e5. [PMID: 29297541 PMCID: PMC5885042 DOI: 10.5830/cvja-2017-033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 07/13/2017] [Indexed: 12/26/2022] Open
Abstract
Miller–Fisher syndrome (MFS) is an uncommon neurological disorder that is considered a variant of the Guillain–Barre syndrome (GBS). It is clinically defined by a triad of symptoms, namely ataxia, areflexia and ophthalmoplegia. These acute inflammatory polyradiculopathic syndromes can be triggered by viral infections, major surgery, pregnancy or vaccination. While the overall incidence of GBS is 1.2–2.3 per 100 000 per year, MFS is a relatively rare disorder. Only six cases of GBS after cardiac surgery have been reported, and to our knowledge, we describe the first case of MFS after coronary artery bypass surgery. Although cardiac surgery with cardiopulmonary bypass may increase the incidence of MFS and GBS, the pathological mechanism is unclear. Cardiac surgery may be a trigger for the immune-mediated response and may cause devastating complications. It is also important to be alert to de novo autoimmune and unexpected neurological disorders such as MFS after coronary bypass surgery.
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Affiliation(s)
- Mustafa Aldag
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Sebnem Albeyoglu
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Ciloglu
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hakan Kutlu
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Levent Ceylan
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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21
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Verboon C, van Berghem H, van Doorn PA, Ruts L, Jacobs BC. Prediction of disease progression in Miller Fisher and overlap syndromes. J Peripher Nerv Syst 2017; 22:446-450. [DOI: 10.1111/jns.12238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | - Liselotte Ruts
- Department of Neurology; Havenziekenhuis; Rotterdam The Netherlands
| | - Bart C. Jacobs
- Department of Neurology; Erasmus MC; Rotterdam The Netherlands
- Department of Immunology; Erasmus MC; Rotterdam The Netherlands
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22
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Bulbar paralysis associated with Miller-Fisher syndrome and its overlaps in Chinese patients. Neurol Sci 2017; 39:305-311. [DOI: 10.1007/s10072-017-3184-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022]
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23
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The Role of Immunoglobulin in the Treatment of Immune-Mediated Peripheral Neuropathies. JOURNAL OF INFUSION NURSING 2017; 40:375-379. [DOI: 10.1097/nan.0000000000000248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Abstract
Guillain-Barré syndrome has been reported in pregnancy and is a potentially lethal condition. It affects the nervous system with acute onset of symmetric ascending weakness and may result in frank respiratory failure and autonomic dysfunction. Most patients recall symptoms of a respiratory or gastrointestinal illness in the weeks preceding the onset of weakness. Recent evidence suggests a potential role of the Zika virus as a trigger for the syndrome. The diagnosis of Guillain-Barré is clinical. Supportive measures include venous thromboembolism prophylaxis, aggressive physical therapy, pressure ulcer prevention, enteral nutrition, and respiratory support. The mainstay of management comprises plasmapheresis or administration of intravenous immunoglobulins. Affected patients must be closely monitored for development of respiratory failure and autonomic dysfunction. Treatment during pregnancy should follow the same principles as for nonpregnant individuals.
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25
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Wang L, Shao C, Yang C, Kang X, Zhang G. Association of anti-gangliosides antibodies and anti-CMV antibodies in Guillain-Barré syndrome. Brain Behav 2017; 7:e00690. [PMID: 28523231 PMCID: PMC5434194 DOI: 10.1002/brb3.690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/10/2017] [Accepted: 02/28/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Numerous types of infection were closely related to GBS, mainly including Campylobacter jejuni, Cytomegalovirus, which may lead to the production of anti-gangliosides antibodies (AGA). Currently, although there are increased studies on the AGA and a few studies of anti-CMV antibodies in GBS, the association between them remains poorly documented. Therefore, our research aims to analyze the correlation of anti-CMV antibodies and AGA in GBS. METHODS A total of 29 patients with GBS were enrolled in this study. The CMV antibodies were tested by the electrochemiluminescence immunoassay "ECLIA" (Roche Diagnostics GmbH). The serum gangliosides were determined by The EUROLINE test kit. RESULTS Of the 29 patients with GBS, 9 (31%) were AGA-seropositive, in which 22 were CMV-IgG positive in CSF at the same time, but all 29 samples were CMV-IgM negative in both serum and CSF. In the AGA-positive group, the rate of both serum and CSF positive was 87.5% (7/8), higher than 50% (7/14) of the negative group, although no statistical significance was found. In addition, we found that there was a trend of higher ratio of men, a younger age onset, less frequent preceding infection, a higher level of CSF proteins, and less frequent cranial nerve deficits, although the data did not reach a statistical significance. CONCLUSION In spite of no statistical significance association was found between serum AGA and CMV-IgG in serum and CSF. However, we found that there was a trend of high positive rate of both serum and CSF-CMV-IgG in AGA-positive than the negative group. So we should further expand the sample size to analyze the association between AGA and CMV or other neurotropic virus antibodies in various diseases, to observe whether they could be serological marker of these diseases (especially GBS) or the underlying pathogenesis.
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Affiliation(s)
- Lijuan Wang
- Department of Clinical Laboratory Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Chunqing Shao
- Department of Clinical Laboratory Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Chunjiao Yang
- Department of Clinical Laboratory Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Xixiong Kang
- Department of Clinical Laboratory Beijing Tiantan Hospital Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China.,Monogenic Disease Research Center for Neurological Disorder Beijing China
| | - Guojun Zhang
- Department of Clinical Laboratory Beijing Tiantan Hospital Capital Medical University Beijing China.,China National Clinical Research Center for Neurological Diseases Beijing China.,Monogenic Disease Research Center for Neurological Disorder Beijing China
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26
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Verboon C, van Doorn PA, Jacobs BC. Treatment dilemmas in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 2017; 88:346-352. [PMID: 27837102 DOI: 10.1136/jnnp-2016-314862] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/21/2016] [Accepted: 10/27/2016] [Indexed: 12/28/2022]
Abstract
Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy with a highly variable clinical course and outcome. Intravenous immunoglobulin (IVIg) and plasma exchange are proven effective treatments, but the efficacy has been demonstrated mainly on motor improvement in adults with a typical and severe form of GBS. In clinical practice, treatment dilemmas may occur in patients with a relatively mild presentation, variant forms of GBS, or when the onset of weakness was more than 2 weeks ago. Other therapeutic dilemmas may arise in patients who do not improve or even progress after initial treatment. We provide an overview of the current literature about therapeutic options in these situations, and additionally give our personal view that may serve as a basis for therapeutic decision-making.
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Affiliation(s)
| | | | - Bart C Jacobs
- Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.,Immunology, Erasmus MC, Rotterdam, The Netherlands
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27
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Salehi N, Choi ED, Garrison RC. A Case of Miller Fisher Syndrome, Thromboembolic Disease, and Angioedema: Association or Coincidence? AMERICAN JOURNAL OF CASE REPORTS 2017; 18:52-59. [PMID: 28090073 PMCID: PMC5260666 DOI: 10.12659/ajcr.901940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Miller Fisher Syndrome is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia, and is considered to be a variant of Guillain-Barre Syndrome. Miller Fisher Syndrome is observed in approximately 1-5% of all Guillain-Barre cases in Western countries. Patients with Miller Fisher Syndrome usually have good recovery without residual deficits. Venous thromboembolism is a common complication of Guillain-Barre Syndrome and has also been reported in Miller Fisher Syndrome, but it has generally been reported in the presence of at least one prothrombotic risk factor such as immobility. A direct correlation between venous thromboembolism and Miller Fisher Syndrome or Guillain-Barre Syndrome has not been previously described. CASE REPORT We report the case of a 32-year-old Hispanic male who presented with acute, severe thromboembolic disease and concurrently demonstrated characteristic clinical features of Miller Fisher Syndrome including ophthalmoplegia, ataxia, and areflexia. Past medical and family history were negative for thromboembolic disease, and subsequent hypercoagulability workup was unremarkable. During the course of hospitalization, the patient also developed angioedema. CONCLUSIONS We describe a possible association between Miller Fisher Syndrome, thromboembolic disease, and angioedema.
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Affiliation(s)
- Nooshin Salehi
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA
| | - Eric D Choi
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Roger C Garrison
- Department of Medicine, Riverside University Health System, Moreno Valley, CA, USA.,School of Medicine, Loma Linda University, Loma Linda, CA, USA
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28
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Sekiguchi Y, Mori M, Misawa S, Sawai S, Yuki N, Beppu M, Kuwabara S. How often and when Fisher syndrome is overlapped by Guillain-Barré syndrome or Bickerstaff brainstem encephalitis? Eur J Neurol 2016; 23:1058-63. [PMID: 26969889 DOI: 10.1111/ene.12983] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/18/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Fisher syndrome (FS) may overlap with Guillain-Barré syndrome (GBS), in particular the pharyngeal-cervical-brachial variant form (PCB-GBS), or Bickerstaff brainstem encephalitis (BBE). Our aim was to elucidate the frequency of this overlap and the patterns of clinical progression in patients with FS. METHODS Sixty consecutive patients with FS were studied. FS/PCB-GBS was diagnosed when the patients developed pharyngeal, cervical and/or brachial weakness. Patients with flaccid tetraparesis were diagnosed as having FS/conventional GBS. FS/BBE was defined as the development of consciousness disturbances. RESULTS All 60 patients initially developed the FS clinical triad alone (pure FS). Of these, 30 (50%) patients had pure FS throughout their course, whereas the remaining 50% of patients showed an overlap: PCB-GBS in 14 (23%) patients, conventional GBS in nine (15%) patients and BBE in seven (12%) patients. The median (range) durations from FS onset to progression to FS/PCB-GBS, FS/GBS or FS/BBE were 5 (1-7), 3 (1-4) and 3 (1-5) days, respectively. Patients with overlap syndromes more frequently received immune-modulating treatment, and the outcomes were generally favourable. The frequencies of positivity for anti-GQ1b, GT1a, GD1a, GD1b, GalNAc-GD1a and GM1 antibodies were not significantly different amongst the four groups. CONCLUSIONS Of the patients with pure FS, 50% later developed an overlap with PCB-GBS, conventional GBS or BBE. The overlap occurred within 7 days of FS onset; thus, physicians should pay attention to the possible development of this overlap during the first week after FS onset.
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Affiliation(s)
- Y Sekiguchi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - M Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Sawai
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - N Yuki
- University of Sydney, Sydney, NSW, Australia
| | - M Beppu
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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29
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Admission neurophysiological abnormalities in Guillain–Barré syndrome: A single-center experience. Clin Neurol Neurosurg 2015; 135:6-10. [DOI: 10.1016/j.clineuro.2015.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/30/2015] [Accepted: 05/02/2015] [Indexed: 11/21/2022]
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30
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Stübgen JP. Lymphoma-associated dysimmune polyneuropathies. J Neurol Sci 2015; 355:25-36. [PMID: 26070654 DOI: 10.1016/j.jns.2015.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/05/2015] [Accepted: 06/01/2015] [Indexed: 12/24/2022]
Abstract
Lymphoma consists of a variety of malignancies of lymphocyte origin. A spectrum of clinical peripheral neuropathy syndromes with different disease mechanisms occurs in about 5% of lymphoma patients. There exists a complex inter-relationship between lymphoproliferative malignancies and autoimmunity. An imbalance in the regulation of the immune system presumably underlies various immune-mediated neuropathies in patients with lymphoma. This article reviews lymphoma and more-or-less well-defined dysimmune neuropathy subgroups that are caused by humoral and/or cell-mediated immune disease mechanisms directed against known or undetermined peripheral nerve antigens.
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Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY 10065-4885, USA.
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31
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van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014; 10:469-82. [DOI: 10.1038/nrneurol.2014.121] [Citation(s) in RCA: 556] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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Watson E, Sherry A, Inglis NF, Lainson A, Jyothi D, Yaga R, Manson E, Imrie L, Everest P, Smith DGE. Proteomic and genomic analysis reveals novel Campylobacter jejuni outer membrane proteins and potential heterogeneity. EUPA OPEN PROTEOMICS 2014; 4:184-194. [PMID: 27525220 PMCID: PMC4975774 DOI: 10.1016/j.euprot.2014.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/19/2014] [Indexed: 12/24/2022]
Abstract
Gram-negative bacterial outer membrane proteins play important roles in the interaction of bacteria with their environment including nutrient acquisition, adhesion and invasion, and antibiotic resistance. In this study we identified 47 proteins within the Sarkosyl-insoluble fraction of Campylobacter jejuni 81-176, using LC-ESI-MS/MS. Comparative analysis of outer membrane protein sequences was visualised to reveal protein distribution within a panel of Campylobacter spp., identifying several C. jejuni-specific proteins. Smith-Waterman analyses of C. jejuni homologues revealed high sequence conservation amongst a number of hypothetical proteins, sequence heterogeneity of other proteins and several proteins which are absent in a proportion of strains.
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Affiliation(s)
- Eleanor Watson
- Moredun Research Institute, Bush Loan, Penicuik, United Kingdom
| | - Aileen Sherry
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Neil F Inglis
- Moredun Research Institute, Bush Loan, Penicuik, United Kingdom
| | - Alex Lainson
- Moredun Research Institute, Bush Loan, Penicuik, United Kingdom
| | | | - Raja Yaga
- Moredun Research Institute, Bush Loan, Penicuik, United Kingdom
| | - Erin Manson
- Moredun Research Institute, Bush Loan, Penicuik, United Kingdom
| | - Lisa Imrie
- Moredun Research Institute, Bush Loan, Penicuik, United Kingdom
| | - Paul Everest
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David G E Smith
- Moredun Research Institute, Bush Loan, Penicuik, United Kingdom; Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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33
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Tzachanis D, Hamdan A, Uhlmann EJ, Joyce RM. Successful treatment of refractory Guillain-Barré syndrome with alemtuzumab in a patient with chronic lymphocytic leukemia. Acta Haematol 2014; 132:240-3. [PMID: 24853856 DOI: 10.1159/000358292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/02/2014] [Indexed: 12/19/2022]
Abstract
This is the case of a 79-year-old man with chronic lymphocytic leukemia who presented with Guillain-Barré syndrome with features overlapping with the Miller Fisher syndrome and Bickerstaff brainstem encephalitis and positive antiganglioside GQ1b antibody about 6 months after treatment with bendamustine and rituximab. His clinical and neurologic condition continued to deteriorate despite sequential treatment with corticosteroids, intravenous immunoglobulin and plasmapheresis, but in the end, he had a complete and durable response to treatment with alemtuzumab.
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MESH Headings
- Aged
- Alemtuzumab
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antigens, CD/immunology
- Antigens, Neoplasm/immunology
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Autoantibodies/blood
- Autoantibodies/immunology
- Autoantigens/immunology
- Bendamustine Hydrochloride
- CD52 Antigen
- Combined Modality Therapy
- Consciousness Disorders/drug therapy
- Consciousness Disorders/etiology
- Consciousness Disorders/therapy
- Gangliosides/immunology
- Glycoproteins/antagonists & inhibitors
- Glycoproteins/immunology
- Guillain-Barre Syndrome/drug therapy
- Guillain-Barre Syndrome/etiology
- Guillain-Barre Syndrome/therapy
- Herpes Zoster/complications
- Herpesvirus 3, Human/physiology
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Methylprednisolone/therapeutic use
- Miller Fisher Syndrome/drug therapy
- Miller Fisher Syndrome/etiology
- Miller Fisher Syndrome/therapy
- Nitrogen Mustard Compounds/administration & dosage
- Nitrogen Mustard Compounds/adverse effects
- Plasmapheresis
- Remission Induction
- Rituximab
- Virus Activation
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34
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Sato H, Naito K, Hashimoto T. Acute isolated bilateral mydriasis: case reports and review of the literature. Case Rep Neurol 2014; 6:74-7. [PMID: 24803906 PMCID: PMC4000296 DOI: 10.1159/000360849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Isolated bilateral internal ophthalmoplegia is a rare and problematic condition affecting activities of daily living. Herein, we describe the cases of 2 patients with postinfectious isolated bilateral internal ophthalmoplegia, i.e., mydriasis without external ophthalmoplegia. One patient demonstrated no other neurological symptom, while the other patient showed mild gait ataxia. Magnetic resonance imaging revealed no abnormal findings in the brain or brainstem. Light-near dissociation of the pupils was not recognized in either patient, and supersensitivity to dilute pilocarpine was observed in 1 of the 2 patients. An increased titer of the anti-GQ1b IgG antibody was noted in 1 patient. A review of the literature revealed five similar cases; the symptomatic characteristics, ratio of positive anti-GQ1b IgG antibody, and effective treatment are discussed.
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Affiliation(s)
- Hiromasa Sato
- Department of Neurology, Aizawa Hospital, Matsumoto, Japan
| | - Kosuke Naito
- Department of Neurology, Aizawa Hospital, Matsumoto, Japan
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35
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Anti-glycolipid antibodies in patients with neuropathy: A diagnostic assessment. J Clin Neurosci 2014; 21:488-92. [DOI: 10.1016/j.jocn.2013.07.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 07/18/2013] [Accepted: 07/29/2013] [Indexed: 11/20/2022]
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36
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Tuuminen T, Lounamo K, Leirisalo-Repo M. A review of serological tests to assist diagnosis of reactive arthritis: critical appraisal on methodologies. Front Immunol 2013; 4:418. [PMID: 24363655 PMCID: PMC3849596 DOI: 10.3389/fimmu.2013.00418] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/16/2013] [Indexed: 01/17/2023] Open
Abstract
On a population-based level, the incidence of reactive arthritis (ReA) is 0.6–27/100,000. The definition of ReA varies and its pathogenesis is not yet clear. Attempts in basic immunology to suggest hypotheses for proliferation of forbidden B cell clones, molecular mimicry, and involvement of cross-reactive antibodies are helpful but not sufficient. Importantly, for the clinical diagnosis of the preceding infection, serology is widely used. Unfortunately, the accuracy of associations between serologic findings and clinical conclusions is plagued by poor standardization of methods. So far, few attempts have been done to examine the pitfalls of different approaches. Here, we review several serologic techniques, their performance and limitations. We will focus on serology for Yersinia, Campylobacter, Salmonella, Shigella, and Chlamydia trachomatis because these bacteria have a longer history of being associated with ReA. We also address controversies regarding the role of serology for some other bacteria linked to autoimmune disorders.
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Affiliation(s)
- Tamara Tuuminen
- Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki , Helsinki , Finland ; Eastern Finland Laboratory Centre Joint Authority Enterprise (ISLAB), Mikkeli District Laboratory , Mikkeli , Finland
| | - Kari Lounamo
- Department of Infectious Diseases, Health Centre of Lahti , Lahti , Finland
| | - Marjatta Leirisalo-Repo
- Institute of Clinical Medicine, University of Helsinki , Helsinki , Finland ; Department of Medicine, Helsinki University Central Hospital , Helsinki , Finland
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37
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Kaymakamzade B, Selcuk F, Koysuren A, Colpak AI, Mut SE, Kansu T. Pupillary Involvement in Miller Fisher Syndrome. Neuroophthalmology 2013; 37:111-115. [PMID: 28163765 DOI: 10.3109/01658107.2013.792356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 02/03/2013] [Accepted: 03/04/2013] [Indexed: 11/13/2022] Open
Abstract
Miller Fisher Syndrome is characterised by the classical triad of ophthalmoplegia, ataxia, and areflexia. Ophthalmoparesis without ataxia, without areflexia, or with neither have been attributed as atypical forms of MFS. We report two patients with MFS who had tonic pupils and raised anti-GQ1b antibody titres. Bilateral dilated pupils (either tonic or fixed) can be a manifestation of MFS and anti-GQ1b immunoglobulin G (IgG) antibodies are useful to confirm the diagnosis in unexplained cases. The site of involvement is thought to be the ciliary ganglion or short ciliary nerves.
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Affiliation(s)
- Bahar Kaymakamzade
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Ferda Selcuk
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Aydan Koysuren
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
| | - Ayse Ilksen Colpak
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
| | - Senem Ertugrul Mut
- Department of Neurology, Dr. Burhan Nalbantoglu State Hospital, Nicosia Northern Cyprus Cyprus
| | - Tulay Kansu
- Department of Neurology, School of Medicine, Hacettepe University Ankara Turkey
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38
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Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS). Presse Med 2013; 42:e193-201. [PMID: 23628447 DOI: 10.1016/j.lpm.2013.02.328] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/15/2013] [Indexed: 01/11/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute polyneuropathy with a variable degree of weakness that reaches its maximal severity within 4 weeks. The disease is mostly preceded by an infection and generally runs a monophasic course. Both intravenous immunoglobulin (IVIg) and plasma exchange (PE) are effective in GBS. Rather surprisingly, steroids alone are ineffective. Mainly for practical reasons, IVIg usually is the preferred treatment. GBS can be subdivided in the acute inflammatory demyelinating polyneuropathy (AIDP), the most frequent form in the western world; acute motor axonal neuropathy (AMAN), most frequent in Asia and Japan; and in Miller-Fisher syndrome (MFS). Additionally, overlap syndromes exist (GBS-MFS overlap). About 10% of GBS patients have a secondary deterioration within the first 8 weeks after start of IVIg. Such a treatment-related fluctuation (TRF) requires repeated IVIg treatment. About 5% of patients initially diagnosed with GBS turn out to have chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with acute onset (A-CIDP). It is yet unknown whether GBS patients who remain able to walk ('mildly affected GBS patients'), or patients with MFS, also benefit from IVIg. Despite current treatment, GBS remains a severe disease, as about 25% of patients require artificial ventilation during a period of days to months, about 20% of patients are still unable to walk after 6 months and 3-10% of patients die. Additionally, many patients have pain, fatigue or other residual complaints that may persist for months or years. Pain can also be very confusing in making the diagnosis, especially when it precedes the onset of weakness. Advances in prognostic modelling resulted in the development of a simple prognostic scale that predicts the chance for artificial ventilation, already at admission; and in an outcome scale that can be used to determine the chance to be able to walk unaided after 1, 3 or 6 months. GBS patients with a poor prognosis potentially might benefit from a more intensified treatment. A larger increase in serum IgG levels after standard IVIg treatment (0.4 g/kg/day for 5 consecutive days) seems to be related with an improved outcome after GBS. This was one of the reasons to start the second course IVIg trial (SID-GBS trial) in GBS patients with a poor prognosis. This study is currently going on. The international GBS outcome study (IGOS) is a new worldwide prognostic study that aims to get further insight in the (immune)pathophysiology and outcome of GBS, both in children and adults. Hopefully these and other studies will further help to improve the understanding and especially the outcome in patients with GBS.
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39
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Current World Literature. Curr Opin Rheumatol 2013; 25:275-83. [DOI: 10.1097/bor.0b013e32835eb755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Lee SY, Lee YH, Chun BY, Lee SY, Cha SI, Kim CH, Park JY, Lee J. An adult case of Fisher syndrome subsequent to Mycoplasma pneumoniae infection. J Korean Med Sci 2013; 28:152-5. [PMID: 23341726 PMCID: PMC3546094 DOI: 10.3346/jkms.2013.28.1.152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 10/24/2012] [Indexed: 11/20/2022] Open
Abstract
Reported herein is an adult case of Fisher syndrome (FS) that occurred as a complication during the course of community-acquired pneumonia caused by Mycoplasma pneumoniae. A 38-yr-old man who had been treated with antibiotics for serologically proven M. pneumoniae pneumonia presented with a sudden onset of diplopia, ataxic gait, and areflexia. A thorough evaluation including brain imaging, cerebrospinal fluid examination, a nerve conduction study, and detection of serum anti-ganglioside GQ1b antibody titers led to the diagnosis of FS. Antibiotic treatment of the underlying M. pneumoniae pneumonia was maintained without additional immunomodulatory agents. A complete and spontaneous resolution of neurologic abnormalities was observed within 1 month, accompanied by resolution of lung lesions.
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Affiliation(s)
- So Yeon Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yong Hoon Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Bo Young Chun
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Shin Yup Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Ick Cha
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chang Ho Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Yong Park
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jaehee Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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41
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Baig F, Knopp M, Rajabally YA. Diagnosis, epidemiology and treatment of inflammatory neuropathies. Br J Hosp Med (Lond) 2012; 73:380-5. [PMID: 22875431 DOI: 10.12968/hmed.2012.73.7.380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reviews the main diagnostic, epidemiological and therapeutic issues relating to the three main inflammatory neuropathies: Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy. The current knowledge base and recent developments are described.
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Affiliation(s)
- Fahd Baig
- Department of Neurology, University Hospitals of Leicester, Leicester, UK
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42
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Lee KY. Anti-GQ1b-negative Miller Fisher syndrome after Campylobacter jejuni enteritis. Pediatr Neurol 2012; 47:213-5. [PMID: 22883289 DOI: 10.1016/j.pediatrneurol.2012.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
Miller Fisher syndrome is a clinical variant of Guillain-Barré syndrome, characterized by acute-onset ophthalmoplegia, ataxia, and areflexia. It results from an immune response to a cross-reactive antigen between GQ1b ganglioside in human neurons and lipo-oligosaccharides of certain bacteria, e.g., Campylobacter jejuni. Anti-GQ1b antibody is a powerful diagnostic marker for Miller Fisher syndrome. However, only a small number of anti-GQ1b-negative Miller Fisher syndrome cases are documented. A 13-year-old boy demonstrated typical clinical features of Miller Fisher syndrome 1 week after C. jejuni enteritis, but was anti-GQ1b and anti-GM1b antibody-negative.
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Affiliation(s)
- Kyung Yeon Lee
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
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