title: Ophthalmoplegic Guillain-Barré syndrome: An independent entity or a transitional spectrum?
abstract: Ophthalmoplegia can occur in both Miller Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS) with typical limb involvement. However, ophthalmoplegic GBS (OGBS) has been poorly defined. We aimed to characterize OGBS and clarify the pathophysiological implications across the overall GBS spectrum. Twenty GBS and seven MFS patients from three university based teaching hospitals in Korea were enrolled and analyzed. Six GBS patients who were classified as OGBS commonly also had facial diplegia (50%) and bulbar palsy (50%), while only a small portion of non-ophthalmoplegic GBS (NOGBS) patients had facial diplegia (21%). None of the patients had bulbar palsy in the NOGBS or MFS groups. The most frequent anti-ganglioside antibody in OGBS was the IgG anti-GT1a antibody (50%). The IgG anti-GM1 antibody was found mainly in NOGBS (57%) with high concordance with the pure motor type classification on electrophysiology. IgG anti-GQ1b antibody was positive uniquely in MFS (100%), although some patients were also positive for anti-GT1a antibody (71%). OGBS had distinct clinical features, including bulbar palsy, as well as ophthalmoplegia and limb weakness for both GBS and MFS. Relevant immunological factors were anti-GT1a antibody. Whether OGBS is an independent entity or a transitional spectrum remains to be established and further study will be needed.
authors.affiliation: Department of Neurology, Dong-A University College of Medicine, Busan, South Korea.
authors.forename: Jong Kuk
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dong-A University College of Medicine, Busan, South Korea.
authors.forename: Seuk Kyung
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Bae
authors.affiliation: Department of Neurology, Dong-A University College of Medicine, Busan, South Korea.
authors.forename: Byeol-A
authors.initials: BA
authors.lastname: Yoon
authors.affiliation: Department of Physiology, Dong-A University College of Medicine, Busan, South Korea.
authors.forename: Hwan Tae
authors.initials: HT
authors.lastname: Park
authors.affiliation: Department of Neurology, Kosin University College of Medicine, Busan, South Korea.
authors.forename: So Young
authors.initials: SY
authors.lastname: Huh
authors.affiliation: Department of Neurology, Inje University College of Medicine, Busan, South Korea.
authors.forename: Sang-Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Gyeongsangnam-do, South Korea.
authors.forename: Jong-Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Department of Neurology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University, Gyeongsangnam-do, South Korea. Electronic address: dskim@pusan.ac.kr.
authors.forename: Dae-Seong
authors.initials: DS
authors.lastname: Kim
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005732:Gangliosides / Q000276:immunology*; D020275:Guillain-Barre Syndrome / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000276:immunology
chemical_list: D005732:Gangliosides; D007074:Immunoglobulin G
keywords: Antibody; Ganglioside; Guillain-Barré syndrome; Miller Fisher syndrome; Ophthalmoplegia