Guillain-Barre Syndrome Publications (8214)


Guillain-Barre Syndrome Publications

Immunol. Res.
Immunol Res 2016 Jul 15. Epub 2016 Jul 15.
Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No 63-C-69, Bogotá, Colombia.
Neurology 2016 Jul 15. Epub 2016 Jul 15.
From the Neurology Department (I.R.F.d.S., O.J.M.d.N.), Universidade Federal Fluminense, Niteroi; Neurocritical Care Unit (I.R.F.d.S.), Americas Medical City, Rio de Janeiro, Brazil; and Neurocritical Care Department (J.A.F.), Cleveland Clinic Foundation, OH.
Hawaii J Med Public Health
Hawaii J Med Public Health 2016 Jul;75(7):196-9
Family Medicine Residency Program, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (IVY).

Miller Fisher Syndrome (MFS) is a rare variant of Guillain-Barré Syndrome (GBS) that has a geographically variable incidence. It is largely a clinical diagnosis based on the cardinal clinical features of ataxia, areflexia, and opthalmoplegia, however, other neurological signs and symptoms may also be present. Serological confirmation with the anti-GQ1b antibody is available and allows for greater diagnostic certainty in the face of confounding symptoms. Read More

A self-limiting course is typical of MFS. The following case report is that of a patient who presented with generalized weakness, somatic pain, inability to walk, and diplopia following an upper respiratory illness. The patient exhibited the classic triad of ataxia, areflexia, and opthalmoplegia characteristic of MFS, but also had less typical signs and symptoms making for a more challenging diagnostic workup. Our suspected diagnosis of MFS was serologically confirmed with positive anti-GQ1b antibody titer and the patient was successfully treated with Intravenous immune globulin (IVIG).

J Clin Neurosci
J Clin Neurosci 2016 Jul 16. Epub 2016 Jul 16.
Department of Neurology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University, Gyeongsangnam-do, South Korea. Electronic address:
MBio 2016 19;7(4). Epub 2016 Jul 19.
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Zika virus (ZIKV) is a mosquito-borne flavivirus responsible for thousands of cases of severe fetal malformations and neurological disease since its introduction to Brazil in 2013. Antibodies to flaviviruses can be protective, resulting in lifelong immunity to reinfection by homologous virus. However, cross-reactive antibodies can complicate flavivirus diagnostics and promote more severe disease, as noted after serial dengue virus (DENV) infections. Read More

The endemic circulation of DENV in South America and elsewhere raises concerns that preexisting flavivirus immunity may modulate ZIKV disease and transmission potential. Here, we report on the ability of human monoclonal antibodies and immune sera derived from dengue patients to neutralize contemporary epidemic ZIKV strains. We demonstrate that a class of human monoclonal antibodies isolated from DENV patients neutralizes ZIKV in cell culture and is protective in a lethal murine model. We also tested a large panel of convalescent-phase immune sera from humans exposed to primary and repeat DENV infection. Although ZIKV is most closely related to DENV compared to other human-pathogenic flaviviruses, most DENV immune sera (73%) failed to neutralize ZIKV, while others had low (50% effective concentration [EC50], <1:100 serum dilution; 18%) or moderate to high (EC50, >1:100 serum dilution; 9%) levels of cross-neutralizing antibodies. Our results establish that ZIKV and DENV share epitopes that are targeted by neutralizing, protective human antibodies. The availability of potently neutralizing human monoclonal antibodies provides an immunotherapeutic approach to control life-threatening ZIKV infection and also points to the possibility of repurposing DENV vaccines to induce cross-protective immunity to ZIKV.
ZIKV is an emerging arbovirus that has been associated with severe neurological birth defects and fetal loss in pregnant women and Guillain-Barré syndrome in adults. Currently, there is no vaccine or therapeutic for ZIKV. The identification of a class of antibodies (envelope dimer epitope 1 [EDE1]) that potently neutralizes ZIKV in addition to all four DENV serotypes points to a potential immunotherapeutic to combat ZIKV. This is especially salient given the precedent of antibody therapy to treat pregnant women infected with other viruses associated with microcephaly, such as cytomegalovirus and rubella virus. Furthermore, the identification of a functionally conserved epitope between ZIKV and DENV raises the possibility that a vaccine may be able to elicit neutralizing antibodies against both viruses.

N. Engl. J. Med.
N Engl J Med 2016 Jul 13. Epub 2016 Jul 13.
From the Departments of Pathology and Immunology (I.U.M., M.S.D.), Obstetrics and Gynecology (I.U.M.), and Medicine and Molecular Microbiology (M.S.D.), and the Center for Human Immunology and Immunotherapy Programs (M.S.D.), Washington University School of Medicine, St. Louis.

There were few studies of Zika virus (ZIKV), a flavivirus, until this past year, when large epidemics in the Americas were accompanied by unexpectedly severe clinical manifestations. Infection in pregnant women has emerged as a major global concern because of its linkage to congenital abnormalities including microcephaly, spontaneous abortion, and intrauterine growth restriction.(1) In addition, ZIKV infection in other age groups has been associated with severe neurologic disease and the Guillain-Barré syndrome. Read More

(2) Transmission cycles between humans and Aedes aegypti mosquitoes in urban settings can cause large-scale epidemics of ZIKV infection. Although mosquitoes clearly are the primary cause of ZIKV outbreaks, . . .

Curr. Opin. Neurol.
Curr Opin Neurol 2016 Jul 13. Epub 2016 Jul 13.
aNeuroimmunology Laboratory, Queen Elizabeth University Hospital bInstitute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

There has been a recent renewed interest in the prevalence of antiglycolipid antibodies and their associations with specific clinical phenotypes in Guillain-Barré syndrome. Recent reports have sought to confirm and expand the antibody-phenotype associations of antiganglioside antibodies, antiganglioside-complex antibodies, and antiglycolipid-complex antibodies in the various acute immune-mediated neuropathies. This is a rapidly developing field with technical advances in assay methodology, which have resulted in numerous new putative antibody-phenotype associations. Read More

Antibodies against single ganglioside species remain the most established serological marker of Guillain-Barré syndrome and its myriad clinical variants. Antibodies against combinations of gangliosides, ganglioside-complex antibodies, detected by the ELISA method have emerged as putative markers of certain clinical features or pathological subtypes, specifically acute motor axonal neuropathy, but do not seem to greatly increase the diagnostic sensitivity of antibody testing as most also react with single ganglioside species. The novel assay method of the combinatorial glycoarray allows high-throughput detection of antibodies recognizing combinations of gangliosides and other glycolipids and early studies suggest it identifies antibody-phenotype associations in addition to significantly increasing the sensitivity of serological testing, including for the acute inflammatory demyelinating polyneuropathy variant.
Antibodies against single ganglioside species remain diagnostically useful in routine clinical practice. Antibodies against ganglioside complexes, or gangliosides and other glycolipid complexes, are emerging as useful markers of various clinic features and pathological subtypes; however, the precise associations remain to be fully delineated and confirmed. The antibody-complex detection methods are rapidly evolving but in most centres are not yet available in routine clinical practice.

Curr. Opin. Neurol.
Curr Opin Neurol 2016 Jul 13. Epub 2016 Jul 13.
National Hospital for Neurology and Neurosurgery, London, England, UK.

Understanding the mechanisms and abnormalities of respiratory function in neuromuscular disease is critical to supporting the patient and maintaining ventilation in the face of acute or chronic progressive impairment.
Retrospective clinical studies reviewing the care of patients with Guillain-Barré syndrome and myasthenia have shown a disturbingly high mortality following step-down from intensive care. This implies high dependency and rehabilitation management is failing despite evidence that delayed improvement can occur with long-term care. Read More

A variety of mechanisms of phrenic nerve impairment have been recognized with newer investigation techniques, including electromyogram and ultrasound. Specific treatment for progressive neuromuscular and muscle disease has been increasingly possible particularly for the treatment of myasthenia, metabolic myopathies, and Duchenne muscular dystrophy. For those conditions without specific treatment, it has been increasingly possible to support ventilation in the domiciliary setting with newer techniques of noninvasive ventilation and better airway clearance. There remained several areas of vigorous debates, including the role for tracheostomy care and the place of respiratory muscle training and phrenic nerve/diaphragm pacing.
Recent studies and systematic reviews have defined criteria for anticipating, recognizing, and managing ventilatory failure because of acute neuromuscular disease. The care of patients requiring long-term noninvasive ventilatory support for chronic disorders has also evolved. This has resulted in significantly improved survival for patients requiring domiciliary ventilatory support.

Iran J Allergy Asthma Immunol
Iran J Allergy Asthma Immunol 2016 Jun;15(3):251-6
Department of Radiology, School of Medicine, Najafabad University of Medical Sciences, Isfahan, Iran.

Multiple sclerosis (MS) is a complex, demyelinating disease of the central nervous system (CNS) with variable phenotypic presentations, while Guillain-Barre Syndrome (GBS) is the prototypic acute inflammatory disorder that affects the peripheral nervous system. Myasthenia gravis (MG) is a T cell dependent and antibody mediated autoimmune disease. Although it has been shown that complement plays a critical role in the pathogenesis of MS, GBS, and MG, the role of mannose-binding lectin (MBL) as a biomarker of immunopathogensis of these diseases and also its association with the severity of them have been poorly investigated. Read More

Therefore, in this study we aimed to measure plasma levels of MBL in patients with MS, GBS, and MG. In a case-control study, plasma was obtained from healthy controls (n=100) and also patients with MS (n=120), GBS (n=30), and MG (n=30). Plasma level measurement of MBL was performed using enzyme-linked immunosorbent assay (ELISA). The mean serum level of MBL was significantly different between groups of patients and healthy controls (p<0.001). We also found a positive correlation between plasma levels of MBL and severity scores of MS, MG, and GBS patients including: expanded disability status scale (EDSS) (r=+0.60 and p=<0.001), quantitative myasthenia gravis score (QMGS) (r=+0.56 and p=0.01), and GBS disability scale (GDS) (r=+0.37 and p=0.04). Taken together, our findings suggest that complement activation mediated by MBL contributes to the pathogenesis and also severity of MS, MG, and GBS. However, because the lectin pathway can be involved in several phases of the immune response, further evidence will be required to elucidate the underlying mechanism.

Acta Med Iran
Acta Med Iran 2016 Jul;54(7):471-4
Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Brain and Spinal Injury Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Acta Neurol Belg
Acta Neurol Belg 2016 Jul 14. Epub 2016 Jul 14.
Department of Pediatric Neurology, Cukurova University Faculty of Medicine, Toros mah., Barış Manço Bul. 78178 Sok., Yeşilpark evleri, A blok, kat:7/13, Çukurova, Adana, Turkey.
PLoS Negl Trop Dis
PLoS Negl Trop Dis 2016 Jul 13;10(7):e0004846. Epub 2016 Jul 13.
Immunization Safety Office, Division of Healthcare Quality Promotion (DHQP), National Center for Zoonotic and Emerging Infectious Diseases (NCZEID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
Indian J Hematol Blood Transfus
Indian J Hematol Blood Transfus 2016 Jun 12;32(Suppl 1):59-61. Epub 2016 Mar 12.
Institute of Child Health, Kolkata, India.
Immunol. Res.
Immunol Res 2016 Jul 13. Epub 2016 Jul 13.
Institute of Chronic Illnesses, Inc, 14 Redgate Ct, Silver Spring, MD, 20905, USA.

Gardasil is a quadrivalent human papillomavirus (HPV4) vaccine that was approved for use by the US Food and Drug Administration in June 2006. HPV4 vaccine is routinely recommended for administration to women in the USA who are 11-12 years old by the Advisory Committee on Immunization Practices. Previous studies suggest HPV4 vaccine administration was associated with autoimmune diseases. Read More

As a consequence, an epidemiological assessment of the vaccine adverse event reporting system database was undertaken for adverse event reports associated with vaccines administered from 2006 to 2014 to 6-39 year-old recipients with a listed US residence and a specified female gender. Cases with the serious autoimmune adverse event (SAAE) outcomes of gastroenteritis (odds ratio (OR) 4.627, 95 % confidence interval (CI) 1.892-12.389), rheumatoid arthritis (OR 5.629, 95 % CI 2.809-12.039), thrombocytopenia (OR 2.178, 95 % CI 1.222-3.885), systemic lupus erythematosus (OR 7.626, 95 % CI 3.385-19.366), vasculitis (OR 3.420, 95 % CI 1.211-10.408), alopecia (OR 8.894, 95 % CI 6.255-12.914), CNS demyelinating conditions (OR 1.585, 95 % CI 1.129-2.213), ovarian damage (OR 14.961, 95 % CI 6.728-39.199), or irritable bowel syndrome (OR 10.021, 95 % CI 3.725-33.749) were significantly more likely than controls to have received HPV4 vaccine (median onset of initial symptoms ranged from 3 to 37 days post-HPV4 vaccination). Cases with the outcome of Guillain-Barre syndrome (OR 0.839, 95 % CI 0.601-1.145) were no more likely than controls to have received HPV4 vaccine. In addition, cases with the known HPV4-related outcome of syncope were significantly more likely than controls to have received HPV4 vaccine (OR 5.342, 95 % CI 4.942-5.777). Cases with the general health outcomes of infection (OR 0.765, 95 % CI 0.428-1.312), conjunctivitis (OR 1.010, 95 % CI 0.480-2.016), diarrhea (OR 0.927, 95 % CI 0.809-1.059), or pneumonia (OR 0.785, 95 % CI 0.481-1.246) were no more likely than controls to have received HPV4 vaccine. Confirmatory epidemiological studies in other databases should be undertaken and long-term clinical consequences of HPV-linked SAAEs should be examined.

Bickerstaff brainstem encephalitis (BE) is a very rare neurological condition with subacute onset of ophthalmoplegia, ataxia and altered sensorium, often postinfectious. The condition is associated with the anti-GQ1b antibody syndrome and is part of the spectrum of diseases including Miller Fisher syndrome and Guillain-Barré syndrome. In this case, we report the history, workup, treatment and follow-up of a 48-year-old woman with probable BE without anti-GQ1b antibodies in relation to the international diagnostic criteria. Read More

Neurosurg Rev
Neurosurg Rev 2016 Jul 12. Epub 2016 Jul 12.
Department of Neurology, American University Medical Center, Beirut, Lebanon.
Biores Open Access
Biores Open Access 2016 1;5(1):171-6. Epub 2016 Jun 1.
Department of Epidemiology and Biostatistics, School of Public Health (Initiative), Jackson State University , Jackson, Mississippi.

A strong causal association has become evident between Zika virus (ZIKV) infection during pregnancy and the occurrence of fetal growth restriction, microcephaly and eye defects. Circumstantial evidence is presented in this paper in support of the hypothesis that these effects, as well as the Guillain-Barré syndrome, are due to an endogenous form of hypervitaminosis A resulting from ZIKV infection-induced damage to the liver and the spillage of stored vitamin A compounds ("retinoids") into the maternal and fetal circulation in toxic concentrations. Retinoids are mainly stored in the liver (about 80%) and are essential for numerous biological functions. Read More

In higher concentration, retinoids are potentially cytotoxic, pro-oxidant, mutagenic and teratogenic, especially if sudden shifts occur in their bodily distribution. Although liver involvement has not been mentioned specifically in recent reports, conventional liver enzyme tests underestimate the true extent of liver dysfunction. The proposed model could be tested by comparing retinoid concentration and expression profiles in microcephalic newborns of ZIKV-infected mothers and nonmicrocephalic newborn controls, and by correlating these profiles with measures of clinical severity.

Case Rep Neurol Med
Case Rep Neurol Med 2016 15;2016:5913840. Epub 2016 Jun 15.
Unit of Neurology, San Francesco Hospital, Via Mannironi, 08100 Nuoro, Italy.

We report the case of a 56-year-old woman who developed status epilepticus (SE) related to independent occipital foci as clinical manifestation of posterior reversible encephalopathy syndrome (PRES) in the background of Guillain-Barrè syndrome (GBS). SE resulted from a series of focal seizures clinically characterized by left- and rightward deviations of the head and consequent oculoclonic movements. Electroencephalography recorded independent seizure activity in both occipital regions with alternate involvement of the two cerebral hemispheres. Read More

The epileptic foci corresponded topographically to parenchymal abnormalities of PRES in the occipital lobes. The manifestation of bilateral, independent occipital seizures with alternate deviations of the head and oculoclonic movements, previously not reported in patients with PRES, highlights the acute epileptogenicity of the cerebral lesions in this syndrome. Despite the variable clinical expression of seizures due to occipital damage in PRES, the development of independent seizure activity in both occipital lobes might represent a distinctive epileptic phenomenon of this encephalopathy.

Am. J. Trop. Med. Hyg.
Am J Trop Med Hyg 2016 Jul 11. Epub 2016 Jul 11.
Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Departamento de Neurología, Hospital Luis Vernaza, Guayaquil, Ecuador;

Zika virus (ZIKV) and chikungunya virus (CHIKV) cocirculate throughout much of the tropical Western Hemisphere; however, few cases of coinfection with these two pathogens have been reported. Herein, we describe three cases of ZIKV-CHIKV coinfection detected at a single center in Ecuador: a patient who developed symptoms on postoperative day 5 from an orthopedic procedure, a woman who had traveled to Ecuador for fertility treatment, and a woman who was admitted for Guillain-Barré syndrome and had ZIKV and CHIKV detected in serum and cerebrospinal fluid. All cases were diagnosed using a multiplex real-time reverse transcription polymerase chain reaction, and ZIKV viremia was detected as late as 16 days after symptom onset. Read More

These cases demonstrate the varied clinical presentation of ZIKV-CHIKV coinfections as well as the importance of multiplexed arboviral testing for these pathogens.

Curr Sports Med Rep
Curr Sports Med Rep 2016 Jul-Aug;15(4):298-300
1United World Wrestling (UWW), Medical and Anti Doping Commission, Vancouver, Canada; 2European College of Sport and Exercise Physicians (ECOSEP), London, UK; 3World Karate Federation (WKF), Medical and Anti Doping Commissions, Madrid, Spain; 4Sports Medicine Committee, Fédération Internationale de Natation (FINA), Tehran, Iran; and 5Department of Family Medicine, University of Colorado School of Medicine, Denver, CO.

Zika virus (ZIKV) is an arthropod-borne virus that is mainly transmitted via a bite from a female mosquito of the Aedes species. However, ZIKV can be transmitted sexually or via blood. Due to the recent ZIKV outbreak in South and Central America, many national and international organizations are concerned about the safety of athletes, coaches, staff, and spectators during the Olympic and Paralympic Games. Read More

Infected individuals are generally asymptomatic or have mild symptoms. However, ZIKV infection can potentially cause serious complications such as Guillain-Barre syndrome and congenital defects. Preferred diagnosis is based on real-time reverse-transcription polymerase chain reaction from blood and urine. Currently, there is no treatment or immunization available for ZIKV infection, and disease control is limited to preventing mosquito bites.

Muscle Nerve
Muscle Nerve 2016 Jul 11. Epub 2016 Jul 11.
Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK.

Paraparetic Guillain-Barré syndrome (GBS) is a rare subtype of GBS characterized by leg weakness and areflexia in the absence of neurological involvement of the arms, cranial nerves, or respiratory muscles. Onset is characterized by lower back, buttock, or leg pain, followed by development of symmetric flaccid limb weakness in the absence of sensory disturbance.
We describe an elderly woman who developed post-infectious symmetric flaccid leg weakness in the absence of sensory disturbance. Read More

Serial nerve conduction studies were carried out over 5 months.
Antecedent infection, monophasic disease course, and the presence of cerebrospinal fluid albuminocytological dissociation suggested a diagnosis of paraparetic GBS. Serial nerve conduction studies demonstrated non-demyelinating reversible conduction failure, which was restricted to the legs. Axonal neuropathy was supported by the presence of anti-GM1 IgG antibodies.
These findings suggest that patients with paraparetic GBS have axonal neuropathy, which is restricted to the lower limbs. This article is protected by copyright. All rights reserved.

Asian Pac J Trop Med
Asian Pac J Trop Med 2016 Jul 31;9(7):626-9. Epub 2016 May 31.
Liver Clinic, Iftikhar Eye Hospital, Mayo Road, Islamabad 44000, Pakistan.

The current Zika outbreak is largest of its kind with 1.4 million cases in Brazil alone. World Health Organization declared the current outbreak as the public health emergency of international concerns. Read More

The major route of Zika virus transmission is mosquito bites. Sexual transmission and monkey bites are also observed in few cases. There is dire need to evaluate the other routes of transmission like blood transfusion, lactation and contact with body fluids. Zika virus is infecting infants, not only causing microcephaly but also creating number of complications resulting in bad outcomes of pregnancy. In Brazil alone, 4000 cases of microcephaly have observed during the current outbreak. The incidence of Guillain-Barre (GB) syndrome is also observed during the current Zika virus outbreak. GB syndrome is acute medical condition leading the patients to death due to weakness of respiratory muscles or can cause the life time disability. There is no anti-viral drug or vaccine available for Zika virus. Zika infection can be prevented by using mosquito repellents, mosquito nets, cooling rooms by air conditions and wearing full sleeves or permethrin-treated clothes. The current outbreak of Zika has not only affected the health care but also caused great economic loss. Estimated loss in Latin America and Caribbean is US$3.5 billion. United Nation's sustainable development goal 3.d stresses the strengthening of early warning, risk reduction and management of national and global health risks. The world will keep on facing new challenges in the form of Ebola or Zika; there is strong need to prepare ourselves for any disease outbreak.

Asian Pac J Trop Med
Asian Pac J Trop Med 2016 Jul 31;9(7):621-5. Epub 2016 May 31.
Department of Microbiology, Qauid-i-Azam University, Islamabad, Pakistan. Electronic address:

Zika virus (ZIKV) was discovered more than half a century ago, recently it has gained unprecedented attention by the global health community. Until 2007, only 14 cases of human ZIKV infections were reported around the globe, while during the current outbreak, estimated cases mounted to approximately 1.5 million in Brazil alone, the virus was disseminated to wider South-American territories and travel-associated ZIKV infections were reported in USA, Europe and recently in China. Read More

ZIKV infections remain asymptomatic in approximately 80% of the individuals, and no anti-viral treatments were recommended. Yet, neurological complications associated with the infections, such as infant microcephaly and Guillain-Barré syndrome are major cause of the concern. Although, based on small numbers of cases, existing evidence strongly supports an exclusive link of viral infection and observed neurological complications. However, much work remains to assign exact numbers of complications caused by ZIKV. Regarding its structural attributes ZIKV shows remarkable resemblance with dengue virus and West-Nile virus. Despite, genomes of different ZIKV strains have already been decoded; role of the viral components in infection process and particularly pathogenesis of the disease remain widely unclear. In vulnerable areas, most viable strategy to ensure public health safety is vector control and enhanced public awareness about the transmission of the disease.

Med J Islam Repub Iran
Med J Islam Repub Iran 2016 23;30:336. Epub 2016 Feb 23.
MD, Assistant Professor of Neurology, Shahid Sadooghi Hospital, Yazd University of Medical Science, Yazd, Iran.

Intravenous immunoglobulin (IVIG) is an established treatment of immune mediated demyelinating neuropathy including Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Recent trials suggest its efficacy in treating relapsing- remitting multiple sclerosis. IVIG exerts a number of effects, which may be beneficial in treating multiple sclerosis (MS): Reduction of inflammation, inhibition of macrophages, and promotion of remyelination. Read More

The aim of this study was to provide an overall assessment of the existing trials of safety and effectiveness of IVIG in relapsing- remitting MS compared to other drugs currently available for the treatment of disease activity in MS.
A systematic search strategy was applied to MEDLINE (PubMed and Ovid Medline (1990- Nov 2014)), Cochrane Library 2014, and Trip Database 2014, CRD. The reference lists from the identified trials, MS clinical handbooks and guidelines for the use of IVIG were studied. This article was conducted without language restrictions. Randomized controlled trials of IVIG in MS were selected. Sixteen double-blinded trails were randomly selected. Ten trials were excluded and we performed a meta-analysis on the six trials (537 participants) of IVIG in comparison to placebo. The methodological quality of the trials was assessed using Jadad checklist.
The meta-analysis showed a significant beneficial effect on proportion of relapse-free patients (OR: 1.693; 95% CI-1.205-2.380), on the proportion of patients who improved (OR:2.977; 95% CI 1.769-5.010; p=0.0001) and deteriorated (OR:0.522; 95% CI0.330-0.827; p=0.006) between placebo and IVIG-treated patients. In addition, there was a reduction in the annual relapse rate in the IVIG group compared to placebo, which was statistically significant (SMD=-0.218; 95% CI-0.412 to -0.024; p=0.028). The results of the meta-analysis did not show significant differences between Expanded Disability Status Scale (EDSS) changes from baseline (SMD,-0.025; 95% CI,-0.211 to 0.161; p=0.860).
IVIG can be considered as an alternative therapeutic option, second-line therapy or adjuvant therapy, considering its beneficial effects (high tolerance, need to be injected with longer intervals, etc.) for treating relapsing-remitting MS patients.

Neurol. Sci.
Neurol Sci 2016 Jul 7. Epub 2016 Jul 7.
Department of Neurology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0180, Japan.

There have been reports from several countries that hepatitis E virus (HEV) infection is frequently associated with Guillain-Barré syndrome (GBS). This study aimed to determine the frequency of HEV infection associated with GBS in Japanese patients, and to clarify the clinical characteristics of these patients. Sera obtained from 63 patients with GBS or Miller Fisher syndrome (MFS) and 60 control subjects were examined for both HEV-IgM and HEV-IgG. Read More

Of the 63 patients, three were positive for both HEV-IgM and elevated hepatic enzymes: Two had GBS, and one had MFS. No control subjects were positive for HEV-IgM. Our study demonstrated that 4.8 % of patients with GBS or MFS from our institution had associated acute HEV infection. There were no clinical differences between GBS with HEV infection and other GBS cases. To our knowledge, this is the first survey in Japan of HEV-associated GBS or MFS.

Ann Clin Transl Neurol
Ann Clin Transl Neurol 2016 Jul 17;3(7):547-51. Epub 2016 May 17.
Department of ImmunologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands; Department of NeurologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands.

Treatment of Guillain-Barré syndrome with a standard course of high-dose intravenous immunoglobulin (IVIg) results in a variable clinical recovery which is associated with changes in serum IgG levels after treatment. The neonatal Fc-receptor protects IgG from degradation, and a genetic polymorphism in its promoter region that influences the expression of Fc-receptor, may in part explain the variation in IgG levels and outcome. This polymorphism was determined by polymerase chain reaction in a cohort of 257 patients with Guillain-Barré syndrome treated with IVIg. Read More

We could not demonstrate a relation between this polymorphism, the pharmacokinetics of IVIg, or the clinical course and outcome.

Emerg Nurse
Emerg Nurse 2016 Jul;24(4):20-3
University of South Florida College of Nursing, Tampa, Florida, US.

Zika virus, a mosquito-borne vector, is an emerging population health threat, and is linked to fetal microcephaly, pregnancy loss and neurologic symptoms like Guillain-Barré syndrome. Global travel and migration increase the risk of transmission significantly, and growing numbers of cases are expected internationally. This article describes transmission of the virus, early and late clinical manifestations, and emergency and supportive care. Read More

It also recommends interventions for prevention.

Nivolumab, an anti-programmed death-1-specific monoclonal antibody, has demonstrated a durable response and effect on overall survival and has become one of the standard treatments for patients with advanced melanoma. Reported herein is a case of nivolumab-induced chronic inflammatory demyelinating polyradiculoneuropathy, in which an 85-year-old woman with stage IV melanoma developed grade 1 paresthesia 2 weeks after the initial dose of nivolumab was administered. With continued treatment, the neurological deficiency deteriorated rapidly, mimicking Guillain-Barré syndrome, causing such a dramatic decrease in her activities of daily living that she could no longer function in daily life. Read More

Thus, nivolumab treatment was discontinued. A course of intravenous immunoglobulin infusion yielded a dramatic clinical improvement; in particular, improved motor control was observed within a few days. Her initial presentation was suggestive of acute inflammatory demyelinating polyradiculoneuropathy, a subtype of Guillain-Barré syndrome; however, the good response to steroids and exacerbation 8 weeks after the onset were suggestive of chronic inflammatory demyelinating polyradiculoneuropathy induced by nivolumab. This is the first case of Guillain-Barré syndrome-like autoimmune polyradiculoneuropathy induced by programmed death-1/programmed death-ligand 1 inhibitors. Although neurological adverse events related to nivolumab are rare, they can become severe, requiring early diagnosis and intervention. Intravenous immunoglobulin may be considered as an effective initial treatment for patients who develop acute autoimmune nervous system disorders due to nivolumab.