title: Acute bulbar palsy as a variant of Guillain-Barré syndrome.
abstract: OBJECTIVE
  To categorize a syndrome manifesting as prominent acute bulbar palsy (ABP) without limb motor weakness as a variant form of Guillain-Barré syndrome (GBS) and differentiate it from Miller Fisher syndrome (MFS) and pharyngeal-cervical-brachial (PCB) variants.
  
  
  METHODS
  We analyzed cases of ABP without limb motor weakness based on a dataset containing clinical information and the results of antiganglioside antibodies assays for acute immune-mediated neuropathies.
  
  
  RESULTS
  Eleven cases with an age at onset ranging from 18 to 65 years (mean 33.8 years) were identified as ABP-plus syndrome. All of the enrolled cases manifested with ABP as the predominant symptom, and with no limb weakness. The following features accompanied ABP in order of decreasing frequency: ophthalmoplegia (n = 9, 82%), ataxia (n = 9, 82%), and facial palsy (n = 6, 55%). An enzyme-linked immunosorbent assay study disclosed that immunoglobulin G (IgG) anti-GT1a antibodies were the most frequent (n = 11), followed by IgG anti-GQ1b antibodies (n = 6).
  
  
  CONCLUSIONS
  We propose that ABP-plus syndrome without neck or limb weakness is a variant of GBS that is distinct from the MFS and PCB variants. The presence of IgG anti-GT1a antibodies can explain the relationships between the distinct clinical characteristics and the underlying pathomechanisms.
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Jong Kuk
authors.initials: JK
authors.lastname: Kim
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Byung-Jo
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Ha Young
authors.initials: HY
authors.lastname: Shin
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Kyong Jin
authors.initials: KJ
authors.lastname: Shin
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Tai-Seung
authors.initials: TS
authors.lastname: Nam
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Jeeyoung
authors.initials: J
authors.lastname: Oh
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Bum Chun
authors.initials: BC
authors.lastname: Suh
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Byeol-A
authors.initials: BA
authors.lastname: Yoon
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Hwan Tae
authors.initials: HT
authors.lastname: Park
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: So-Young
authors.initials: SY
authors.lastname: Huh
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea.
authors.forename: Seong-Il
authors.initials: SI
authors.lastname: Oh
authors.affiliation: From the Departments of Neurology (J.K.K., B.-A.Y.) and Physiology (H.T.P.), College of Medicine, Dong-A University, Busan; the Department of Neurology (B.-J.K.), College of Medicine, Korea University, Seoul; the Department of Neurology (H.Y.S.), College of Medicine, Yonsei University, Seoul; the Department of Neurology (K.J.S., S.-I.O.), College of Medicine, Inje University, Busan; the Department of Neurology (T.-S.N.), College of Medicine, Chonnam National University, Gwangju; the Department of Neurology (J.O.), School of Medicine, Konkuk University, Seoul; the Department of Neurology (B.C.S.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; the Department of Neurology (S.-Y.H.), College of Medicine, Kosin University, Busan; and the Department of Neurology (J.S.B.), College of Medicine, Hallym University, Seoul, Korea. lwsbae@naver.com.
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Bae
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D010244:Bulbar Palsy, Progressive / Q000097:blood* / Q000145:classification / Q000175:diagnosis*; D016208:Databases, Factual; D005260:Female; D020275:Guillain-Barre Syndrome / Q000097:blood* / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G