title: Guillain-Barré syndrome in Asia.
abstract: Over the past 20 years, the most notable advance in understanding Guillain-Barré syndrome (GBS) has been the identification of an axonal variant. This advance arose chiefly through studies undertaken in East Asian countries and comprised two major aspects: first, the immunopathogenesis of axonal GBS related to anti-ganglioside antibodies and molecular mimicry of Campylobacter jejuni; and second, the observation that distinct electrophysiological patterns of axonal GBS existed, reflecting reversible conduction failure (RCF). As a consequence, the pathophysiology of acute motor axonal neuropathy (AMAN) has perhaps become better understood than acute inflammatory demyelinating polyneuropathy. Despite these more recent advances, a critical issue remains largely unresolved: whether axonal GBS is more common in Asia than in Europe or North America. If it is more common in Asia, then causative factors must be more critically considered, including geographical differences, issues of genetic susceptibility, the role of antecedent infections and other potential triggering factors. It has become apparent that the optimal diagnosis of AMAN requires serial electrophysiological testing, to better delineate RCF, combined with assessment for the presence of anti-ganglioside antibodies. Recent collaborative approaches between Europe and Asia have suggested that both the electrophysiological pattern of AMAN and the seropositivity for anti-ganglioside antibodies develop similarly. Separately, however, current electrodiagnostic criteria for AMAN limited to a single assessment appear inadequate to identify the majority of cases. As such, diagnostic criteria will need to be revised to improve the diagnostic sensitivity for AMAN.
authors.affiliation: Department of Neurology, College of Medicine, Hallym University, Seoul, Korea Neuroscience Research Australia, Sydney, Australia.
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Bae
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Yuki
authors.affiliation: Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Satoshi
authors.identifier: http://orcid.org/0000-0002-4716-8578
authors.initials: S
authors.lastname: Kuwabara
authors.affiliation: Department of Neurology, College of Medicine, Dong-A University, Busan, Korea.
authors.forename: Jong Kuk
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Neuroscience Research Australia, Sydney, Australia Department of Neurology, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Vucic
authors.affiliation: Neuroscience Research Australia, Sydney, Australia.
authors.forename: Cindy S
authors.initials: CS
authors.lastname: Lin
authors.affiliation: Bushell Chair of Neurology, Brain & Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Kiernan
mesh_terms: D001208:Asia / Q000453:epidemiology; D016123:Campylobacter jejuni / Q000276:immunology; D004568:Electrodiagnosis; D020275:Guillain-Barre Syndrome / Q000145:classification / Q000453:epidemiology*; D006801:Humans; D018716:Molecular Mimicry; D009431:Neural Conduction / Q000502:physiology