Guillain-Barre Syndrome Publications (7608)


Guillain-Barre Syndrome Publications

Clin Neurol Neurosurg
Clin Neurol Neurosurg 2015 May 11;135:6-10. Epub 2015 May 11.
Department Geriatrics, Neurosciences & Orthopedics, Institute of Neurology, Catholic University of the Sacred Heart, Rome, Italy.
Int. J. Neurosci.
Int J Neurosci 2015 May 22:1-5. Epub 2015 May 22.
Division of Infectious Diseases, University of Genoa and IRCCS San Martino-IST, Genoa , Italy.

Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy, usually triggered by an infectious episode, mostly of viral origin. Varicella zoster virus (VZV) is a rare cause of GBS, mainly in case of latent infection reactivation. We report on 3 adult patients who developed GBS following chickenpox, after a short period of latency. Read More

They were promptly treated with intravenous immunoglobulin, and the first one with plasma exchange additionally. All the patients experienced almost complete clinical recovery. Our experience suggests that primary VZV infection constitutes a GBS triggering event.

Int. J. Neurosci.
Int J Neurosci 2015 May 22:1-29. Epub 2015 May 22.
The first department of Neurology, the First Affiliated Hospital of Harbin Medical University, Harbin , China.

Background Guillain-Barre syndrome (GBS) fulfils most of the clinical features of an autoimmune disease except for its male predominance. No previous studies have evaluated the differential genome-wide expression between male and female GBS patients. Objective This study sought to identify differences between male and female GBS patients in the gene expression profiles of peripheral leukocytes. Read More

Methods We downloaded gene chip datasets pertaining to peripheral leukocyte samples from GBS patients using the Gene Expression Omnibus (GEO) (submitted by Kuo-Hsuan Chang, et al.) and applied hierarchical cluster analysis to detect whether there was a gender difference in genome-wide gene expression levels. Then, we identified the sexually differentially expressed genes using a bioinformatic approach and applied enrichment analysis to the gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) terms to identify significant pathways related to these genes. Results We observed gender stratification among GBS patients. 20 genes were expressed more highly in male patients and were enriched for functions such as macrophage differentiation, leukocyte migration, bladder cancer, pathogenic E. coli infection. In female patients, 62 genes were more highly expressed and were enriched for responses to viral infection and defense, retinoic acid-inducible gene I (RIG-I)-like receptors, cytoplasmic DNA sensing. Matrix metalloproteinase 9 (MMP9) seem to play an important role in the male predominance of GBS. Conclusions This study demonstrated gender differences in the genome-wide gene expression of patients with GBS. Bioinformatic approaches offer new means for identifying candidate genes and pathways relevant to the pathophysiology of GBS.

Vaccine 2015 May 18. Epub 2015 May 18.
Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), Universidad de Valladolid, Ramón y Cajal, 7, 47005 Valladolid, Spain. Electronic address:

Cases of Guillain-Barré syndrome (GBS) have been occasionally associated with influenza vaccines; this possible risk, even if rare, is a matter of much concern. To learn the strength of this association, a systematic review and a meta-analysis have been conducted; for the purpose, controlled observational studies addressing the risk of GBS associated with different influenza vaccines were sought. We finally selected 39 studies of interest published between 1981 and 2014 (seasonal influenza vaccines, 22; pandemic influenza vaccines, 16; both vaccines simultaneously administered, 1); funnel plot did not identify publication bias. Read More

At the association between any influenza vaccine - whether seasonal or pandemic - with GBS, the overall risk estimate was 1.41 (95%CI, 1.20-1.66); pandemic vaccines presented a slightly, though non significant, higher risk (RR=1.84; 95%CI, 1.36-2.50) compared to seasonal vaccines (RR=1.22; 95%CI, 1.01-1.48). Pandemic adjuvanted vaccines were not found to be related to a higher risk compared to non-adjuvanted vaccines. The results of the present meta-analysis point to a small but statistically significant association between influenza vaccines, particularly the pandemic ones, and GBS, which is consistent with current explanations upon possible mechanisms for this condition to appear.

Acta Neurol. Scand.
Acta Neurol Scand 2015 May 21. Epub 2015 May 21.
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Intravenous immunoglobulins (IVIGs) are often used in the treatment of autoimmune disorders and immunodeficiencies, and it has been estimated that neurologic indications can account for up to 43% of IVIG used in clinical practice. In neurologic clinical practice, IVIG is used for acute therapy of newly diagnosed autoimmune disorders or exacerbations of pre-existing conditions, or as long-term maintenance treatment for chronic disorders. IVIG exerts its effects on humoral and cell-based immunity through multiple pathways, without a single dominant mechanism. Read More

Clinical use of IVIG has been supported by guidelines from American Academy of Neurology and European Federation of Neurologic Societies. IVIG is generally recommended for the treatment of Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy in adults, multifocal motor neuropathy and myasthenia gravis, and should be considered as a treatment option for dermatomyositis in adults and Lambert-Eaton myasthenic syndrome. Additional potential indications include stiff person syndrome, multiple sclerosis during pregnancy or while breastfeeding, refractory autoimmune epilepsy, and paraneoplastic disorders. Clinical use of IVIG is mostly safe but few adverse effects may still occur with potentially severe complications, including aseptic meningitis and thromboembolism. In addition to intravenous route (IVIG), subcutaneous immunoglobulins have been used as an alternative treatment option, especially in patients with limited intravenous access. Treatment with IVIG is effective in various autoimmune diseases, but its broader use is constrained by limited supply. This review evaluates the use of immunoglobulins in treatment of neurologic diseases.

J Clin Neuromuscul Dis
J Clin Neuromuscul Dis 2015 Jun;16(4):220-2
*Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA; and †Department of Neurology, Thomas Jefferson University, Philadelphia, PA.
Oxf Med Case Reports
Oxf Med Case Reports 2015 Feb 26;2015(2):200-2. Epub 2015 Feb 26.
Department of Neurology , Barrow Neurological Institute , Phoenix, AZ , USA.

Acute inflammatory demyelinating polyneuropathy or Guillain-Barré syndrome is well recognized as a presenting feature of human immunodeficiency virus (HIV) seroconversion and, to a lesser extent, as a complication of HIV infection, particularly immune reconstitution. Acute motor axonal neuropathy (AMAN) is much rarer in this setting. A case is presented of acute motor neuropathy, with features most consistent with AMAN in the setting of congenital HIV and prolonged non-compliance with antiretroviral treatment. Read More

The case throws new light on the pathogenesis of this condition. Macrophage activation is proposed as fundamental; the patient was predisposed by HIV as well as the use of granulocyte colony-stimulating factor and AMAN was then precipitated by a bacterial infection.

Oxf Med Case Reports
Oxf Med Case Reports 2014 Oct 29;2014(7):132-4. Epub 2014 Oct 29.
Department of Neurology , Sawai Man Singh Medical College , Jaipur, Rajasthan , India.

The majority of adverse reactions of intravenous immunoglobulin (IVIG) therapy are mild, transient and self-limiting with potentially serious complications occurring in <5% of patients. IVIG-associated transient aseptic meningitis is one such rare adverse effect, which has been seldomly described in the literature. We report a case of aseptic meningitis due to IVIG therapy in a Guillain-Barré syndrome (GBS) patient. Read More

The cerebrospinal fluid analysis revealed high cell counts with predominance of lymphocytic cells, raised protein, normal glucose level and no growth of the organisms on culture. The patient improved with supportive care such as intravenous fluids and analgesics without neurological complications. This case emphasizes the importance of recognizing IVIG-associated complications like aseptic meningitis in GBS patients.

Prim. Care
Prim Care 2015 Jun 20;42(2):189-193. Epub 2015 Mar 20.
2300-A Manchester Expressway, Suite 201, Columbus, GA 31903, USA.

Guillain-Barré syndrome and its clinical variants are a group of rapidly progressing, potentially debilitating neurologic disorders that may have significant morbidity/mortality if left unrecognized or untreated. The most common symptoms include ascending limb weakness and paralysis, which may progress to respiratory failure. Diagnosis is made clinically with laboratory testing. Read More

Several treatment options exist, including plasma exchange and intravenous immunoglobulin administration. Most cases may resolve without sequelae, but those that do not may leave behind significant persistent debility.

J. Peripher. Nerv. Syst.
J Peripher Nerv Syst 2015 May 15. Epub 2015 May 15.
Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
J. Neurol. Neurosurg. Psychiatr.
J Neurol Neurosurg Psychiatry 2015 May 13. Epub 2015 May 13.
Services of Neurology, University Hospital Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Universidad de Cantabria (UC) and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain.
Clin Neurophysiol
Clin Neurophysiol 2015 Apr 24. Epub 2015 Apr 24.
Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla", IDIVAL, UC and CIBERNED, Santander, Spain.
Clin Neurophysiol
Clin Neurophysiol 2015 Apr 23. Epub 2015 Apr 23.
Departments of Medicine and Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Mol Med Rep
Mol Med Rep 2015 May 5. Epub 2015 May 5.
Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China.

Guillain-Barré syndrome (GBS) is an autoimmune disorder of the peripheral nervous system characterized by weakness in the limbs. To date, numerous hypotheses have been suggested to explain the pathogenesis of GBS; however, the pathogenesis of GBS remains to be elucidated. The aim of the present study was to investigate the association between Toll‑like receptor (TLR) 2, TLR4 and GBS. Read More

Therefore, the mRNA of TLR2, TLR4, myeloid differentiation factor (MyD)88 and nuclear factor (NF)‑κB of peripheral blood mononuclear cells (PBMCs) in patients with GBS and healthy controls was assessed. To confirm the function of TLR2 and TLR4 in the pathogenesis of GBS, PBMCs derived from patients with GBS and healthy controls were cultured with various TLR agonists. The levels of tumor necrosis factor (TNF)‑α and interleukin (IL)‑1β were measured in the culture supernatant and fasting serum was obtained for the detection of anti‑ganglioside antibodies. The results revealed that the mRNA levels of TLR2, TLR4, MyD88 and NF‑κB were significantly increased in patients with GBS compared with those in healthy controls (P=0.003, 0.017, 0.032 and 0.015, respectively). PBMCs from patients with GBS secreted higher levels of TNF‑α and IL‑1β than those from control subjects. The positive rate of immunoglobulin (Ig)G and IgM anti‑ganglioside antibodies in patients with severe GBS was 42.86%, which was markedly higher than rates found in patients with mild GBS (9.09 and 18.18%, respectively). The results of the present study demonstrated that TLR2 and TLR4 are involved in the pathogenesis of GBS and that they and their associated signaling pathways may be targets for the treatment of GBS.

Posterior reversible encephalopathy syndrome (PRES) is a rare occurrence in patients with Guillain-Barré syndrome (GBS). Two patients with neuroradiological evidence of PRES without central nervous system (CNS) symptoms were recently reported. We present the case of a GBS patient with minimal CNS symptoms and magnetic resonance imaging findings consistent with PRES. Read More

PRES in GBS might be an underestimated condition. It should be suspected in GBS patients in the presence of even mild CNS symptoms. A timely PRES diagnosis along with early correction of autonomic system dysfunction in GBS patients is recommended to prevent possible dangerous CNS complications.

World Neurosurg
World Neurosurg 2015 Apr 27. Epub 2015 Apr 27.
Department of Neurology, the Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China. Electronic address:
J. Neurosci.
J Neurosci 2015 Apr;35(17):6770-85
Department of Neurology, University of Texas Medical School at Houston, Houston, Texas 77030
Pract Neurol
Pract Neurol 2015 Jun 27;15(3):236-9. Epub 2015 Apr 27.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Int. J. Infect. Dis.
Int J Infect Dis 2015 Apr 16;35:34-36. Epub 2015 Apr 16.
Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Luigi Villa Foundation, Milan, Italy. Electronic address:
Neurol. Neurochir. Pol.
Neurol Neurochir Pol 2015 12;49(2):137-8. Epub 2015 Mar 12.
Department of Neurology, Wrocław Medical University, Wrocław, Poland.

Miller-Fisher Syndrome (MFS) is a rare acute polyneuropathy composed of the clinical triad of ataxia, areflexia and ophthalmoplegia, with a monophasic, self-limited course and spontaneous improvement.
The authors present a 65-year-old man with Miller-Fisher syndrome consisting of bilateral ophthalmoplegia, trigeminal and facial nerve palsy, mild ataxia and peripheral neuropathy. The disease had a progressive, subacute course within 3 months. Read More

A high titer of anti-GQ1b antibodies was detected. As a result of plasmapheresis, complete recovery was achieved.
The presented case was atypical in its clinical course and treatment. It could support the theory of the continuity between MFS, Bickerstaff brainstem encephalitis (BBE), and Guillain-Barré syndrome (GBS).

Public Health
Public Health 2015 Apr 15. Epub 2015 Apr 15.
French Army Centre for Epidemiology and Public Health, Marseille, France; École du Val-de-Grâce, Paris, France.

French military personnel are subject to a compulsory vaccination schedule. The aim of this study was to present the results of surveillance of vaccine adverse events (VAEs) reported from 2011 to 2012 in the French armed forces.
VAEs were surveyed among all French armed forces from 2011 to 2012 by the epidemiological departments of the military health service. Read More

For each case, a notification form providing patient and clinical information was provided.
Case definitions were derived from the French drug safety guidelines. Three types of VAE were considered: non-serious, serious and unexpected. Incidence rates were calculated by relating VAEs to the number of vaccine doses delivered.
In total, 161 VAE cases were reported. The overall VAE reporting rate was 24.6 VAEs per 100,000 doses, and the serious VAE rate was 1.3 per 100,000 doses (nine cases). The serious VAEs included two cases of Guillain-Barré syndrome, one case of optic neuritis, one case of a meningeal-like syndrome, one case of rheumatoid purpura, one case of acute asthma and three cases of fainting. The highest rates of VAE were observed with the Bacille Calmette-Guérin vaccine (BCG) (482.3 per 100,000 doses), inactivated diphtheria-tetanus-poliovirus with acellular pertussis vaccine (dTap-IPV) (106.1 per 100,000 doses) and meningococcal quadrivalent glycoconjugate vaccine (MenACWY-CRM) (39.3 per 100,000 doses).
The global rates of VAE observed in 2011 and 2012 confirm the increase that has been observed since 2009 in the French armed forces, which could reflect improved practitioner awareness about VAEs and the use of certain vaccines added to the vaccination schedule recently (dTap-IPV in 2008 and MenACWY-CRM in 2010). VAEs appear to be relatively rare, particularly serious VAEs, which indicates acceptable tolerance of vaccines.

J. Neurol. Sci.
J Neurol Sci 2015 May 10;352(1-2):135-6. Epub 2015 Apr 10.
Department of Neurology, Warren Alpert Medical School of Brown University, 110 Lockwood Street, Suite 324, Providence, RI 02903, USA. Electronic address:
J Pediatr Neurosci
J Pediatr Neurosci 2015 Jan-Mar;10(1):67-9
Department of Pediatrics, Pediatric Intensive Care Unit, Max Superspecialty Hospital, Saket, New Delhi, India.
J Pediatr Neurosci
J Pediatr Neurosci 2015 Jan-Mar;10(1):61-3
Department of Pediatrics, MGIMS, Sevagram, Wardha, Maharashtra, India.

Acute disseminated encephalomyelitis (ADEM) and Guillain-Barré syndrome (GBS) are distinct demyelinating disorders that share an autoimmune pathogenesis and prior history of viral infection or vaccination. Our patient is a 10 years with acute flaccid paralysis, quadriparesis (lower limbs affected more than upper limbs), generalized areflexia and urinary retention. He had difficulty in speech and drooling of saliva. Read More

He also presented with raised intracranial pressure with papilledema; then bilateral optic neuritis developed during the later course of illness. Based on the temporal association and exclusion of alternative etiologies, diagnosis of the association between ADEM and GBS was made. Electro-diagnosis (electromyography-nerve conduction velocity) and magnetic resonance imaging study supported our diagnosis. He improved remarkably after treatment with intravenous immunoglobulin and intravenous methylprednisolone.

Neuroradiology 2015 Apr 16. Epub 2015 Apr 16.
Department of Radiology, Baskent University Faculty of Medicine, 44. Sokak No:11/8, Bahcelievler, Ankara, Turkey,
Berl. Munch. Tierarztl. Wochenschr.
Berl Munch Tierarztl Wochenschr 2015 Mar-Apr;128(3-4):90-7

Campylobacter (C.) jejuni is the most important reported cause for bacterial diarrhoea. The infection can be accompanied by fever and abdominal cramps and in rare cases the Guillain-Barré syndrome or reactive arthritis can develop as a post-infection complication. Read More

Several biological properties of Cjejuni, e. g. motility and chemotaxis, contribute to the biological fitness of the pathogen. For this, deficiencies in the function of these features clearly reduce the pathogenicity of C. jejuni without being a virulence factor per se. Opposing to this, there are two essential requirements to determine the virulence of C. jejuni which represent the adherence to, and the invasion of host cells. Thereby, adherence, as a virulence factor, is mediated by many different bacterial-derived components like proteins but also by several oligo- and polysaccharide structures that are linked to surface proteins but also to the flagella. In addition, several invasion-relevant features of C. jejuni have been detected so far. Whereas some of them are described functionally to modulate cytoskeleton arrangement of the host cell, others are only described as invasion relevant. Indeed, investigations with respect to the pathogenic potential of some adherence- and invasion-relevant components did not give identical results indicating that their relevance might depend on the interplay of the respective C. jejuni strains used in these studies with the corresponding host cells. This review summarizes the C. jejuni components for adherence to and invasion of host cells together with their particular mode of action if known.

 Life-threatening Streptococcus pneumoniae infections often occur after hematopoietic stem cell transplant (HSCT); vaccination is important for prevention.
 In an open-label study, patients (n = 251) 3-6 months after allogeneic HSCT received 3 doses of 13-valent pneumococcal conjugate vaccine (PCV13) at 1-month intervals, a fourth dose 6 months later, and 1 dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) 1 month later. Immunogenicity at prespecified time points and vaccine safety were assessed. Read More

 In the evaluable immunogenicity population (N = 216; mean age, 37.8 years), geometric mean fold rises (GMFRs) of immunoglobulin G geometric mean concentrations from baseline to postdose 3 showed significant increases in antibody levels across all PCV13 serotypes (GMFR range, 2.99-23.85; 95% confidence interval lower limit, >1); there were significant declines over the next 6 months, significant increases from predose 4 to postdose 4 (GMFR range, 3.00-6.97), and little change after PPSV23 (GMFR range, 0.86-1.12). Local and systemic reactions were more frequent after dose 4. Six patients experienced serious adverse events possibly related to PCV13 (facial diplegia, injection-site erythema and pyrexia, autoimmune hemolytic anemia, and suspected lack of vaccine efficacy after dose 3 leading to pneumococcal infection), PCV13 and PPSV23 (Guillain-Barré syndrome), or PPSV23 (cellulitis). There were 14 deaths, none related to study vaccines.
 A 3-dose PCV13 regimen followed by a booster dose may be required to protect against pneumococcal disease in HSCT recipients. Dose 4 was associated with increased local and systemic reactions, but the overall safety profile of a 4-dose regimen was considered acceptable.

PLoS One 2015 13;10(4):e0124004. Epub 2015 Apr 13.
Department of Neurology, Dokkyo Medical University, Tochigi, Japan; Departments of Medicine and Physiology, National University of Singapore, Singapore, Singapore.

Molecular mimicry between Campylobacter jejuni lipo-oligosaccharides (LOSs) and human gangliosides GM1 and GD1a induces the production of anti-GM1 and anti-GD1a antibodies, and the development of Guillain-Barré syndrome. Complexes of two different gangliosides form new molecular shapes capable of enhancing recognition by anti-ganglioside antibodies. To test the hypothesis that the complex of GM1-like and GD1a-like LOSs of C. Read More

jejuni induces the development of anti-GM1b antibodies in Guillain-Barré syndrome patients.
Mass spectrometry analysis determined the LOS outer core structures, with which mice were immunized. IgG antibodies to single gangliosides and complex of gangliosides were tested in sera from Guillain-Barré syndrome patients from whom C. jejuni LOS had been isolated.
Two isolates from GBS patients who had anti-GM1b antibodies, but neither anti-GM1 nor -GD1a antibodies, expressed both GM1-like and GD1a-like LOSs, but not GM1b-like LOS. Anti-GM1b antibodies were induced in one of the mice immunized with the C. jejuni bearing GM1-like and GD1a-like LOS. Sera from 20 patients had antibodies to the complex of GM1 and GD1a, all of which carried anti-GM1b reactivity. Five of these sera harbored neither anti-GM1 nor anti-GD1a antibodies. IgG antibodies to the complex were absorbed by GM1b, but by neither GM1 nor GD1a.
GM1-like and GD1a-like LOSs form a GM1b epitope, inducing the development of anti-GM1b antibodies in patients with Guillain-Barré syndrome subsequent to C. jejuni enteritis. Here, we present a new paradigm that the complex of two different structures forms a new molecular mimicry, inducing the production of autoantibodies.