Guillain-Barre Syndrome Publications (8081)


Guillain-Barre Syndrome Publications

Zika virus infection emerged as a public health emergency after increasing evidence for its association with neurologic disorders and congenital malformations. In Salvador, Brazil, outbreaks of acute exanthematous illness (AEI) attributed to Zika virus, Guillain-Barré syndrome (GBS), and microcephaly occurred in 2015. We investigated temporal correlations and time lags between these outbreaks to identify a common link between them by using epidemic curves and time series cross-correlations. Read More

Number of GBS cases peaked after a lag of 5-9 weeks from the AEI peak. Number of suspected cases of microcephaly peaked after a lag of 30-33 weeks from the AEI peak, which corresponded to time of potential infections of pregnant mothers during the first trimester. These findings support the association of GBS and microcephaly with Zika virus infection and provide evidence for a temporal relationship between timing of arboviral infection of pregnant women during the first trimester and birth outcome.

Anc Sci Life
Anc Sci Life 2016 Jan-Mar;35(3):184
Department of Neurology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India.

Acute inflammatory demyelinating polyneuropathy (AIDP) - the main form of Guillain-Barre syndrome (GBS) - is a rare and severe disorder of the peripheral nervous system (PNS) with an unknown etiology. One of the hallmarks of the AIDP pathogenesis is a significantly elevated cerebrospinal fluid (CSF) protein level. In this paper CSF peptidome and proteome in AIDP were analyzed and compared with multiple sclerosis (MS) and control patients. Read More

A total protein concentration increase was shown to be due to even changes in all proteins rather than some specific response, supporting the hypothesis of protein leakage from blood through the blood-nerve barrier. The elevated CSF protein level in AIDP was complemented by activization of protein degradation and much higher peptidome diversity. Due to the studies of the acute motor axonal form, GBS as a whole is thought to be associated with autoimmune response against neurospecific molecules. Thus, in AIDP, autoantibodies against cell adhesion (CAM) proteins localized at Ranvier's nodes were suggested as possible targets in AIDP. Indeed, AIDP CSF peptidome analysis revealed CAM proteins degradation, however no reliable dependence on the corresponding autoantibodies levels was found. Proteome analysis revealed overrepresentation of Gene Ontology groups related to responses to bacteria and virus infections, which were earlier suggested as possible AIDP triggers. Immunoglobulin blood serum analysis against most common neuronal viruses did not reveal any specific pathogen; however AIDP patients were more immunopositive in average and often had polyinfections. Cytokine analysis of both AIDP CSF and blood did not show a systemic adaptive immune response or general inflammation, while innate immunity cytokines were upregulated. To supplement the widely-accepted though still unproven autoimmunity-based AIDP mechanism we propose a hypothesis of the primary PNS damaging initiated as an innate immunity-associated local inflammation following neurotropic viruses egress, while the autoantibody production might be an optional complementary secondary process.

J Neuroinflammation
J Neuroinflammation 2016 3;13(1):97. Epub 2016 May 3.
Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Anshan Road, Heping District, Tianjin, 300052, China.

Guillain-Barré syndrome (GBS) is an acute, post-infectious, immune-mediated, demyelinating disease of peripheral nerves and nerve roots. Dimethyl fumarate (DMF), a fumaric acid ester, exhibits various biological activities, including multiple immunomodulatory and neuroprotective effects. However, the potential mechanism underlying the effect of DMF in GBS animal model experimental autoimmune neuritis (EAN) is unclear. Read More

Using EAN, an established GBS model, we investigated the effect of DMF by assessing clinical score, histological staining and electrophysiological studies. Then, we further explored the potential mechanism by Western blot analysis, flow cytometry, fluorescence immunohistochemistry, PCR, and ELISA analysis. The Mann-Whitney U test was used to compare differences between control group and treatment groups where appropriate.
DMF treatment reduced the neurological deficits by ameliorating inflammatory cell infiltration and demyelination of sciatic nerves. In addition, DMF treatment decreased the level of pro-inflammatory M1 macrophages while increasing the number of anti-inflammatory M2 macrophages in the spleens and sciatic nerves of EAN rats. In RAW 264.7, a shift in macrophage polarization from M1 to M2 phenotype was demonstrated to be depended on DMF application. In sciatic nerves, DMF treatment elevated the level of the antioxidant transcription factor nuclear factor erythroid-derived 2-related factor 2 (Nrf2) and its target gene hemoxygenase-1 (HO-1) which could facilitate macrophage polarization toward M2 type. Moreover, DMF improved the inflammatory milieu in spleens of EAN rats, characterized by downregulation of messenger RNA (mRNA) of IFN-γ, TNF-α, IL-6, and IL-17 and upregulation of mRNA level of IL-4 and IL-10.
Taken together, our data demonstrate that DMF can effectively suppress EAN, and the mechanism involves altering the balance of M1/M2 macrophages and attenuating inflammation.

Am. J. Trop. Med. Hyg.
Am J Trop Med Hyg 2016 May 2. Epub 2016 May 2.
Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado; Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado.

Zika virus (ZIKV) is a mosquito-borne flavivirus serologically grouped within the family Flaviviridae, which was initially isolated from a febrile sentinel monkey in the Zika Forest of Uganda in 1947. Subsequent genetic analyses have demonstrated the presence of two distinctive African and Asian viral genotypes. After years of being associated only with sporadic human illness, the first outbreak of ZIKV disease was reported in 2007, on the island of Yap in the Federated States of Micronesia (with 49 laboratory confirmed cases documented). Read More

In subsequent years, ZIKV was associated with outbreaks in French Polynesia and then in the South Pacific Islands of New Caledonia and Easter Island, before disease being identified in Brazil in early 2015. Although the majority of human ZIKV infections have been found to result in asymptomatic or mild illness, the recent identification of an association of ZIKV infection during pregnancy with an increase in the incidence of microcephaly in neonates, as well as the development of Guillain-Barré syndrome resulted in the World Health Organization's declaration that the ZIKV outbreak constituted a "Public Health Emergency of International Concern." The unprecedented geographic expansion of the virus, with up to 1.3 million estimated human infections as of December 2015, its sexual transmission potential, and its severe pathogenic effects in fetuses (microcephaly, ocular malformations) have emphasized the critical need for available vaccines and antiviral therapies, as well as an improved understanding of the pathological mechanisms that result in human disease after infection with this virus.

Eur. J. Neurol.
Eur J Neurol 2016 Apr 29. Epub 2016 Apr 29.
Department of Neurology, University Medical Centre Maastricht, Maastricht, The Netherlands.
Immunotherapy 2016 Apr 29. Epub 2016 Apr 29.
Baxalta Innovations GmbH, Immunology, Industriestraße 67, 1220, Vienna, Austria.
J Community Hosp Intern Med Perspect
J Community Hosp Intern Med Perspect 2016 25;6(2):30689. Epub 2016 Apr 25.
Department of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health, Abington, PA, USA.

Systemic lupus erythematous (SLE) is frequently encountered in clinical practice; a widespread immunological response can involve any organ system, sometimes leading to rare and diagnostically challenging presentations. We describe a 38-year-old female who presented with symmetric numbness and tingling of the hands and feet, and cervical pain. Imaging studies were not diagnostic of any serious underlying pathology. Read More

The patient developed ascending paresis involving lower extremities and cranial muscles (dysphagia and facial weakness). Guillain-Barré syndrome (GBS) was diagnosed on the basis of electromyography and lumbar puncture showing albuminocytologic dissociation. Intravenous immunoglobulins (IVIG) were administered for 5 days. Supported by anti-dsDNA antibody, oral ulcers, proteinuria of 0.7 g in 24 h, and neurological manifestation, she was diagnosed with lupus. After completion of IVIG, she received pulse-dose corticosteroids and one dose of low-dose cyclophosphamide. Her neurological symptoms improved and she had complete neurological recovery several months after her initial presentation. Literature search provides evidence of co-occurrence of lupus and GBS occurring mostly later in the course of the disease. However, GBS as initial manifestation of SLE is exceedingly rare and less understood. The association of GBS with lupus is important to recognize for rapid initiation of appropriate therapy and for consideration of immunosuppressive therapy which may affect the outcome.

Intensive Care Med
Intensive Care Med 2016 Apr 27. Epub 2016 Apr 27.
Intensive Care Unit, University Hospital of Fort de France, Martinique, France.
Lancet 2016 Apr;387(10026):1482
Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK; Walton Centre NHS Foundation Trust, Liverpool, UK.
Int. J. Infect. Dis.
Int J Infect Dis 2016 Apr 21. Epub 2016 Apr 21.
Department of Laboratory Medicine, Wonkwang University College of Medicine, Iksan, Korea.

We conducted a retrospective analysis of patients diagnosed with tetanus to evaluate the occurrence of Guillain-Barré syndrome (GBS). Two of 13 tetanus cases were complicated with GBS, and their symptoms and signs related to GBS were markedly improved after a 5-day infusion of intravenous immunoglobulin. Physicians should keep in mind that GBS can be an important cause of muscle weakness in patients with tetanus. Read More

J. Clin. Virol.
J Clin Virol 2016 Jun 14;79:74-6. Epub 2016 Apr 14.
Institut de Biologie Structurale (IBS), CEA, CNRS, University Grenoble Alpes, 38044 Grenoble, France; Laboratory of Virology, Grenoble University Hospital, 38043 Grenoble, France; University Grenoble Alpes, 38042 Grenoble, France.

Guillain-Barré syndrome (GBS) is an immune-mediated disorder which can be triggered by cytomegalovirus (CMV) infection. GBS following CMV primary infection is a rare event during pregnancy, which raises the question of maternal and fetal management. We describe an unusual case of GBS after CMV primary infection in a pregnant woman. Read More

The mother was successfully treated with standard immunoglobulins but in utero fetal death caused by CMV congenital infection unfortunately occurred. Similar cases have rarely been reported in the literature.

Adv Biomed Res
Adv Biomed Res 2016 16;5:32. Epub 2016 Mar 16.
Department of Neurology, Kashani Hospital, Shahre-Kord University of Medical Sciences, Shahre-Kord, Iran.

Acute onset bulbar symptoms with respiratory failure and descending paralysis may occur in several neuromuscular disorders including variants of Guillain-Barre syndrome (GBS), diphtheria, botulism and toxins. We present a 51-year-old man who presented with complains of ptosis and dyspnea following pyrethroids spraying in an enclosed area for eradication of flea. Within 5-6 days of admission limb weakness, dysphagia, dysarthria, blurred vision, diplopia, tremor and respiratory distress added to previous symptoms. Read More

Temporal profile of events after exposure, development of similar symptoms in patient's son, electrodiagnostic findings and exclusion of other etiologies confirms intoxication etiology. We reviewed the literature and provide an extensive electrodiagnostic overview.

Pol. Merkur. Lekarski
Pol Merkur Lekarski 2016 Mar;40(237):149-52
EMC Medical Institute SA - Department of Internal Medicine and Lung Disease, Hospital st. Anna in Piaseczno, Poland.
Case Rep Surg
Case Rep Surg 2016 21;2016:5430708. Epub 2016 Mar 21.
Department of Neurosurgery, Van District Training and Research Hospital, 65100 Van, Turkey.

A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS). The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. Read More

The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI) showed an image of a mass compressing the medulla.

Zhonghua Liu Xing Bing Xue Za Zhi
Zhonghua Liu Xing Bing Xue Za Zhi 2016 Apr;37(4):450-4
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.

Zika virus belongs to Aedes mosquito-borne flavivirus. In response to the current cluster of congenital malformations (microcephaly) and other neurological complications (Guillain-Barré Syndrome) that could be linked to Zika virus infection, WHO declares that Zika virus is of global public health importance. Data sources were from peer review articles and WHO documents. Read More

The sources of Zika virus infection would include patients, people with asymptomatic infections and primates. The infectious period of Zika virus remains unclear. However, according to the period that RNA of Zika virus can be positively detected in blood, saliva, urine or semen, we can presume that the communicable period may last for 2 months or even longer. Zika virus is primarily transmitted to humans by infected Aedes spp. mosquitoes. Presumptive vertical, blood or sexual routes of transmission have been reported. More evidence indicated the existence of a cause-effect relationship between Zika virus infection and congenital microcephaly/Guillain-Barre syndrome. Strategies include successful control the amount of mosquitoes and minimize the contacts between mosquitoes and human beings could effectively prevent the Zika virus transmission. Other preventive measures as cutting off vertical, blood or sexual routes of transmission should also be adopted. The epidemiology of Zika virus remains uncertain which calls for further research.

J. Neurol. Sci.
J Neurol Sci 2016 May 26;364:154-9. Epub 2016 Mar 26.
Department of Neurology, Tokushima University, Tokushima, Japan.
J. Neurol. Sci.
J Neurol Sci 2016 May 3;364:59-64. Epub 2016 Mar 3.
Department of Neurology, Kobe City Medical Center General Hospital, Japan. Electronic address:

Zika virus infection has been linked to increased risk for Guillain-Barré syndrome and adverse fetal outcomes, including congenital microcephaly. In January 2016, after notification from a local health care provider, an investigation by Dallas County Health and Human Services (DCHHS) identified a case of sexual transmission of Zika virus between a man with recent travel to an area of active Zika virus transmission (patient A) and his nontraveling male partner (patient B). At this time, there had been one prior case report of sexual transmission of Zika virus (1). Read More

The present case report indicates Zika virus can be transmitted through anal sex, as well as vaginal sex. Identification and investigation of cases of sexual transmission of Zika virus in nonendemic areas present valuable opportunities to inform recommendations to prevent sexual transmission of Zika virus.

Eur. Neurol.
Eur Neurol 2016 15;75(3-4):199-206. Epub 2016 Apr 15.
Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.

In the clinical evaluation of patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), scant attention is paid to symptoms such as fatigue, pain and anxiety/depression. We aimed at addressing seminal studies that focused on the burden of these symptoms and their impact on quality of life (QoL) in these conditions.
Fatigue, pain, and anxiety/depression are increasingly being recognized in patients with GBS and CIDP, although their pathophysiological provenance remains unknown. Read More

Fatigue and pain are significant in terms of prevalence and intensity, may be a presenting symptom, and can persist for years after apparent functional recovery, suggesting residual injury. Anxiety/depression has also been examined although studies are limited. Despite their negative impact on QoL, the long-term dynamics of these symptoms in patients with GBS and particularly CIDP receiving therapy in routine clinical practice have not been systematically evaluated. Such observations formed the basis for the ongoing (GAMEDIS) studies evaluating the effect of Gamunex® on fatigue and depression in patients with CIDP, of which some preliminary data are presented.
Strength and sensory deficits are the main areas of focus in patients with GBS and CIDP, but they do not explain the total reduction in QoL, suggesting the possible role of other complaints. A more comprehensive approach to patient care demands that factors such as pain, fatigue and anxiety/depression receive greater attention. The non-interventional GAMEDIS studies are expected to provide valuable insight into the long-term effectiveness of Gamunex® in everyday practice.

Emerging Infect. Dis.
Emerg Infect Dis 2016 Jul 15;22(7). Epub 2016 Jul 15.

Zika virus is a mosquitoborne flavivirus that is the focus of an ongoing pandemic and public health emergency. Previously limited to sporadic cases in Africa and Asia, the emergence of Zika virus in Brazil in 2015 heralded rapid spread throughout the Americas. Although most Zika virus infections are characterized by subclinical or mild influenza-like illness, severe manifestations have been described, including Guillain-Barre syndrome in adults and microcephaly in babies born to infected mothers. Read More

Neither an effective treatment nor a vaccine is available for Zika virus; therefore, the public health response primarily focuses on preventing infection, particularly in pregnant women. Despite growing knowledge about this virus, questions remain regarding the virus's vectors and reservoirs, pathogenesis, genetic diversity, and potential synergistic effects of co-infection with other circulating viruses. These questions highlight the need for research to optimize surveillance, patient management, and public health intervention in the current Zika virus epidemic.


Zika virus infection has emerged as the world's newest health threat, linked to microcephaly in infants and Guillain-Barré syndrome in adults. We address the rapid global spread of this disease, and the prospects for successful prevention and treatment. Read More

Eur. J. Obstet. Gynecol. Reprod. Biol.
Eur J Obstet Gynecol Reprod Biol 2016 Apr 1. Epub 2016 Apr 1.
Department of Obstetrics and Gynecology, Kawasaki Medical School, Japan.
Neuroradiology 2016 Apr 11. Epub 2016 Apr 11.
Department of Radiology, Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, CEP 25685.120, Petrópolis, Rio de Janeiro, Brazil.
Cell Host Microbe
Cell Host Microbe 2016 Apr 5. Epub 2016 Apr 5.
Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA; The Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO 63110, USA. Electronic address:

The ongoing Zika virus (ZIKV) epidemic and unexpected clinical outcomes, including Guillain-Barré syndrome and birth defects, has brought an urgent need for animal models. We evaluated infection and pathogenesis with contemporary and historical ZIKV strains in immunocompetent mice and mice lacking components of the antiviral response. Four- to six-week-old Irf3(-/-)Irf5(-/-)Irf7(-/-) triple knockout mice, which produce little interferon α/β, and mice lacking the interferon receptor (Ifnar1(-/-)) developed neurological disease and succumbed to ZIKV infection, whereas single Irf3(-/-), Irf5(-/-), and Mavs(-/-) knockout mice exhibited no overt illness. Read More

Ifnar1(-/-) mice sustained high viral loads in the brain and spinal cord, consistent with evidence that ZIKV causes neurodevelopmental defects in human fetuses. The testes of Ifnar1(-/-) mice had the highest viral loads, which is relevant to sexual transmission of ZIKV. This model of ZIKV pathogenesis will be valuable for evaluating vaccines and therapeutics as well as understanding disease pathogenesis.