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Chen J, Tian M, Shu X. Only anti-GM4 antibody positivity in a Chinese girl with overlapping MFS/GBS: a case report. Neurol Sci 2024; 45:2331-2335. [PMID: 38270731 PMCID: PMC11021322 DOI: 10.1007/s10072-024-07300-6] [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: 07/27/2023] [Accepted: 01/01/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS), as the most common cause of acute flaccid paralysis worldwide, is considered a part of a clinical spectrum in which discrete, complete, or incomplete forms of GBS and overlapping syndromes lie on the basis of their clinical features. The term overlapping Miller Fisher syndrome (MFS)/GBS is used when patients with MFS also suffer from progressive motor weakness of the limbs. Anti-ganglioside GQ1b has been specifically associated with MFS and ophthalmoplegia. CASE DESCRIPTION Here, we report a Chinese girl who was diagnosed with overlapping MFS/GBS showing acute flaccid paralysis of all four limbs, sensory symptoms, cranial nerve dysfunction, autonomic involvement, ophthalmoplegia, and ataxia. She had high serum and cerebrospinal fluid titres of monospecific anti-GM4 IgG antibody instead of anti-GQ1b antibody in the acute phase. CONCLUSION Anti-GM4 antibodies usually coexist with other antiganglioside antibodies, leading to missed diagnoses. The findings of the present study show that antibodies to ganglioside GM4 may in overlapping MFS/GBS as the lone immunological factors.
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Affiliation(s)
- Jing Chen
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, No. 143, Dalian Road, Zunyi, 563003, China
| | - Maoqiang Tian
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, No. 143, Dalian Road, Zunyi, 563003, China
| | - XiaoMei Shu
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, No. 143, Dalian Road, Zunyi, 563003, China.
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Luijten LWG, Doets AY, Arends S, Dimachkie MM, Gorson KC, Islam B, Kolb NA, Kusunoki S, Papri N, Waheed W, Walgaard C, Yamagishi Y, Lingsma H, Jacobs BC. Modified Erasmus GBS Respiratory Insufficiency Score: a simplified clinical tool to predict the risk of mechanical ventilation in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 2023; 94:300-308. [PMID: 36428088 DOI: 10.1136/jnnp-2022-329937] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to determine the clinical and diagnostic factors associated with mechanical ventilation (MV) in Guillain-Barré syndrome (GBS) and to simplify the existing Erasmus GBS Respiratory Insufficiency Score (EGRIS) for predicting the risk of MV. METHODS Data from the first 1500 patients included in the prospective International GBS Outcome Study (IGOS) were used. Patients were included across five continents. Patients <6 years and patients from Bangladesh were excluded. Univariable logistic and multivariable Cox regression were used to determine which prespecified clinical and diagnostic characteristics were associated with MV and to predict the risk of MV at multiple time points during disease course. RESULTS 1133 (76%) patients met the study criteria. Independent predictors of MV were a shorter time from onset of weakness until admission, the presence of bulbar palsy and weakness of neck flexion and hip flexion. The modified EGRIS (mEGRIS) was based on these factors and accurately predicts the risk of MV with an area under the curve (AUC) of 0.84 (0.80-0.88). We internally validated the model within the full IGOS cohort and within separate regional subgroups, which showed AUC values of 0.83 (0.81-0.88) and 0.85 (0.72-0.98), respectively. CONCLUSIONS The mEGRIS is a simple and accurate tool for predicting the risk of MV in GBS. Compared with the original model, the mEGRIS requires less information for predictions with equal accuracy, can be used to predict MV at multiple time points and is also applicable in less severely affected patients and GBS variants. Model performance was consistent across different regions.
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Affiliation(s)
- Linda W G Luijten
- Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.,Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Alex Y Doets
- Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Samuel Arends
- Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.,Neurology, Haga Hospital, Den Haag, The Netherlands
| | - Mazen M Dimachkie
- Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kenneth C Gorson
- Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| | - Badrul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division (LSSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Noah A Kolb
- Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Susumu Kusunoki
- Neurology, Kindai University Faculty of Medicine Graduate School of Medical Sciences, Osakasayama, Osaka, Japan
| | - Nowshin Papri
- Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.,Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division (LSSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Waqar Waheed
- Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Christa Walgaard
- Neurology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Yuko Yamagishi
- Neurology, Kindai University Faculty of Medicine Graduate School of Medical Sciences, Osakasayama, Osaka, Japan
| | - Hester Lingsma
- Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bart C Jacobs
- Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
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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: 0.5] [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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