Chinese paralytic syndrome

Axonal Guillain-Barré syndrome: a critical review

Axonal Guillain-Barré Syndrome (GBS) was first described by Feasby et al. in 1986, challenging the existent notion of GBS being a primarily demyelinating disease. The severe course and slow recovery commonly seen in these patients was ascribed to axonal degeneration. Other authors challenged this claim on several grounds. Amidst these controversies, epidemics of a similar illness were reported from China, which were given the acronym AMAN, having exclusive motor involvement in contrast to the cases already described in which both motor and sensory involvement were present (AMSAN). Pathologically, Wallerian degeneration, minimal lymphocytic response, absent demyelination or inflammation and periaxonal macrophages are prominent features. Ultrastructural studies have revealed node of Ranvier to be the prime target of immune attack. A frequent occurrence of antecedent Campylobacter jejuni infection and a strong association between elevated titres of IgG GM1 and axonal GBS on a background of preceding C. jejunii infection has been observed and molecular mimicry between lipopolysaccharides of C. jejuni and neural epitopes has been proposed as a mechanism of injury. Clinically axonal variant is similar to AIDP, but a more severe course, with frequent respiratory involvement, ventilator dependence and significant residue may be seen. Diagnosis is essentially electrophysiological. Treatment is similar to AIDP, preferential benefit of either IVIG or plasmapheresis needs to be further evaluated. A critical review of existing literature in axonal GBS is presented.

Asian paralysis syndrome

We report 20 children admitted to the paediatric ward of a public general hospital for acute flaccid paralysis, which was bilaterally symmetrical in all cases and was associated with bulbar involvement in eight of them. Recovery was partial. Nerve conduction studies showed motor axonal neuropathy. This new disease, variously termed as non-inflammatory neuropathy/Chinese paralysis syndrome must be differentiated from Guillain-Barré syndrome (GBS) and poliomyelitis. Both GBS and Asian paralysis syndrome have bilaterally symmetrical flaccid paralysis but GBS tends to have sensory involvement, full recovery occurs in 90% of cases and nerve conduction shows demyelinating neuropathy. Asian paralysis syndrome and poliomyelitis are pure motor lesions without sensory changes and partial recovery, but poliomyelitis differs in that paralysis is asymmetrical and unequal, muscle spasm is always present in the initial stage and there are prodromal symptoms. Nerve conduction studies show anterior horn cell disease. This new entity, common in Asian populations, assumes public health importance when it mimics poliomyelitis in a country that has tried to eliminate poliomyelitis by universal immunization. To the best of our knowledge, this is the first report of Asian paralysis syndrome in children in our area.