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Chen H, Zhang Y, Pan Y, Wu L, Wang W, Zhang H, Lou H. Antibiotic-induced microbiome depletion promotes intestinal colonization by Campylobacter jejuni in mice. BMC Microbiol 2024; 24:156. [PMID: 38724913 PMCID: PMC11080253 DOI: 10.1186/s12866-024-03313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND To establish a method to induce Campylobacter jejuni colonization in the intestines of C57BL/6 mice through antibiotic-induced microbiome depletion. RESULTS Fifty-four female C57BL/6 mice were divided into the normal, control, and experimental groups. The experimental group was administered intragastric cefoperazone sodium and sulbactam sodium (50 mg/mL) for 2 days; then, the experimental and control mice were intragastrically administered 200 µL C. jejuni, which was repeated once more after 2 days. Animal feces were collected, and the HipO gene of C. jejuni was detected using TaqMan qPCR from day 1 to day 14 after modeling completion. Immunofluorescence was used to detect intestinal C. jejuni colonization on day 14, and pathological changes were observed using hematoxylin and eosin staining. Additionally, 16S rDNA analyses of the intestinal contents were conducted on day 14. In the experimental group, C. jejuni was detected in the feces from days 1 to 14 on TaqMan qPCR, and immunofluorescence-labeled C. jejuni were visibly discernable in the intestinal lumen. The intestinal mucosa was generally intact and showed no significant inflammatory-cell infiltration. Diversity analysis of the colonic microbiota showed significant inter-group differences. In the experimental group, the composition of the colonic microbiota differed from that in the other 2 groups at the phylum level, and was characterized by a higher proportion of Bacteroidetes and a lower proportion of Firmicutes. CONCLUSIONS Microbiome depletion induced by cefoperazone sodium and sulbactam sodium could promote long-term colonization of C. jejuni in the intestines of mice.
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Affiliation(s)
- Haohao Chen
- Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, No. 1188 Wuzhou Street, Wucheng District, Jinhua, Zhejiang Province, P.R. China.
| | - Yanfang Zhang
- Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, No. 1188 Wuzhou Street, Wucheng District, Jinhua, Zhejiang Province, P.R. China
| | - Yi Pan
- Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, No. 1188 Wuzhou Street, Wucheng District, Jinhua, Zhejiang Province, P.R. China
| | - Lin Wu
- Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, No. 1188 Wuzhou Street, Wucheng District, Jinhua, Zhejiang Province, P.R. China
| | - Wenqian Wang
- Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, No. 1188 Wuzhou Street, Wucheng District, Jinhua, Zhejiang Province, P.R. China
| | - Hui Zhang
- Animal Center, Jinhua Food and Drug Inspection and Testing Research Institute, Jinhua, Zhejiang Province, P.R. China
| | - Hongqiang Lou
- Medical Molecular Biology Laboratory, School of Medicine, Jinhua Polytechnic, No. 1188 Wuzhou Street, Wucheng District, Jinhua, Zhejiang Province, P.R. China.
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Zhang X, Yu D. Superacute onset of Guillain-Barré syndrome after elective spinal surgery: A case report and literature review. Medicine (Baltimore) 2024; 103:e37925. [PMID: 38701319 PMCID: PMC11062723 DOI: 10.1097/md.0000000000037925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
RATIONALE Guillain-Barré syndrome (GBS) epitomizes an acute peripheral neuropathy hallmarked by an autoimmune retort directed at the myelin sheath enwrapping peripheral nerves. While it is widely acknowledged that a majority of GBS patients boast a history of antecedent infections, the documentation of postoperative GBS occurrences is progressively mounting. Drawing upon an exhaustive compendium of recent case reports, the disease's inception spans a gamut from within 1 hour to 1.2 years. PATIENT CONCERNS At this juncture, we proffer a singular case: an instance involving a 51-year-old gentleman who underwent lumbar spine surgery, only to encounter immediate debilitation of limb and respiratory musculature. DIAGNOSES Post elimination of variables linked to anesthetic agents, encephalon, and spinal cord pathologies, a potent suspicion of superacute GBS onset emerged. INTERVENTIONS Subsequent to immunoglobulin therapy, plasmapheresis, and adjunctive support, the patient's ultimate demise became manifest. OUTCOMES No progress was found to date. LESSONS Given GBS's potential to instigate paralysis, respiratory collapse, and autonomic nervous system aberrations, alongside other pernicious sequelae, coupled with the exceptional rarity of the temporal onset in this particular instance, it undeniably proffers an imposing conundrum for anesthetists in the realm of differential diagnosis and therapeutic conduct. During the postoperative convalescence phase under anesthesia, should the patient evince deviant limb musculature vigor and compromised respiratory sinews, the prospect of GBS must not be consigned to oblivion. Precision in diagnosis conjoined with apt therapeutic measures could well be the harbinger of a divergent denouement for the afflicted patient.
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Affiliation(s)
- Xinyu Zhang
- Department of Anesthesiology, The Second People’s Hospital of Yibin, Yibin, China
| | - Deshui Yu
- Department of Anesthesiology, The Second People’s Hospital of Yibin, Yibin, China
- Clinical Research and Translational Center, Second People’s Hospital of Yibin City-West China Yibin Hospital, Sichuan University, Yibin, China
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Vallat J, Mathis S. Pathology explains various mechanisms of auto-immune inflammatory peripheral neuropathies. Brain Pathol 2024; 34:e13184. [PMID: 37356965 PMCID: PMC10901618 DOI: 10.1111/bpa.13184] [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: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023] Open
Abstract
Autoimmune neuropathies are a heterogeneous group of rare and disabling diseases in which the immune system is thought to target antigens in the peripheral nervous system: they usually respond to immune therapies. Guillain-Barré syndrome is divided into several subtypes including "acute inflammatory demyelinating polyradiculoneuropathy," "acute motor axonal neuropathy," "acute motor sensory neuropathy," and other variants. Chronic forms such as chronic inflammatory demyelinating polyneuropathy (CIDP) and other subtypes and polyneuropathy associated with IgM monoclonal gammopathy; autoimmune nodopathies also belong to this group of auto-immune neuropathies. It has been shown that immunoglobulin G from the serum of about 30% of CIDP patients immunolabels nodes of Ranvier or paranodes of myelinated axons. Whatever the cause of myelin damage of the peripheral nervous system, the initial attack on myelin by a dysimmune process may begin either at the internodal area or in the paranodal and nodal regions. The term "nodoparanodopathy" was first applied to some "axonal Guillain-Barré syndrome" subtypes, then extended to cases classified as CIDP bearing IgG4 antibodies against paranodal axoglial proteins. In these cases, paranodal dissection develops in the absence of macrophage-induced demyelination. In contrast, the mechanisms of demyelination of other dysimmune neuropathies induced by macrophages are unexplained, as no antibodies have been identified in such cases. The main objective of this presentation is to show that the pathology illustrates, confirms, and may explain such mechanisms.
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Affiliation(s)
- Jean‐Michel Vallat
- Department and Laboratory of Neurology, National Reference Center for ‘Rare Peripheral Neuropathies’University Hospital of Limoges (CHU Limoges)LimogesFrance
| | - Stéphane Mathis
- Department of Neurology (Nerve‐Muscle Unit), ‘Grand Sud‐Ouest’ National Reference Center for Neuromuscular Disorders, ALS CenterUniversity Hospital of Bordeaux (CHU Bordeaux)BordeauxFrance
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Berciano J. The pathophysiological role of endoneurial inflammatory edema in early classical Guillain-Barré syndrome. Clin Neurol Neurosurg 2024; 237:108131. [PMID: 38308937 DOI: 10.1016/j.clineuro.2024.108131] [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: 11/21/2023] [Revised: 12/22/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
The objective of this review was to analyze the pathophysiological role of endoneurial inflammatory edema in initial stages of classic Guillain-Barré syndrome (GBS), arbitrarily divided into very early GBS (≤ 4 days after symptom onset) and early GBS (≤ 10 days). Classic GBS, with variable degree of flaccid and areflexic tetraparesis, encompasses demyelinating and axonal forms. Initial autopsy studies in early GBS have demonstrated that endoneurial inflammatory edema of proximal nerve trunks, particularly spinal nerves, is the outstanding lesion. Variable permeability of the blood-nerve barrier dictates such lesion topography. In proximal nerve trunks possessing epi-perineurium, edema may increase the endoneurial fluid pressure causing ischemic changes. Critical analysis the first pathological description of the axonal form GBS shows a combination of axonal degeneration and demyelination in spinal roots, and pure Wallerian-like degeneration in peripheral nerve trunks. This case might be reclassified as demyelinating GBS with secondary axonal degeneration. Both in acute motor axonal neuropathy and acute motor-sensory axonal neuropathy, Wallerian-like degeneration of motor fibers predominates in the distal part of ventral spinal roots abutting the dura mater, another feature re-emphasizing the pathogenic relevance of this area. Electrophysiological and imaging studies also point to a predominant alteration at the spinal nerve level, which is a hotspot in any early GBS subtype. Serum biomarkers of axonal damage, including neurofilament light chain and peripherin, are increased in the great majority of patients with any early GBS subtype; endoneurial ischemia of proximal nerve trunks could contribute to such axonal damage. It is concluded that inflammatory edema of proximal nerve trunks is an essential pathogenic event in early GBS, which has a tangible impact for accurate approach to the disease.
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Affiliation(s)
- José Berciano
- University of Cantabria, University Hospital "Marqués de Valdecilla (IDIVAL)", and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
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Qinrong H, Yuxia C, Ling L, Huayu L, Lei X, Xiaoli L, Nong X. Reliability and validity of prognostic indicators for Guillain-Barré syndrome in children. Dev Med Child Neurol 2023; 65:563-570. [PMID: 36175376 DOI: 10.1111/dmcn.15418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
AIM To explore the clinical characteristics and prognostic predictors of Guillain-Barré syndrome (GBS) in Chinese paediatric patients. METHOD The clinical features of children with GBS hospitalized in the Children's Hospital of Chongqing Medical University were summarized retrospectively. The correlation between the Erasmus GBS Outcome Score (EGOS)/modified Erasmus GBS Outcome Score (mEGOS), GBS disability score (GDS)/modified Rankin Scale (MRS), Erasmus GBS Respiratory Insufficiency Score (EGRIS), and mechanical ventilation were evaluated. RESULTS One hundred forty-two patients (86 males, 56 females; median 62.50 months [interquartile range 41.00-97.50]) with classic GBS were enrolled in the study. In the present GBS cohort, 134 (94.37%) patients could walk independently (GDS ≤2) and 121 (85.21%) could manage without assistance (MRS ≤2) at 6 months. Eighteen (12.68%) patients with GBS required mechanical ventilation. The performance of mEGOS on admission, mEGOS on day 7, and EGOS-predicted GDS outcome at 4 weeks, 3 months, and 6 months in the paediatric patients with GBS admitted within 2 weeks of disease onset and that of the MRS outcome were evaluated. The EGRIS in individuals who required mechanical ventilation was significantly higher than in patients without mechanical ventilation (median = 6 vs median = 3, p < 0.001). INTERPRETATION In Chinese paediatric patients with GBS who were admitted 2 weeks after disease onset, the mEGOS and EGOS are validated indicators for the prediction of clinical outcomes 6 months after onset. EGRIS is helpful in predicting the implementation of mechanical ventilation in the acute phase. WHAT THIS PAPER ADDS The Erasmus Guillain-Barré syndrome (GBS) Outcome Score (EGOS) and modified EGOS are reliable prognostic predictors in paediatric patients with GBS. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is an effective predictor of mechanical ventilation in paediatric patients with GBS. An EGRIS of ≥5 indicates a high risk of mechanical ventilation in the acute phase.
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Affiliation(s)
- Huang Qinrong
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Chen Yuxia
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Liu Ling
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Luo Huayu
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xu Lei
- Department of Rehabilitation Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Li Xiaoli
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xiao Nong
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
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Kozyreva AA, Bembeeva RT, Druzhinina ES, Zavadenko NN. [Guillain-Barre syndrome in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-32. [PMID: 37942969 DOI: 10.17116/jnevro202312309220] [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] [Indexed: 11/10/2023]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated disease of the peripheral nervous system that can occur in both children and adults. The classic presentation of GBS is characterized by progressive symmetrical, ascending muscle weakness. Patients with GBS require meticulous monitoring due to the risk of bulbar syndrome, respiratory failure and autonomic dysfunction, which can be life-threatening. Early diagnosis and timely prescription of pathogenetic therapy for GBS are particularly important, especially in young children. Meanwhile, the spectrum of disorders covered by GBS has expanded significantly; its eponym is now designate any variant of acute dysimmune polyneuropathy, and its atypical forms pose a serious diagnostic problem for clinicians. This review article provides an analysis of the data available in the medical literature on GBS in children and discusses the tactics for diagnosing and managing patients with GBS, taking into account the Russian and European clinical recommendations.
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Affiliation(s)
- A A Kozyreva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - R Ts Bembeeva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - E S Druzhinina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - N N Zavadenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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Younger DS. Critical illness-associated weakness and related motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:707-777. [PMID: 37562893 DOI: 10.1016/b978-0-323-98818-6.00031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Weakness of limb and respiratory muscles that occurs in the course of critical illness has become an increasingly common and serious complication of adult and pediatric intensive care unit patients and a cause of prolonged ventilatory support, morbidity, and prolonged hospitalization. Two motor disorders that occur singly or together, namely critical illness polyneuropathy and critical illness myopathy, cause weakness of limb and of breathing muscles, making it difficult to be weaned from ventilatory support, commencing rehabilitation, and extending the length of stay in the intensive care unit, with higher rates of morbidity and mortality. Recovery can take weeks or months and in severe cases, and may be incomplete or absent. Recent findings suggest an improved prognosis of critical illness myopathy compared to polyneuropathy. Prevention and treatment are therefore very important. Its management requires an integrated team approach commencing with neurologic consultation, creatine kinase (CK) measurement, detailed electrodiagnostic, respiratory and neuroimaging studies, and potentially muscle biopsy to elucidate the etiopathogenesis of the weakness in the peripheral and/or central nervous system, for which there may be a variety of causes. These tenets of care are being applied to new cases and survivors of the coronavirus-2 disease pandemic of 2019. This chapter provides an update to the understanding and approach to critical illness motor disorders.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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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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Campylobacter jejuni Infection, Anti-Ganglioside Antibodies, and Neuropathy. Microorganisms 2022; 10:microorganisms10112139. [PMID: 36363731 PMCID: PMC9695184 DOI: 10.3390/microorganisms10112139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Preceding infection with Campylobacter jejuni (Cj) occurs in approximately 30% of patients with Guillain–Barre syndrome (GBS), and the risk of GBS following Cj infection is increased by 77 to 100-fold. GBS is most often of the axonal subtype and is thought to be mediated by IgG antibodies to peripheral nerve gangliosides that are cross reactive with oligosaccharides in the Cj lipopolysaccharides (LPS). The antibodies are thought to be induced by molecular mimicry, where immune reactivity to a cross reactive epitope in the infectious organism and normal tissue can cause autoimmune disease. Clonally restricted IgM antibodies that react with the same oligosaccharides in gangliosides and Cj-LPS are associated with chronic neuropathies of otherwise similar phenotypes. The anti-ganglioside antibodies in GBS are of the IgG1 and IgG3 subclasses, indicating T-cell reactivity to the same antigens that could help disrupt the blood–nerve barrier. Cj infection can activate multiple innate and adoptive pro-inflammatory pathways that can overcome immune tolerance and induce autoimmunity. Elucidation of the specific immune mechanisms involved in the development of the autoantibodies and neuropathy would help our understanding of the relation between infection and autoimmunity and aid in the development of more effective preventive interventions and therapies.
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Zhai Q, Guo C, Xue F, Qiang J, Li C, Guo L. Guillain-Barré Syndrome in Northern China: A Retrospective Analysis of 294 Patients from 2015 to 2020. J Clin Med 2022; 11:jcm11216323. [PMID: 36362550 PMCID: PMC9658830 DOI: 10.3390/jcm11216323] [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: 08/27/2022] [Revised: 09/26/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Acute motor axonal neuropathy (AMAN) was first reported to be the main subtype of Guillain−Barré syndrome (GBS) in northern China in the 1990s. About 30 years has passed, and it is unknown whether the disease spectrum has changed over time in northern China. We aimed to study the epidemiological, clinical, and electrophysiological features of GBS in northern China in recent years. Methods: We retrospectively analyzed the medical records of GBS patients admitted to the Second Hospital of Hebei Medical University in northern China from 2015 to 2020. Results: A total of 294 patients with GBS were enrolled, with median age 53 years and 60.5% of participants being male, and a high incidence in summer and autumn. AMAN was still the predominant subtype in northern China (40.1%). The AMAN patients had shorter time to nadir, longer hospitalization time, and a more severe HFGS score at discharge than acute inflammatory demyelinating polyneuropathies (AIDP) (p < 0.05). With SPSS multivariable logistic regression analysis, we found the GBS disability score (at admission), dysphagia, and dysautonomia were independent risk factors for GBS patients requiring MV (p < 0.05). In comparison with other regions, the proportion of AMAN in northern China (40.1%) was higher than in eastern (35%) and southern (19%) China. Conclusions: AMAN is still the predominant subtype in northern China after 30 years, but there have been changes over time in the GBS spectrum since the 1990s. There are regional differences in GBS in China.
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Affiliation(s)
- Qiongqiong Zhai
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Cheng Guo
- Department of Pediatrics, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Fang Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Jing Qiang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Chaonan Li
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
- Correspondence:
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Stein RA. Campylobacter jejuni and Postinfectious Autoimmune Diseases: A Proof of Concept in Glycobiology. ACS Infect Dis 2022; 8:1981-1991. [PMID: 36137262 DOI: 10.1021/acsinfecdis.2c00397] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Glycans, one of the most diverse groups of macromolecules, are ubiquitous constituents of all cells and have many critical functions, including the interaction between microbes and their hosts. One of the best model organisms to study the host-pathogen interaction, the gastrointestinal pathogen Campylobacter jejuni dedicates extensive resources to glycosylation and exhibits a diverse array of surface sugar-coated displays. The first bacterium where N-linked glycosylation was described, C. jejuni can additionally modify proteins by O-linked glycosylation, has extracellular capsular polysaccharides that are important for virulence and represent the major determinant of the Penner serotyping scheme, and has outer membrane lipooligosaccharides that participate in processes such as colonization, survival, inflammation, and immune evasion. In addition to causing gastrointestinal disease and extraintestinal infections, C. jejuni was also linked to postinfectious autoimmune neuropathies, of which Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) are the most extensively characterized ones. These postinfectious autoimmune neuropathies occur when specific bacterial surface lipooligosaccharides mimic gangliosides in the host nervous system. C. jejuni provided the first proof of concept for the involvement of molecular mimicry in the pathogenesis of an autoimmune disease and, also, for the ability of a bacterial polymorphism to shape the clinical presentation of the postinfectious autoimmune neuropathy. The scientific journey that culminated with elucidating the mechanistic details of the C. jejuni-GBS link was the result of contributions from several fields, including microbiology, structural biology, glycobiology, genetics, and immunology and provides an inspiring and important example to interrogate other instances of molecular mimicry and their involvement in autoimmune disease.
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Affiliation(s)
- Richard A Stein
- Industry Associate Professor NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn, New York 11201, United States
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Berciano J. Axonal pathology in early stages of Guillain-Barré syndrome. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:466-479. [PMID: 35779867 DOI: 10.1016/j.nrleng.2020.08.001] [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: 05/15/2018] [Accepted: 06/12/2018] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an acute-onset, immune-mediated disease of the peripheral nervous system. It may be classified into 2 main subtypes: demyelinating (AIDP) and axonal (AMAN). This study aims to analyse the mechanisms of axonal damage in the early stages of GBS (within 10 days of onset). DEVELOPMENT We analysed histological, electrophysiological, and imaging findings from patients with AIDP and AMAN, and compared them to those of an animal model of myelin P2 protein-induced experimental allergic neuritis. Inflammatory oedema of the spinal nerve roots and spinal nerves is the initial lesion in GBS. The spinal nerves of patients with fatal AIDP may show ischaemic lesions in the endoneurium, which suggests that endoneurial inflammation may increase endoneurial fluid pressure, reducing transperineurial blood flow, potentially leading to conduction failure and eventually to axonal degeneration. In patients with AMAN associated with anti-ganglioside antibodies, nerve conduction block secondary to nodal sodium channel dysfunction may affect the proximal, intermediate, and distal nerve trunks. In addition to the mechanisms involved in AIDP, active axonal degeneration in AMAN may be associated with nodal axolemma disruption caused by anti-ganglioside antibodies. CONCLUSION Inflammatory oedema of the proximal nerve trunks can be observed in early stages of GBS, and it may cause nerve conduction failure and active axonal degeneration.
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Affiliation(s)
- J Berciano
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain.
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Berciano J. Axonal pathology in early stages of Guillain-Barré syndrome. Neurologia 2022; 37:466-479. [PMID: 30057217 DOI: 10.1016/j.nrl.2018.06.002] [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: 05/15/2018] [Revised: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an acute-onset, immune-mediated disease of the peripheral nervous system. It may be classified into 2 main subtypes: demyelinating (AIDP) and axonal (AMAN). This study aims to analyse the mechanisms of axonal damage in the early stages of GBS (within 10days of onset). DEVELOPMENT We analysed histological, electrophysiological, and imaging findings from patients with AIDP and AMAN, and compared them to those of an animal model of myelin P2 protein-induced experimental allergic neuritis. Inflammatory oedema of the spinal nerve roots and spinal nerves is the initial lesion in GBS. The spinal nerves of patients with fatal AIDP may show ischaemic lesions in the endoneurium, which suggests that endoneurial inflammation may increase endoneurial fluid pressure, reducing transperineurial blood flow, potentially leading to conduction failure and eventually to axonal degeneration. In patients with AMAN associated with anti-ganglioside antibodies, nerve conduction block secondary to nodal sodium channel dysfunction may affect the proximal, intermediate, and distal nerve trunks. In addition to the mechanisms involved in AIDP, active axonal degeneration in AMAN may be associated with nodal axolemma disruption caused by anti-ganglioside antibodies. CONCLUSION Inflammatory oedema of the proximal nerve trunks can be observed in early stages of GBS, and it may cause nerve conduction failure and active axonal degeneration.
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Affiliation(s)
- J Berciano
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, España.
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14
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Arends S, Drenthen J, van den Bergh P, Franssen H, Hadden RDM, Islam B, Kuwabara S, Reisin RC, Shahrizaila N, Amino H, Antonini G, Attarian S, Balducci C, Barroso F, Bertorini T, Binda D, Brannagan TH, Buermann J, Casasnovas C, Cavaletti G, Chao CC, Dimachkie MM, Fulgenzi EA, Galassi G, Gutiérrez Gutiérrez G, Harbo T, Hartung HP, Hsieh ST, Kiers L, Lehmann HC, Manganelli F, Marfia GA, Mataluni G, Pardo J, Péréon Y, Rajabally YA, Santoro L, Sekiguchi Y, Stein B, Stettner M, Uncini A, Verboon C, Verhamme C, Vytopil M, Waheed W, Wang M, Zivkovic S, Jacobs BC, Cornblath DR. Electrodiagnosis of Guillain-Barre syndrome in the International GBS Outcome Study: Differences in methods and reference values. Clin Neurophysiol 2022; 138:231-240. [PMID: 35078730 DOI: 10.1016/j.clinph.2021.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe the heterogeneity of electrodiagnostic (EDx) studies in Guillain-Barré syndrome (GBS) patients collected as part of the International GBS Outcome Study (IGOS). METHODS Prospectively collected clinical and EDx data were available in 957 IGOS patients from 115 centers. Only the first EDx study was included in the current analysis. RESULTS Median timing of the EDx study was 7 days (interquartile range 4-11) from symptom onset. Methodology varied between centers, countries and regions. Reference values from the responding 103 centers were derived locally in 49%, from publications in 37% and from a combination of these in the remaining 15%. Amplitude measurement in the EDx studies (baseline-to-peak or peak-to-peak) differed from the way this was done in the reference values, in 22% of motor and 39% of sensory conduction. There was marked variability in both motor and sensory reference values, although only a few outliers accounted for this. CONCLUSIONS Our study showed extensive variation in the clinical practice of EDx in GBS patients among IGOS centers across the regions. SIGNIFICANCE Besides EDx variation in GBS patients participating in IGOS, this diversity is likely to be present in other neuromuscular disorders and centers. This underlines the need for standardization of EDx in future multinational GBS studies.
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Affiliation(s)
- Samuel Arends
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Haga Teaching Hospital The Hague, The Hague, the Netherlands.
| | - Judith Drenthen
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | | | - Hessel Franssen
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert D M Hadden
- Department of Neurology, King's College Hospital, London, United Kingdom.
| | - Badrul Islam
- Laboratory Sciences and Services Division (LSSD), International Centre for Diarrhoeal Disease Research (icddr,b) Dhaka, Bangladesh.
| | - Satoshi Kuwabara
- Department of Neurology, Chiba University Hospital, Chiba, Japan.
| | - Ricardo C Reisin
- Department of Neurology, Hospital Británico, Buenos Aires, Argentina.
| | | | - Hiroshi Amino
- Department of Neurology, Chiba University Hospital, Chiba, Japan
| | - Giovanni Antonini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Shahram Attarian
- Department Neuromuscular Disorders, Hôpital de La Timone, Marseille, France.
| | - Claudia Balducci
- Department of Neurology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Fabio Barroso
- Department of Neurology, Fleni Hospital, Buenos Aires, Argentina.
| | - Tulio Bertorini
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, USA.
| | - Davide Binda
- Department of Neurology, Valduce Hospital, Como, Italy
| | | | - Jan Buermann
- Department of Neurology, University Hospital of Saarland, Homburg, Germany; Department of Neurology, MVZ Pfalzklinikum, Kusel, Germany.
| | - Carlos Casasnovas
- Department of Neurology, Hospital Universitari de Bellvitge-IDIBELL and CIBERER, Barcelona, Spain.
| | - Guido Cavaletti
- Department of Neurology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Chi-Chao Chao
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Mazen M Dimachkie
- Department of Neurology, The University of Kansas Medical Center, Kansas City, USA.
| | - Ernesto A Fulgenzi
- Department of Neurology, Hospital Cesar Milstein, Buenos Aires, Argentina.
| | - Giuliana Galassi
- Department of Neurology, University Hospital of Modena, Modena, Italy.
| | | | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Sung-Tsang Hsieh
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Lynette Kiers
- Clinical Neurophysiology, Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia.
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - Girolama A Marfia
- Department of System Medicine, Dysimmune Neuropathies Unit, Policlinico Tor Vergata, Roma, Italy.
| | - Giorgia Mataluni
- Department of System Medicine, Dysimmune Neuropathies Unit, Policlinico Tor Vergata, Roma, Italy
| | - Julio Pardo
- Department of Neurology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
| | - Yann Péréon
- Department of Clinical Neurophysiology, Reference Centre for Neuromuscular Disorders AOC, Filnemus, Euro-NMD, University of Nantes, Nantes, France.
| | - Yusuf A Rajabally
- Department of Neurology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
| | - Lucio Santoro
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy.
| | - Yukari Sekiguchi
- Department of Neurology, Chiba University Hospital, Chiba, Japan.
| | - Beth Stein
- Department of Neurology, St. Joseph's Regional Medical Center, Paterson, USA.
| | - Mark Stettner
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University of Duisburg-Essen, Essen, Germany.
| | - Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. D'Annunzio", Chieti, Italy.
| | - Christine Verboon
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Camiel Verhamme
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Michal Vytopil
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA.
| | - Waqar Waheed
- Department of Neurology, University of Vermont Medical Centre, Burlington, USA.
| | - Min Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
| | - Sasha Zivkovic
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, USA.
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - David R Cornblath
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Lv J, Zhaori G. Collaborative studies of U.S.–China neurologists on acute motor axonal neuropathy. Pediatr Investig 2022; 6:1-4. [PMID: 35382424 PMCID: PMC8960912 DOI: 10.1002/ped4.12316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Junlan Lv
- Department of Neurology, Beijing Children's Hospital Capital Medical University, National Center for Children's Health Beijing China
| | - Getu Zhaori
- Editorial Office, Pediatric Investigation Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China
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16
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Lestayo O'Farrill Z, González-Quevedo A, Gutierrez-Gil J, Hernández-Cáceres JL, Sistach-Vega V. Proposal for the functional assessment of acute inflammatory neuropathy (FAAIN) in Guillain-Barré syndrome. Neurol Res 2022; 44:534-543. [PMID: 35168471 DOI: 10.1080/01616412.2021.2024725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Guillain Barré syndrome (GBS) functional assessment is necessary in clinical practice, research and clinical trials. Existing instruments are not sensitive to change and are not applicable to the current GBS clinical spectrum. OBJECTIVE To construct a functional assessment for acute inflammatory neuropathies (FAAIN-GBS), inclusive for current GBS spectrum that assesses extension and intensity separately. METHODS FAAIN-GBS subscales were constructed. Its structure and interpretation were defined. It was validated using data from medical record of 167 GBS patients admitted to the Institute of Neurology and Neurosurgery. Cronbach α was used for items reduction and reliability analysis. Bartlett sphericity test was performed. Exploratory factor analysis (EFA) of the main components, with varimax rotation, was applied to evaluate dimensionality and content validity. Hughes scale was used as gold standard for criterion validity. Sensitivity, specificity and area under the receiver operating characteristic curves (AUROC), were calculated. Construct validity was assessed by confirmatory factor analysis (CFA). RESULTS FAAIN-GBS is made up of two subscales (extension and intensity). The final score is obtained by averaging both dimensions. Internal consistency was acceptable (Cronbach 0.745). EFA showed three dimensions: intensity, spinal extension and cranial extension. Spearman correlation between FAAIN-GBS and Hughes scale was 0.463. Sensitivity (0.714) and specificity (0.986) values showed the good behavior of the scale; AUROC was 0.93. CONCLUSION FAAIN-GBS was constructed and a first step of validation was made, showing good internal consistency and validity. New prospective studies with large populations will be necessary to perfect this instrument that could be useful in neurological practice.
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Affiliation(s)
- Zurina Lestayo O'Farrill
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
| | - Alina González-Quevedo
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
| | - Joel Gutierrez-Gil
- Neuromuscular Section, Neurology Department, National Institute of Neurology and Neurosurgery, La Habana, Cuba
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17
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Marzoughi S, Marulanda L, Ngo D, Chen T. Pearls & Oy-sters: Delayed Diagnosis of Acute Motor Axonal Neuropathy With Cardiac Arrest. Neurology 2021; 98:336-339. [PMID: 34906977 DOI: 10.1212/wnl.0000000000013220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present the case of a 53-year-old female who presented with right lower extremity weakness with preceding systemic symptoms including fever and chest pain. She developed rapid quadriparesis over 24 hours and had ventricular fibrillation with cardiac arrest. Examination demonstrated tetraplegia, facial diplegia with spared extra-ocular movements and areflexia. Electrodiagnostic studies including nerve conduction studies and electromyography were consistent with Acute Motor Axonal Neuropathy (AMAN). This case highlights an atypical asymmetric presentation with initially preserved reflexes, rapid progression and cardiac dysfunction that can occur independent of dysautonomia. Treatment options include intravenous immunoglobulin (IVIg) or plasmapheresis as well as supportive care and long term multidisciplinary rehabilitation and communication strategies.
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Affiliation(s)
- Sina Marzoughi
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Marulanda
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dian Ngo
- School of Pharmacy, Department of Pharmacy, University of British Columbia, Vancouver BC, Canada
| | - Tychicus Chen
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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18
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Zhao F, Wang J, Zhang J, Pang X, Huang S, Chang X, Guo J, Zhang W. Pain in acute motor axonal neuropathy. Muscle Nerve 2021; 64:739-743. [PMID: 34506042 DOI: 10.1002/mus.27414] [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: 04/08/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS Patients with acute motor axonal neuropathy (AMAN) generally have pure motor neuropathy and clinicians usually do not link pain with AMAN. The aim of this retrospective study was to describe the character, location, and intensity of pain in AMAN and acute inflammatory demyelinating polyneuropathy (AIDP) in the acute phase. METHODS This was a retrospective study in 44 patients with Guillain-Barré syndrome (GBS) having progressive weakness of more than one limb. The information, including the demographic characteristics, preceding infections, clinical symptoms and signs, severity at nadir, the characteristics of pain, use of analgesics, laboratory and electrophysiological data, and the medical treatment for GBS, were collected from the medical records. RESULTS In 44 patients, 40.9% were diagnosed as AMAN, and 34.1% as AIDP. Pain was more prevalent in AMAN (76.5%) than in AIDP (26.7%, P = .02). Low back and extremities were the most common locations of pain in AMAN (7/13 and 7/13, respectively) and AIDP (2/4 and 2/4, respectively). DISCUSSION Pain was a common symptom in AMAN in the acute stage. The presence or absence of pain is not useful for distinguishing AIDP from AMAN.
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Affiliation(s)
- Fei Zhao
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaomin Pang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Shan Huang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xueli Chang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junhong Guo
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
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19
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Ruiz-Sandoval JL, Salvatella-Gutiérrez AP, López-Valencia G, Chiquete E, Ruiz-Herrera V, Pérez-Gómez HR, Adrián MGL, Jiménez-Ruiz A, Rodríguez-Hinojosa J, Quintero-Reyes Á, González-Jaime JDJ, Villaseñor Cabrera TDJ. Clinical Characteristics and Predictors of Short-Term Outcome in Mexican Adult Patients with Guillain-Barré Syndrome. Neurol India 2021; 69:107-114. [PMID: 33642280 DOI: 10.4103/0028-3886.310063] [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] [Indexed: 11/04/2022]
Abstract
Background Information regarding the clinical presentation and outcome of Guillain-Barré Syndrome (GBS) in adults from Latin America is limited. Objective To identify clinical characteristics and short-term outcome predictors in adult Mexican patients with GBS. Patients and Methods We included adult patients with clinical and electrophysiological data with confirmed GBS, admitted to a tertiary hospital in Western Mexico, from January 2002 to February 2011. A good outcome at hospital discharge was considered if patients had a Hughes score of 0-2 and at 3 and 6 months, a Hughes score of 0-1. Results A total of 115 patients were analyzed (68% men, mean age 44 years old, range 18-84). Previous infection occurred in 63% of cases. Descendent pattern of weakness was observed in 40 (35%) patients. GBS subtypes were: acute motor axonal neuropathy in 31%, acute inflammatory demyelinating polyneuropathy in 29%, sensory axonal neuropathy (AMSAN) in 18%, and equivocal in 22%. A total of 73 (63%) patients received induction therapy: 50 (68%) received plasmapheresis and 13 (18%) received intravenous immunoglobulin (IVIG). In-hospital mortality occurred in 14 (12%) patients. Early gait complaints and emergency room admission with mild Hughes score (0-2) were predictors for a good outcome at hospital discharge (P < 0.05); meanwhile, age >75 years; dysarthria and higher Hughes score were associated with a poor outcome(P < 0.05). Conclusions Axonal pattern, motor involvement, and the descendent pattern of presentation were the main clinical GBS findings in our cohort. Higher Hughes scale scores at hospital admission were a strong predictor for a bad outcome at hospital discharge and short-term follow-up, independently of treatment type or in-hospital management. GBS in Mexico still carries considerable mortality.
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Affiliation(s)
- Jose Luis Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara; Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | | | - Germán López-Valencia
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Erwin Chiquete
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Vida Ruiz-Herrera
- Department of Infectology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Héctor Raúl Pérez-Gómez
- Department of Infectology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Miranda-García Luis Adrián
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara; Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Amado Jiménez-Ruiz
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Jorge Rodríguez-Hinojosa
- Department of Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Ángeles Quintero-Reyes
- Department of Blood Bank and Transfusional Center, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - José de Jesús González-Jaime
- Department of Physical Medicine and Rehabilitation, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Teresita de Jesús Villaseñor Cabrera
- Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Department of Neuropsychology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
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20
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Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet 2021; 397:1214-1228. [PMID: 33647239 DOI: 10.1016/s0140-6736(21)00517-1] [Citation(s) in RCA: 220] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/07/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
Guillain-Barré syndrome is the most common cause of acute flaccid paralysis worldwide. Most patients present with an antecedent illness, most commonly upper respiratory tract infection, before the onset of progressive motor weakness. Several microorganisms have been associated with Guillain-Barré syndrome, most notably Campylobacter jejuni, Zika virus, and in 2020, the severe acute respiratory syndrome coronavirus 2. In C jejuni-related Guillain-Barré syndrome, there is good evidence to support an autoantibody-mediated immune process that is triggered by molecular mimicry between structural components of peripheral nerves and the microorganism. Making a diagnosis of so-called classical Guillain-Barré syndrome is straightforward; however, the existing diagnostic criteria have limitations and can result in some variants of the syndrome being missed. Most patients with Guillain-Barré syndrome do well with immunotherapy, but a substantial proportion are left with disability, and death can occur. Results from the International Guillain-Barré Syndrome Outcome Study suggest that geographical variations exist in Guillain-Barré syndrome, including insufficient access to immunotherapy in low-income countries. There is a need to provide improved access to treatment for all patients with Guillain-Barré syndrome, and to develop effective disease-modifying therapies that can limit the extent of nerve injury. Clinical trials are currently underway to investigate some of the potential therapeutic candidates, including complement inhibitors, which, together with emerging data from large international collaborative studies on the syndrome, will contribute substantially to understanding the many facets of this disease.
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Affiliation(s)
- Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Helmar C Lehmann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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21
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Oh SJ. Nodal conduction block: A unifying concept. Muscle Nerve 2020; 63:178-180. [PMID: 33184867 DOI: 10.1002/mus.27115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 01/17/2023]
Abstract
A newly introduced term, "axonal conduction block," brought a confusion in the electrodiagnostic diagnosis of Guillain-Barrè syndrome (GBS). I am proposing the term "nodal conduction block" for "axonal conduction block." This unifying concept of nodal conduction block will accommodate both the traditional concept of demyelination as well as the new concept of nodopathy in the "axonal form of GBS,", making the practice of electrodiagnosis much easier.
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Affiliation(s)
- Shin J Oh
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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22
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Shang P, Zhu M, Baker M, Feng J, Zhou C, Zhang HL. Mechanical ventilation in Guillain-Barré syndrome. Expert Rev Clin Immunol 2020; 16:1053-1064. [PMID: 33112177 DOI: 10.1080/1744666x.2021.1840355] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Up to 30% of patients with Guillain-Barré syndrome (GBS) develop respiratory failure requiring intensive care unit (ICU) admission and mechanical ventilation. Progressive weakness of the respiratory muscles is the leading cause of acute respiratory distress and respiratory failure with hypoxia and/or hypercarbia. Bulbar weakness may compromise airway patency and predispose patients to aspiration pneumonia. Areas covered: Clinical questions related to the use of mechanical ventilation include but are not limited to: When to start? Invasive or noninvasive? When to wean from mechanical ventilation? When to perform tracheostomy? How to manage complications of GBS in the ICU including nosocomial infection, ventilator-associated pneumonia, and ICU-acquired weakness? In this narrative review, the authors summarize the up-to-date knowledge of the incidence, pathophysiology, evaluation, and general management of respiratory failure in GBS. Expert opinion: Respiratory failure in GBS merits more attention from caregivers. Emergency intubation may lead to life-threatening complications. Appropriate methods and time point of intubation and weaning, an early tracheostomy, and predictive prophylaxis of complications benefit patients' long-term prognosis.
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University , Changchun, China.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Mingqin Zhu
- Department of Neurology, First Hospital of Jilin University , Changchun, China.,Departments of Laboratory Medicine and Pathology, Neurology and Immunology, Mayo Clinic , Rochester, MN, USA
| | - Matthew Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University , Changchun, China
| | - Chunkui Zhou
- Department of Neurology, First Hospital of Jilin University , Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China , Beijing, China
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23
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Mathis S, Soulages A, Le Masson G, Vallat JM. Epidemics and outbreaks of peripheral nervous system disorders: I. infectious and immune-mediated causes. J Neurol 2020; 268:879-890. [PMID: 32914207 PMCID: PMC7483039 DOI: 10.1007/s00415-020-10215-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
The history of mankind is marked by numerous epidemics, some of which involved diseases of the peripheral nervous system, either infectious or otherwise. We describe here the three main infectious causes of epidemics that affect the peripheral nervous system: leprosy, poliomyelitis and diphtheria. We then discuss the main epidemics of immune-mediated origin.
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Affiliation(s)
- Stéphane Mathis
- Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Place Amélie Raba-Léon, 33076, Bordeaux, France.
| | - Antoine Soulages
- Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Gwendal Le Masson
- Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Place Amélie Raba-Léon, 33076, Bordeaux, France.,University of Bordeaux, U1215, 33000, Bordeaux, France.,INSERM, Neurocentre Magendie, 'Physiopathologie de La Plasticité Neuronale', U1215, 33000, Bordeaux, France
| | - Jean-Michel Vallat
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital, 2 Avenue Martin Luther King, 87042, Limoges, France
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López-Hernández JC, Colunga-Lozano LE, Garcia-Trejo S, Gomez-Figueroa E, Delgado-Garcia G, Bazán-Rodríguez L, Cervantes-Uribe R, Burgos-Centeno J, Fernandez-Valverde F, Vargas-Cañas ES. Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with Guillain-Barré syndrome, a single center experience. J Clin Neurosci 2020; 80:292-297. [PMID: 32674942 DOI: 10.1016/j.jocn.2020.04.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical characteristics of electrophysiological subtypes and prognostic factors of Mexican adults diagnosed with Guillain-Barré Syndrome (GBS) have not been described. MATERIALS AND METHODS A single center, ambispective, cohort study was performed (2015-2019). GBS was defined following the Asbury and Cornblath criteria. Electrodiagnosis was made according to Hadden criteria. Clinical, biochemical and electrodiagnostic parameters were described, compared and analyzed using a multivariate model. Only patients who completed a 3-month follow-up were included. RESULTS 137 GBS patients (92 males; mean age 46.6 ± 16.6).132 (96.3%) underwent an electrodiagnostic assessment.68 (51.5%) were classified as axonal GBS, with further classified into two groups: acute motor axonal neuropathy (AMAN) 45.4%, and acute motor and sensory axonal neuropathy (AMSAN) 8,6%. The following characteristics were lower in the AMAN group: Medical Research Counsel sumscore (MRC) 30.1 ± 16.3 vs 36.4 ± 14.4, unilateral facial palsy 10% vs 25.9% and albuminocytologic dissociation 41.3% vs. 71.7%.Multivariate analysis found AMAN as an independent predictor of an unfavorable outcome OR: 3.34 (p = 0.03) CONCLUSIONS: AMAN subtype is the most frequent presentation of GBS in Mexican adult patients and an independent predictor of inability to walk independently at 3 months after discharge.
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Affiliation(s)
| | | | - Sofia Garcia-Trejo
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Enrique Gomez-Figueroa
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Lisette Bazán-Rodríguez
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Roberto Cervantes-Uribe
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jorge Burgos-Centeno
- Department of Clincal Neuphysiology, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Edwin Steven Vargas-Cañas
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
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25
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Berciano J. Axonal degeneration in Guillain-Barré syndrome: a reappraisal. J Neurol 2020; 268:3728-3743. [PMID: 32607643 DOI: 10.1007/s00415-020-10034-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/28/2022]
Abstract
The aim of this review was to analyse the pathophysiology of axonal degeneration in Guillain-Barré syndrome (GBS) with emphasis on early stages (≤ 10 days after onset). An overview of experimental autoimmune neuritis (EAN) models is provided. Originally GBS and acute inflammatory demyelinating polyneuropathy were equated, presence of axonal degeneration being attributed to a "bystander" effect. Afterwards, primary axonal GBS forms were reported, designated as acute motor axonal neuropathy/acute motor-sensory axonal neuropathy. Revision of the first pathological description of axonal GBS indicates the coexistence of active axonal degeneration and demyelination in spinal roots, and pure Wallerian-like degeneration in peripheral nerve trunks. Nerve conduction studies are essential for syndrome subtyping, though their sensitivity is scanty in early GBS. Serum markers of axonal degeneration include increased levels of neurofilament light chain and presence of anti-ganglioside reactivity. According to nerve ultrasonographic features and autopsy studies, ventral rami of spinal nerves are a hotspot in early GBS. In P2-induced EAN models, the initial pathogenic change is inflammatory oedema of spinal roots and sciatic nerve, which is followed by demyelination, and Wallerian-like degeneration in nerve trunks possessing epi-perineurium; a critical elevation of endoneurial fluid pressure is a pre-requisite for inducing ischemic axonal degeneration. Similar lesion topography may occur in GBS. The repairing role of adaxonal Schwann cytoplasm in axonal degeneration is analysed. A novel pathophysiological mechanism for nerve trunk pain in GBS, including pure motor forms, is provided. The potential therapeutic role of intravenous boluses of methylprednisolone for early severe GBS and intractable pain is argued.
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Affiliation(s)
- José Berciano
- Professor Emeritus of Neurology, Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", University of Cantabria, Santander, Spain.
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Ashrafi MR, Mohammadalipoor A, Naeini AR, Amanat M, Tavasoli AR, Heidari M, Badv RS, Mohammadi M, Zamani GR, Rahimi-Dehgolan S, Rahimi R, Akbari MG. Clinical Characteristics and Electrodiagnostic Features of Guillain-Barré Syndrome Among the Pediatric Population. J Child Neurol 2020; 35:448-455. [PMID: 32156188 DOI: 10.1177/0883073820905157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Guillain-Barré syndrome is an immune-mediated peripheral neuropathy characterized by different clinical manifestations. We aimed to describe the clinical features, seasonal distribution, subtypes, and electrodiagnostic characteristics of Iranian children with Guillain-Barré syndrome. METHODS In this prospective study, a total of 30 children with Guillain-Barré syndrome were evaluated. All demographic features were collected and electrodiagnostic study was assessed. RESULTS Twelve participants were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy and 18 patients were identified with acute motor axonal neuropathy. The initial findings showed that a significant number of patients (23 cases, P = .003) resided in rural areas. Our results showed a higher incidence of Guillain-Barré syndrome in summer and autumn months. No significant difference was observed between the seasonal distribution of acute inflammatory demyelinating polyradiculoneuropathy and acute motor axonal neuropathy subtypes. Antecedent history of pulmonary infections was recorded in 14 children with Guillain-Barré syndrome. Electrophysiological findings revealed a pattern of prolonged F wave latency with reduced persistency, absence of sensory nerve action potential, reduced compound muscle action potential amplitude, prolonged distal motor latency, reduced nerve conduction velocity, and abnormal temporal dispersion or conduction block in most patients with acute inflammatory demyelinating polyradiculoneuropathy. However, reduced compound muscle action potential amplitude, F wave with normal latency and reduced persistency, normal sensory nerve action potential amplitude, normal distal latency, normal sensory nerve conduction velocity, and conduction block or temporal dispersion were observed in most acute motor axonal neuropathy patients. CONCLUSION The data support a correlation between Guillain-Barré syndrome incidence with seasonal variation and living area. Further studies should assess the Guillain-Barré syndrome features in pediatric population.
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Affiliation(s)
- Mahmoud Reza Ashrafi
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ariadokht Mohammadalipoor
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ranjbar Naeini
- Department of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Man Amanat
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Tavasoli
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Heidari
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Mohammadi
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Zamani
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Rahimi-Dehgolan
- Physical Medicine and Rehabilitation Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Rahimi
- Physical Medicine and Rehabilitation Department, Khatamolanbia Hospital, Tehran, Iran
| | - Masood Ghahvechi Akbari
- Physical Medicine and Rehabilitation Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Mathis S, Soulages A, Le Masson G, Vallat JM. History of acute polyradiculoneuropathy (part 2): From 1916 to 2019. Neurology 2020; 94:836-840. [PMID: 32345731 DOI: 10.1212/wnl.0000000000009402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/10/2020] [Indexed: 12/27/2022] Open
Abstract
First reported by Guillain, Barré, and Strohl during the Great War, the concept of "Guillain-Barré syndrome" (GBS) progressively emerged as a clinical entity in its own right. Despite many debates about its clinical and pathophysiologic characteristics, GBS is now recognized as a disease throughout the world. We describe here the main steps of the rich history of GBS, from 1916 to the present.
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Affiliation(s)
- Stéphane Mathis
- From the Department of Neurology, Nerve-Muscle Unit (S.M., A.S., G.L.M.), CHU Bordeaux (Pellegrin University Hospital); University of Bordeaux (G.L.M.); INSERM (G.L.M.), Neurocentre Magendie, "Physiopathologie de la Plasticité Neuronale," Bordeaux; and Department of Neurology (J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France.
| | - Antoine Soulages
- From the Department of Neurology, Nerve-Muscle Unit (S.M., A.S., G.L.M.), CHU Bordeaux (Pellegrin University Hospital); University of Bordeaux (G.L.M.); INSERM (G.L.M.), Neurocentre Magendie, "Physiopathologie de la Plasticité Neuronale," Bordeaux; and Department of Neurology (J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
| | - Gwendal Le Masson
- From the Department of Neurology, Nerve-Muscle Unit (S.M., A.S., G.L.M.), CHU Bordeaux (Pellegrin University Hospital); University of Bordeaux (G.L.M.); INSERM (G.L.M.), Neurocentre Magendie, "Physiopathologie de la Plasticité Neuronale," Bordeaux; and Department of Neurology (J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
| | - Jean-Michel Vallat
- From the Department of Neurology, Nerve-Muscle Unit (S.M., A.S., G.L.M.), CHU Bordeaux (Pellegrin University Hospital); University of Bordeaux (G.L.M.); INSERM (G.L.M.), Neurocentre Magendie, "Physiopathologie de la Plasticité Neuronale," Bordeaux; and Department of Neurology (J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
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Umer SR, Nisa Q, Kumari M, Abbas S, Mahesar SA, Shahbaz NN. Clinical Features Indicating the Need for Mechanical Ventilation in Patients with Guillain Barre Syndrome. Cureus 2019; 11:e5520. [PMID: 31687295 PMCID: PMC6819055 DOI: 10.7759/cureus.5520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Guillain Barre Syndrome (GBS) is an immune-mediated inflammatory polyradiculoneuropathy. Respiratory failure is one of its recognized and most dreaded complications, requiring ventilatory assistance. Early recognition of distinct clinical predictors of mechanical ventilation may help in the better management of GBS patients in our setup. Objective To determine the clinical predictors indicating the need for mechanical ventilation in patients with Guillain Barre Syndrome and to compare the presenting features in patients who require mechanical ventilation and who do not. Method It was a prospective observational study. A total of 100 consecutive patients, over the period of one year, were included in this study. All patients were clinically examined for limb weakness, neck weakness, bulbar and facial nerve involvement, and followed up till seven days of hospitalization for whether the patient required mechanical ventilation or not. Results were recorded on a specifically designed proforma. Data were entered and analyzed using SPSS version 20.0 (IBM Corp., Armonk, NY, US). Results Out of 100 patients, 13% required mechanical ventilation. When clinical presentations were compared in patients who required mechanical ventilation and those who did not, a shorter interval between the onset of symptoms and the attainment of maximal disability, facial weakness, bulbar dysfunction, and neck weakness turned out to be significant factors (p-value<0.000). Conclusion According to these significant outcomes of our study, the course of patients with GBS leading to mechanical ventilation can be predicted on the basis of clinical presentations. So we can recommend that shorter time duration between symptom onset and peak disability, along with the presence of facial, bulbar, and neck weakness, should be taken as an indication of impending respiratory failure.
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Affiliation(s)
- Sumera R Umer
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Qamar Nisa
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Monika Kumari
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Saira Abbas
- Neurology, Dow University of Health Sciences, Karachi, PAK
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Ding X, Jiang H, Hu X, Ren H, Cai H. Guillain-Barré Syndrome and Low Back Pain: Two Cases and Literature Review. Open Med (Wars) 2018; 13:503-508. [PMID: 30426088 PMCID: PMC6227845 DOI: 10.1515/med-2018-0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe the clinical, electrophysiological, and lumbar magnetic resonance imaging (MRI) features of two cases of atypical Guillain-Barré syndrome (GBS). Methods We reported two GBS variant cases with initial and prominent symptoms of low back pain. We analysed their clinical, electrophysiological, and lumbar MRI features. Results Two patients with GBS reported low back pain as the initial and prominent symptom, which was not accompanied by limb weakness. The electrophysiological study showed abnormal F-waves in the common peroneal and tibial nerves, and acute polyradiculoneuropathy in the cauda equina. Examination of the cerebrospinal fluid (CSF) showed albuminocytologic dissociation. Serum was positive for GQ1b-IgM antibodies. Lumbar MRI showed gadolinium enhancement of the nerve roots and cauda equina. A standard regime of intravenous immunoglobulin markedly alleviated the low back pain. Conclusions Low back pain caused by GBS should be differentiated from other diseases. This initial or early prominent symptom may delay the diagnosis of GBS; therefore, it is important to conduct a detailed electrophysiological, CSF, and gadolinium-enhanced lumbar MRI analysis.
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Affiliation(s)
- Xianjun Ding
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, HangzhouChina
| | - Hong Jiang
- Department of Neuroelectrophysiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, HangzhouChina
| | - Xingyue Hu
- Department of Neurology, Brain Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, HangzhouChina
| | - Hong Ren
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, HangzhouChina
| | - Huaying Cai
- Department of Neurology, Brain Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, HangzhouChina
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Liu S, Xiao Z, Lou M, Ji F, Shao B, Dai H, Luo C, Hu B, Zhou R, Zou Z, Li J, Li X, Xu J, Hu F, Qin C, Wang L, Liu T, Bai R, Chen Y, Lv H, Zhang R, Wang X, Wang Y, Ren S, He X, Jiang Z, Wu H, Yu D, Yang W, Luo W, Gong D, Chen B, Liu Y, Yao J, Yang Y, Guan J, Zhu M, Fu X, Gao G, Zhang H, Ding M, Fan S, Cao Q, Lu J, Lu Z. Guillain-Barré syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River. J Neurol Neurosurg Psychiatry 2018; 89:618-626. [PMID: 29326294 DOI: 10.1136/jnnp-2017-316930] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The clinical and epidemiological profiles of Guillain-Barré syndrome (GBS) in southern China have yet to be fully recognised. We aimed to investigate the subtypes of GBS in southern China, compare the clinical features of demyelinating form with that of axonal form and test whether preceding infections and age have influence on the clinical phenotype, disease course and severity of GBS. METHODS Medical records of patients with a diagnosis of GBS admitted to 31 tertiary hospitals, located in 14 provinces in southern China, from 1 January 2013 to 30 September 2016, were collected and retrospectively reviewed. RESULTS Finally. 1056 patients, including 887 classic GBS and 169 variants, were enrolled. The 661 classic patients with available electromyographic data were grouped as having acute inflammatory demyelinating polyneuropathy (AIDP, 49.0%), acute motor axonal neuropathy (AMAN, 18.8%), inexcitable (0.9%) and equivocal (31.3%). In contrast to AIDP, patients with AMAN were characterised by earlier nadir (P=0.000), higher Hughes score at nadir (P=0.003) and at discharge (P=0.000). Preceding upper respiratory infections were identified in 369 (34.9%) patients, who were more inclined to develop AIDP (P=0.000) and Miller-Fisher syndrome (P=0.027), whereas gastrointestinal infection were found in 89 (8.4%) patients, who were more prone to develop AMAN (P=0.000), with more severe illness (P=0.001) and longer hospital stay (P=0.009). Children (≤15 years) and the elderly (≥56 years) were more severe at nadir, the elderly had the longest hospital stay (P=0.023). CONCLUSION AIDP is the predominant form in southern China, which is different from data of northern China. The different subtypes, preceding infection and age of onset can partially determine the disease progression, severity and short-term recovery speed of GBS. CLINICAL TRIAL REGISTRATION ChiCTR-RRC-17014152.
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Affiliation(s)
- Shuping Liu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zheman Xiao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Fang Ji
- Department of Neurology, First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Bei Shao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongyuan Dai
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Can Luo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruiling Zhou
- Department of Neurology, Fujian Provincial Hospital, Fuzhou, China
| | - Zhangyu Zou
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jing Li
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoyi Li
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jun Xu
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Fan Hu
- Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lian Wang
- Department of Geriatric Medicine, Kunming General Hospital of PLA, Kunming, China
| | - Tao Liu
- Department of Neurology, Hainan General Hospital, Haikou, China
| | - Runtao Bai
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyan Lv
- Department of Neurology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Ruxu Zhang
- Department of Neurology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yunfu Wang
- Department of Neurology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Shanling Ren
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoming He
- Department of Neurology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, China
| | - Zhenwei Jiang
- Department of Neurology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Huiwen Wu
- Department of Neurology, The First People's Hospital Of Yichang, China Three Gorges University, Yichang, China
| | - Donghui Yu
- Department of Neurology, XianNing Central hospital, The First Affiliated Hospital of Hubei University of Science and Technology, XianNing, China
| | - Wenqiong Yang
- Department of Neurology, Dongfeng General Hospital of Hubei University of Medicine, Shiyan, China
| | - Wenjing Luo
- Department of Neurology, Wuhan General Hospital of PLA, Wuhan, China
| | - Daokai Gong
- Department of Neurology, Jingzhou Central Hospital, Tongji Medical College, Huazhong University of Science Technology, Jingzhou, China
| | - Bin Chen
- Department of Neurology, Jingmen No. 1 People's Hospital, Jingmen, China
| | - Yin Liu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiajia Yao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yujie Yang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingxia Guan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mingzhen Zhu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiujuan Fu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Genshan Gao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hong Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Man Ding
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shanghua Fan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Cao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingyi Lu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zuneng Lu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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Berciano J. Additional arguments supporting that Franklin Delano Roosevelt's paralytic illness was related to Guillain-Barré syndrome. JOURNAL OF MEDICAL BIOGRAPHY 2018; 26:142-143. [PMID: 29461141 DOI: 10.1177/0967772017749691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- José Berciano
- Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)" and CIBERNED, University of Cantabria, Santander, Spain
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Hughes RAC, Cornblath DR, Willison HJ. Guillain-Barré syndrome in the 100 years since its description by Guillain, Barré and Strohl. Brain 2018; 139:3041-3047. [PMID: 29106487 DOI: 10.1093/brain/aww247] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/09/2016] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - David R Cornblath
- The Johns Hopkins University, Meyer 6-181a, 601 North Wolfe St, Baltimore, MD 21287-7681, USA
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, Glasgow Biomedical Research Centre 120 University Place Glasgow G12 8TA, UK
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Gamunex® in Guillain-Barré Syndrome: A Postmarketing, Retrospective, Observational Study. Can J Neurol Sci 2018; 44:711-717. [PMID: 29391076 DOI: 10.1017/cjn.2017.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objective of this retrospective study was to evaluate the effectiveness and safety of Gamunex® (immune globulin [human] 10%; hereinafter "Gamunex") when administered intravenously in the initial treatment of Guillain-Barré syndrome (GBS). The study was conducted as a postapproval commitment for Health Canada. METHODS A medical chart review for hospitalized patients diagnosed with GBS and treated with Gamunex (Gamunex 10% and IGIVnex® 10%; N=109; n=69 evaluable) was conducted at seven Canadian study centers in reverse chronological order. The primary endpoint for assessing effectiveness was the proportion of patients with treatment success compared with a prospectively defined historical effectiveness threshold for plasma exchange (PE) treatment (55.05%). Treatment success was assessed as ≥1 point improvement from baseline on the GBS Disability Scale or abbreviated GBS Disability Scale. Cases were not evaluable if treatment success, relapse, or treatment failure could not be determined by the available chart data. RESULTS Applying a conservative estimate with all nonevaluable patients (n= 40) classified as treatment failures, Gamunex treatment success was estimated at 57.8% (63 of 109 patients), which exceeded the predefined historical PE effectiveness threshold. In the evaluable population of this study, Gamunex treatment was successful in 91.3% of patients (63/69). Some 23 (21.1%) of 109 Gamunex-treated patients experienced ≥1 adverse event; the profile and frequency were consistent with the adverse events reported for Gamunex in the product's labeling and with the natural clinical course of GBS. CONCLUSIONS The effectiveness of Gamunex for treatment of GBS was comparable to PE therapy. Gamunex was observed to have an acceptable safety profile in this study population.
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Acute Motor Axonal Neuropathy. Neuromuscul Disord 2018. [DOI: 10.1007/978-981-10-5361-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Berciano J. Spinal nerve involvement in early Guillain-Barré syndrome: The Haymaker and Kernohan's legacy. J Neurol Sci 2017; 382:1-9. [PMID: 29110997 DOI: 10.1016/j.jns.2017.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022]
Abstract
Pathological studies of early Guillain-Barré syndrome (GBS), defined as of 10days of disease onset, are scanty making it difficult to interpret the physiopathology of clinical and electrophysiological features. In 1949, Webb Haymaker and James Kernohan reported 50 clinico-pathological studies of fatal GBS cases, 32 of them having died between days 2 and 10 after onset. They established that the brunt of initial lesions, consisting of endoneurial oedema interpreted as degenerative, relied on spinal nerves. That this oedema was inflammatory was soon thereafter recognized. Two decades later, however, the pathogenic role of endoneurial oedema was disputed. In experimental allergic neuritis, considered an animal model of GBS, the initial lesion appearing on day 4 post-inoculation is marked inflammatory oedema in the sciatic nerve and lumbosacral nerve roots. Additional detailed clinico-pathological studies corroborated that the appearance of epi-perineurium at the subarachnoid angle, where anterior and posterior roots join to form the spinal nerve, is a pathological hotspot in early GBS, there developing inflammatory oedema, incipient demyelination and endoneurial ischemic zones with axonal degeneration. Furthermore, nerve ultrasonography has demonstrated predominant spinal nerve changes in early GBS, either demyelinating or axonal. Other outstanding Haymaker and Kernohan's contributions were to clarify the complex nosology of the syndrome bringing under the same rubric Landry's paralysis, acute febrile polyneuritis and GBS, and critically analyzing GBS exclusion criteria by then prevailing. It is concluded that the authors' legacy remains as relevant as ever.
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Affiliation(s)
- José Berciano
- University of Cantabria, Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain.
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Mathis S, Magy L, Le Masson G, Vallat JM. Did Jules Dejerine describe AMAN at the end of the 19th century? Neurology 2017; 89:1749-1753. [PMID: 29038133 DOI: 10.1212/wnl.0000000000004527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/18/2017] [Indexed: 11/15/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a heterogeneous group of acute immune-mediated neuropathies, including acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). AMAN is an axonal subtype of GBS that has been known since the 1990s; this term was first used to describe a summer epidemic of acute ascending paralysis observed in children in northern China (and Mexico). It is pathologically characterized by noninflammatory axonal degeneration of the motor nerves (with little or no demyelination). The French neurologist Jules Dejerine (1849-1917) conducted a clinical and pathologic description of AMAN in the late 19th century. We describe his observations, which provide us with valuable information on the course of pathologic lesions in this disease.
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Affiliation(s)
- Stéphane Mathis
- From the Department of Neurology (S.M., G.L.M.), Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Bordeaux; and Department of Neurology (L.M., J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France.
| | - Laurent Magy
- From the Department of Neurology (S.M., G.L.M.), Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Bordeaux; and Department of Neurology (L.M., J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
| | - Gwendal Le Masson
- From the Department of Neurology (S.M., G.L.M.), Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Bordeaux; and Department of Neurology (L.M., J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
| | - Jean-Michel Vallat
- From the Department of Neurology (S.M., G.L.M.), Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), Bordeaux; and Department of Neurology (L.M., J.-M.V.), National Reference Center for "Rare Peripheral Neuropathies," University Hospital, Limoges, France
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Usha K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Zhang LJ, Guo HY, Zhang DQ, Wang R, Li T, Li LM, Suo DM, Yang L. Analysis of serum interleukin-27 and interleukin-35 concentrations in patients with Guillain-Barré syndrome. Clin Chim Acta 2017; 468:5-9. [DOI: 10.1016/j.cca.2017.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/25/2016] [Accepted: 02/02/2017] [Indexed: 01/27/2023]
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Asymmetric Acute Motor Axonal Neuropathy With Unilateral Tongue Swelling Mimicking Stroke. Neurologist 2017; 21:106-108. [PMID: 27801771 DOI: 10.1097/nrl.0000000000000102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A 60-year-old man presented with acute onset of left hemiparesis and left hypoglossal nerve palsy with ipsilateral tongue swelling. He then progressed to tetraparesis in a few days. Cerebrospinal fluid showed cell protein dissociation. A nerve conduction study showed motor axonal neuropathy with sensory sparing. A subsequent blood test revealed anti-GD1b IgG antibody positivity. He was diagnosed to have acute motor axonal neuropathy (AMAN) and treated with a course of intravenous immunoglobulin with slow improvement. This is probably the first AMAN with asymmetrical presentation mimicking stroke reported in the literature in detail. The anti-GD1b IgG antibody is also not commonly associated with AMAN.
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Pinto-Díaz CA, Rodríguez Y, Monsalve DM, Acosta-Ampudia Y, Molano-González N, Anaya JM, Ramírez-Santana C. Autoimmunity in Guillain-Barré syndrome associated with Zika virus infection and beyond. Autoimmun Rev 2017; 16:327-334. [PMID: 28216074 DOI: 10.1016/j.autrev.2017.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/05/2016] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases share common immunopathogenic mechanisms (i.e., the autoimmune tautology), which explain the clinical similarities among them as well as their familial clustering. Guillain-Barré syndrome (GBS), an autoimmune peripheral neuropathy, has been recently associated with Zika virus (ZIKV) infection. Based on a series of cases, this review article provides a comparative analysis of GBS associated with ZIKV infection, contrasted with the general characteristics of GBS in light of the autoimmune tautology, including gender differences in prevalence, subphenotypes, polyautoimmunity, familial autoimmunity, age at onset, pathophysiology, ecology, genetics, ancestry, and treatment.
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Affiliation(s)
- Carlos A Pinto-Díaz
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Nicolás Molano-González
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia.
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Abstract
In 1916, Guillain, Barré and Strohl reported on two cases of acute flaccid paralysis with high cerebrospinal fluid protein levels and normal cell counts - novel findings that identified the disease we now know as Guillain-Barré syndrome (GBS). 100 years on, we have made great progress with the clinical and pathological characterization of GBS. Early clinicopathological and animal studies indicated that GBS was an immune-mediated demyelinating disorder, and that severe GBS could result in secondary axonal injury; the current treatments of plasma exchange and intravenous immunoglobulin, which were developed in the 1980s, are based on this premise. Subsequent work has, however, shown that primary axonal injury can be the underlying disease. The association of Campylobacter jejuni strains has led to confirmation that anti-ganglioside antibodies are pathogenic and that axonal GBS involves an antibody and complement-mediated disruption of nodes of Ranvier, neuromuscular junctions and other neuronal and glial membranes. Now, ongoing clinical trials of the complement inhibitor eculizumab are the first targeted immunotherapy in GBS.
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Affiliation(s)
- John A Goodfellow
- Neuroimmunology Laboratory, Laboratory Building, Queen Elizabeth University Hospital, Glasgow, G51 4TF, Scotland, UK
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation, University of Glasgow, University Place, Glasgow, G12 8TA, Scotland, UK
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Affiliation(s)
- Yuta Nakano
- Department of Neurology and Clinical Neuroscience; Yamaguchi University Graduate School of Medicine; Ube Yamaguchi Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience; Yamaguchi University Graduate School of Medicine; Ube Yamaguchi Japan
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Clinical Heterogeneity of Guillain-Barré Syndrome in the Emergency Department: Impact on Clinical Outcome. Case Rep Emerg Med 2016; 2016:4981274. [PMID: 27761272 PMCID: PMC5059554 DOI: 10.1155/2016/4981274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/07/2016] [Indexed: 11/18/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is mainly classified into acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). Although diagnosis of GBS requires progressive weakness and universal areflexia or hyporeflexia, cases of GBS with preserved or increased deep tendon reflexes (DTRs) have been increasingly recognized. We report three cases of GBS, presenting at a single unit in six months. Our first case presented with pure sensory symptoms. The second case had nonspecific generalized weakness, while the third presented with typical ascending weakness. One of our patients had preserved DTRs, while the other two had increased DTRs. Our two cases with hyperreflexia were found to have a preceding Campylobacter jejuni infection and anti-ganglioside antibodies, and their electrophysiological studies revealed AMAN. The other case had an AIDP. Only one case was offered a diagnosis and treatment from the first emergency department (ED) visit and had a better clinical outcome. Clinical diagnosis of GBS in the ED can be challenging. Delay in diagnosis of GBS in the ED is common due to cases with intact or increased DTRs, atypical pattern of weakness, or pure sensory symptoms. Emergency physicians should be aware of GBS clinical heterogeneity, because early diagnosis and treatment improve clinical outcome.
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Guillain-Barré syndrome: What have we learnt during one century? A personal historical perspective. Rev Neurol (Paris) 2016; 172:632-644. [PMID: 27659900 DOI: 10.1016/j.neurol.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022]
Abstract
We are approaching the centenary of the first description of Guillain-Barré syndrome. The past 30 years had witnessed an amazing progress in the understanding of the immunological and pathological mechanisms of this disorder. We now recognize that Guillain-Barré syndrome is remarkably heterogeneous and under this umbrella term are several variants and subtypes with distinct clinical, electrophysiological and immunopathological features. This review is a historical journey, through a personal perspective, following the milestones that led to the current substantial knowledge of Guillain-Barré syndrome.
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Proximal nerve lesions in early Guillain-Barré syndrome: implications for pathogenesis and disease classification. J Neurol 2016; 264:221-236. [PMID: 27314967 DOI: 10.1007/s00415-016-8204-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 12/13/2022]
Abstract
Guillain-Barré syndrome (GBS) is an acute-onset, immune-mediated disorder of the peripheral nervous system. In early GBS, arbitrarily established up to 10 days of disease onset, patients could exhibit selective manifestations due to involvement of the proximal nerves, including nerve roots, spinal nerves and plexuses. Such manifestations are proximal weakness, inaugural nerve trunk pain, and atypical electrophysiological patterns, which may lead to delayed diagnosis. The aim of this paper was to analyze the nosology of early GBS reviewing electrophysiological, autopsy and imaging studies, both in acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor/motor-sensory axonal neuropathy (AMAN/AMSAN). Early electrophysiology showed either well-defined demyelinating or axonal patterns, or a non-diagnostic pattern with abnormal late responses; there may be attenuated M responses upon lumbar root stimulation as the only finding. Pathological changes predominated in proximal nerves, in some studies, most prominent at the sides where the spinal roots unite to form the spinal nerves; on very early GBS endoneurial inflammatory edema was the outstanding feature. In the far majority of cases, spinal magnetic resonance imaging showed contrast enhancement of cauda equina, selectively involving anterior roots in AMAN. Both in AIDP and AMAN/AMSAN, ultrasonography has demonstrated frequent enlargement of ventral rami of C5-C7 nerves with blurred boundaries, whereas sonograms of upper and lower extremity peripheral nerves exhibited variable and less frequent abnormalities. We provide new insights into the pathogenesis and classification of early GBS.
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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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Friedman Y, Lee L, Wherrett JR, Ashby P, Carpenter S. Simulation of Brain Death from Fulminant De-efferentation. Can J Neurol Sci 2014; 30:397-404. [PMID: 14672276 DOI: 10.1017/s0317167100003152] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background:Guillain-BarrÈ syndrome (GBS) classically presents with a subacutely evolving areflexic paralysis, with typical laboratory findings of elevated cerebrospinal fluid protein and abnormal nerve conduction studies. There is now an increasing recognition of GBS variants that differ in clinical presentation, prognosis, electrophysiology and presumed pathogenesis. Fulminant cases of GBS have been reported in which a rapid deterioration evolves to a clinical state resembling ìbrain deathî.Methods:A retrospective analysis of two such cases of fulminant neuropathy are described, that includes the clinical course, electrophysiology and neuropathology where available.Results:We describe two patients that presented with a rapid course of neurological deterioration, lapsing into what resembled a ìclinically brain-deadî state that was subsequently ascribed to a fulminant polyneuropathy. Investigations (electrophysiological, pathological) and the clinical course suggested an axonal neuropathy.Conclusion:A fulminant neuropathy can result in a clinical state resembling ìbrain deathî through diffuse de-efferentation. Although generally attributed to aggressive demyelination with secondary axonal degeneration, a primary axonopathy can also lead to a similar clinical presentation.
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Affiliation(s)
- Yael Friedman
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Gallardo E, Sedano MJ, Orizaola P, Sánchez-Juan P, González-Suárez A, García A, Terán-Villagrá N, Ruiz-Soto M, Álvaro RL, Berciano MT, Lafarga M, Berciano J. Spinal nerve involvement in early Guillain-Barré syndrome: a clinico-electrophysiological, ultrasonographic and pathological study. Clin Neurophysiol 2014; 126:810-9. [PMID: 25213352 DOI: 10.1016/j.clinph.2014.06.051] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Although prevailing spinal nerve involvement has been recognized in a few detailed Guillain-Barré syndrome (GBS) autopsy reports, imaging studies addressing this question in cervical nerves are lacking. METHODS We describe clinical, electrophysiological, ultrasonographic (US) and pathological findings in six consecutive early GBS patients, evaluated within 10 days of onset. RESULTS Patients' ages ranged from 37 to 80 years. Five patients required mechanical ventilation, two of them having died 9 and 28 days after onset. Upper- and lower-limb nerve US showed abnormal findings in just 8.8% of scanned peripheral nerves. In comparison with 46 aged-matched control subjects, US of the fifth to seventh cervical nerves showed changes in four cases, which consisted of significant nerve enlargement, blurred boundaries of the corresponding ventral rami, or both. Autopsy study in one case demonstrated that pathology, consisting of demyelination and endoneurial inflammatory oedema, mainly involved cervical and lumbar nerves. CONCLUSIONS In early GBS inflammatory oedema of spinal nerves is a pathogenically relevant feature to understanding the mechanism of ascending paralysis, particularly when conventional electrophysiological studies are normal or not diagnostic. SIGNIFICANCE Findings advocate the use of cervical nerve US in early GBS.
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Affiliation(s)
- Elena Gallardo
- Service of Radiology, University Hospital "Marqués de Valdecilla", "Instituto de Investigación Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC) and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - María J Sedano
- Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Pedro Orizaola
- Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Pascual Sánchez-Juan
- Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Andrea González-Suárez
- Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Antonio García
- Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain
| | - Nuria Terán-Villagrá
- Service of Pathology, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - María Ruiz-Soto
- Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain
| | - Rosa Landeras Álvaro
- Service of Radiology, University Hospital "Marqués de Valdecilla", "Instituto de Investigación Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC) and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - María T Berciano
- Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain
| | - Miguel Lafarga
- Department of Anatomy and Cell Biology, UC, IDIVAL and CIBERNED, Santander, Spain
| | - José Berciano
- Service of Neurology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
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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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Schnaar RL, Gerardy-Schahn R, Hildebrandt H. Sialic acids in the brain: gangliosides and polysialic acid in nervous system development, stability, disease, and regeneration. Physiol Rev 2014; 94:461-518. [PMID: 24692354 DOI: 10.1152/physrev.00033.2013] [Citation(s) in RCA: 489] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Every cell in nature carries a rich surface coat of glycans, its glycocalyx, which constitutes the cell's interface with its environment. In eukaryotes, the glycocalyx is composed of glycolipids, glycoproteins, and proteoglycans, the compositions of which vary among different tissues and cell types. Many of the linear and branched glycans on cell surface glycoproteins and glycolipids of vertebrates are terminated with sialic acids, nine-carbon sugars with a carboxylic acid, a glycerol side-chain, and an N-acyl group that, along with their display at the outmost end of cell surface glycans, provide for varied molecular interactions. Among their functions, sialic acids regulate cell-cell interactions, modulate the activities of their glycoprotein and glycolipid scaffolds as well as other cell surface molecules, and are receptors for pathogens and toxins. In the brain, two families of sialoglycans are of particular interest: gangliosides and polysialic acid. Gangliosides, sialylated glycosphingolipids, are the most abundant sialoglycans of nerve cells. Mouse genetic studies and human disorders of ganglioside metabolism implicate gangliosides in axon-myelin interactions, axon stability, axon regeneration, and the modulation of nerve cell excitability. Polysialic acid is a unique homopolymer that reaches >90 sialic acid residues attached to select glycoproteins, especially the neural cell adhesion molecule in the brain. Molecular, cellular, and genetic studies implicate polysialic acid in the control of cell-cell and cell-matrix interactions, intermolecular interactions at cell surfaces, and interactions with other molecules in the cellular environment. Polysialic acid is essential for appropriate brain development, and polymorphisms in the human genes responsible for polysialic acid biosynthesis are associated with psychiatric disorders including schizophrenia, autism, and bipolar disorder. Polysialic acid also appears to play a role in adult brain plasticity, including regeneration. Together, vertebrate brain sialoglycans are key regulatory components that contribute to proper development, maintenance, and health of the nervous system.
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