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Prevalence of anti-ganglioside antibodies and their clinical correlates with guillain-barré syndrome in Korea: a nationwide multicenter study.

Kim JK, Bae JS, Kim DS, Kusunoki S, Kim JE, Kim JS, Park YE, Park KJ, Song HS, Kim SY, Lim JG, Kim NH, Suh BC, Nam TS, Park MS, Choi YC, Sohn EH, Na SJ, Huh SY, Kwon O, Lee SY, Lee SH, Oh SY, Jeong SH, Lee TK, Kim DU - J Clin Neurol (2014)

Bottom Line: Anti-GT1a-antibody positivity was more frequently associated with bulbar weakness and was highly associated with ophthalmoplegia when coupled with the coexisting anti-GQ1b antibody.Anti-ganglioside antibodies were frequently found in the serum of Korean GBS patients, and each antibody was correlated strongly with the various clinical manifestations.Nevertheless, without an anti-ganglioside antibody assay, in Korea AMAN is frequently misdiagnosed as AIDP by single electrophysiological studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, College of Medicine, Dong-A University, Busan, Korea.

ABSTRACT

Background and purpose: No previous studies have investigated the relationship between various anti-ganglioside antibodies and the clinical characteristics of Guillain-Barré syndrome (GBS) in Korea. The aim of this study was to determine the prevalence and types of anti-ganglioside antibodies in Korean GBS patients, and to identify their clinical significance.

Methods: Serum was collected from patients during the acute phase of GBS at 20 university-based hospitals in Korea. The clinical and laboratory findings were reviewed and compared with the detected types of anti-ganglioside antibody.

Results: Among 119 patients, 60 were positive for immunoglobulin G (IgG) or immunoglobulin M antibodies against any type of ganglioside (50%). The most frequent type was IgG anti-GM1 antibody (47%), followed by IgG anti-GT1a (38%), IgG anti-GD1a (25%), and IgG anti-GQ1b (8%) antibodies. Anti-GM1-antibody positivity was strongly correlated with the presence of preceding gastrointestinal infection, absence of sensory symptoms or signs, and absence of cranial nerve involvement. Patients with anti-GD1a antibody were younger, predominantly male, and had more facial nerve involvement than the antibody-negative group. Anti-GT1a-antibody positivity was more frequently associated with bulbar weakness and was highly associated with ophthalmoplegia when coupled with the coexisting anti-GQ1b antibody. Despite the presence of clinical features of acute motor axonal neuropathy (AMAN), 68% of anti-GM1- or anti-GD1a-antibody-positive cases of GBS were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) by a single electrophysiological study.

Conclusions: Anti-ganglioside antibodies were frequently found in the serum of Korean GBS patients, and each antibody was correlated strongly with the various clinical manifestations. Nevertheless, without an anti-ganglioside antibody assay, in Korea AMAN is frequently misdiagnosed as AIDP by single electrophysiological studies.

No MeSH data available.


Related in: MedlinePlus

Patients who were IgG anti-GT1a-antibody positive frequently exhibited cranial nerve signs (n=17, 74%; not shown in the figure). The most prominent sign was oropharyngeal weakness (n=16, 70%). Ophthalmoplegia was also frequent, and was strongly correlated with oropharyngeal weakness and coexisting IgG anti-GQ1b-antibody positivity. However, four of the ten IgG anti-GQ1b-antibody-positive cases had no oculomotor palsy during the disease course. The numerals inside circles represent the numbers for each condition.
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Figure 2: Patients who were IgG anti-GT1a-antibody positive frequently exhibited cranial nerve signs (n=17, 74%; not shown in the figure). The most prominent sign was oropharyngeal weakness (n=16, 70%). Ophthalmoplegia was also frequent, and was strongly correlated with oropharyngeal weakness and coexisting IgG anti-GQ1b-antibody positivity. However, four of the ten IgG anti-GQ1b-antibody-positive cases had no oculomotor palsy during the disease course. The numerals inside circles represent the numbers for each condition.

Mentions: In addition to the typical anti-GM1 antibody related to AMAN pattern, the present results revealed that a large proportion of the patients had anti-GT1a or anti-GQ1b positivity. The IgG anti-GT1a antibody was frequently associated with cranial nerve abnormality (17/23, 74%; p=0.001) (Fig. 2). Compared with the IgG anti-GM1-antibody-positive group, presence of the anti-GT1a antibody was strongly associated with oropharyngeal weakness or other lower cranial neuropathies (16/23, 70% vs. 4/28, 14%; p<0.001). Although ophthalmoplegia appeared to occur more frequently in the anti-GT1a-positive group compared with the anti-GM1-positive group (8/23, 35% vs. 3/27, 11%), the difference was not significant (p=0.084). The simultaneous presence of the IgG anti-GQ1b antibody was more common in the anti-GT1a-positive group than in the anti-GM1-positive group (10/23, 44% vs. 1/28, 4%; p=0.001). Extraocular muscle weakness was strongly correlated with the co-occurrence of anti-GQ1b antibody in the anti-GT1a-positive group (6/10 anti-GQ1b-antibody-positive cases) (Fig. 2). IgG anti-GD1a-antibody positivity was more common in the anti-GT1a-antibody-positive group than in the anti-GM1-antibody-positive group (9/23, 39% vs. 2/28, 7%; p=0.014). Only four cases were simultaneously positive for anti-GM1 and anti-GT1a antibodies, among whom one was also positive for anti-GD1a antibody and another was also positive for anti-GQ1b antibody.


Prevalence of anti-ganglioside antibodies and their clinical correlates with guillain-barré syndrome in Korea: a nationwide multicenter study.

Kim JK, Bae JS, Kim DS, Kusunoki S, Kim JE, Kim JS, Park YE, Park KJ, Song HS, Kim SY, Lim JG, Kim NH, Suh BC, Nam TS, Park MS, Choi YC, Sohn EH, Na SJ, Huh SY, Kwon O, Lee SY, Lee SH, Oh SY, Jeong SH, Lee TK, Kim DU - J Clin Neurol (2014)

Patients who were IgG anti-GT1a-antibody positive frequently exhibited cranial nerve signs (n=17, 74%; not shown in the figure). The most prominent sign was oropharyngeal weakness (n=16, 70%). Ophthalmoplegia was also frequent, and was strongly correlated with oropharyngeal weakness and coexisting IgG anti-GQ1b-antibody positivity. However, four of the ten IgG anti-GQ1b-antibody-positive cases had no oculomotor palsy during the disease course. The numerals inside circles represent the numbers for each condition.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4017025&req=5

Figure 2: Patients who were IgG anti-GT1a-antibody positive frequently exhibited cranial nerve signs (n=17, 74%; not shown in the figure). The most prominent sign was oropharyngeal weakness (n=16, 70%). Ophthalmoplegia was also frequent, and was strongly correlated with oropharyngeal weakness and coexisting IgG anti-GQ1b-antibody positivity. However, four of the ten IgG anti-GQ1b-antibody-positive cases had no oculomotor palsy during the disease course. The numerals inside circles represent the numbers for each condition.
Mentions: In addition to the typical anti-GM1 antibody related to AMAN pattern, the present results revealed that a large proportion of the patients had anti-GT1a or anti-GQ1b positivity. The IgG anti-GT1a antibody was frequently associated with cranial nerve abnormality (17/23, 74%; p=0.001) (Fig. 2). Compared with the IgG anti-GM1-antibody-positive group, presence of the anti-GT1a antibody was strongly associated with oropharyngeal weakness or other lower cranial neuropathies (16/23, 70% vs. 4/28, 14%; p<0.001). Although ophthalmoplegia appeared to occur more frequently in the anti-GT1a-positive group compared with the anti-GM1-positive group (8/23, 35% vs. 3/27, 11%), the difference was not significant (p=0.084). The simultaneous presence of the IgG anti-GQ1b antibody was more common in the anti-GT1a-positive group than in the anti-GM1-positive group (10/23, 44% vs. 1/28, 4%; p=0.001). Extraocular muscle weakness was strongly correlated with the co-occurrence of anti-GQ1b antibody in the anti-GT1a-positive group (6/10 anti-GQ1b-antibody-positive cases) (Fig. 2). IgG anti-GD1a-antibody positivity was more common in the anti-GT1a-antibody-positive group than in the anti-GM1-antibody-positive group (9/23, 39% vs. 2/28, 7%; p=0.014). Only four cases were simultaneously positive for anti-GM1 and anti-GT1a antibodies, among whom one was also positive for anti-GD1a antibody and another was also positive for anti-GQ1b antibody.

Bottom Line: Anti-GT1a-antibody positivity was more frequently associated with bulbar weakness and was highly associated with ophthalmoplegia when coupled with the coexisting anti-GQ1b antibody.Anti-ganglioside antibodies were frequently found in the serum of Korean GBS patients, and each antibody was correlated strongly with the various clinical manifestations.Nevertheless, without an anti-ganglioside antibody assay, in Korea AMAN is frequently misdiagnosed as AIDP by single electrophysiological studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, College of Medicine, Dong-A University, Busan, Korea.

ABSTRACT

Background and purpose: No previous studies have investigated the relationship between various anti-ganglioside antibodies and the clinical characteristics of Guillain-Barré syndrome (GBS) in Korea. The aim of this study was to determine the prevalence and types of anti-ganglioside antibodies in Korean GBS patients, and to identify their clinical significance.

Methods: Serum was collected from patients during the acute phase of GBS at 20 university-based hospitals in Korea. The clinical and laboratory findings were reviewed and compared with the detected types of anti-ganglioside antibody.

Results: Among 119 patients, 60 were positive for immunoglobulin G (IgG) or immunoglobulin M antibodies against any type of ganglioside (50%). The most frequent type was IgG anti-GM1 antibody (47%), followed by IgG anti-GT1a (38%), IgG anti-GD1a (25%), and IgG anti-GQ1b (8%) antibodies. Anti-GM1-antibody positivity was strongly correlated with the presence of preceding gastrointestinal infection, absence of sensory symptoms or signs, and absence of cranial nerve involvement. Patients with anti-GD1a antibody were younger, predominantly male, and had more facial nerve involvement than the antibody-negative group. Anti-GT1a-antibody positivity was more frequently associated with bulbar weakness and was highly associated with ophthalmoplegia when coupled with the coexisting anti-GQ1b antibody. Despite the presence of clinical features of acute motor axonal neuropathy (AMAN), 68% of anti-GM1- or anti-GD1a-antibody-positive cases of GBS were diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) by a single electrophysiological study.

Conclusions: Anti-ganglioside antibodies were frequently found in the serum of Korean GBS patients, and each antibody was correlated strongly with the various clinical manifestations. Nevertheless, without an anti-ganglioside antibody assay, in Korea AMAN is frequently misdiagnosed as AIDP by single electrophysiological studies.

No MeSH data available.


Related in: MedlinePlus