Transient Isolated Lower Bulbar Palsy With Elevated Serum Anti-GM1 and Anti-GD1b Antibodies During Aripiprazole Treatment.
Transient bulbar palsy without involvement of the facial or extraocular muscles is a rare presentation. It is considered a form of cranial polyneuropathy, a variant of Guillain-Barré syndrome that is related to the autoimmune mechanisms induced by preceding infections or vaccinations. However, drug-induced cranial polyneuropathy has not previously been reported. We describe a boy with isolated bulbar palsy and positive serum antiganglioside antibodies during aripiprazole treatment.



This 12-year-old boy was admitted with a seven-day history of dysarthria, tongue discomfort, and tinnitus. Three weeks before symptom onset, aripiprazole was added to the patient's medications for attention-deficit hyperactivity disorder. On examination, he showed curtaining of the pharyngeal wall, tongue fasciculation and deviation, and a weak gag reflex. Cranial magnetic resonance imaging suggested lower cranial nerve involvement. Serum anti-GM1 IgG and anti-GD1b IgG antibodies were positive. After stopping aripiprazole, his bulbar symptoms improved. However, on readministration of aripiprazole seven weeks later, dysarthria recurred and again resolved after stopping the drug.



We describe the first patient with anti-GM1 IgG and anti-GD1b IgG antibodies-associated transient cranial polyneuropathy presenting as isolated bulbar palsy. These findings could be an adverse effect of aripiprazole treatment.
Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea.
Tae Hwan
TH
Han
Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea.
Do Yeon
DY
Kim
Department of Radiology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea.
Dong Woo
DW
Park
Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea. Electronic address: jinhwamoon@hanyang.ac.kr.
Jin-Hwa
JH
Moon
D000068180:Aripiprazole / Q000009:adverse effects* / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000276:immunology; D010244:Bulbar Palsy, Progressive / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000276:immunology; D002648:Child; D005677:G(M1) Ganglioside / Q000276:immunology*; D005732:Gangliosides / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008297:Male; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000627:therapeutic use
D005732:Gangliosides; D007074:Immunoglobulin G; D011619:Psychotropic Drugs; C033851:ganglioside, GD1b; D005677:G(M1) Ganglioside; D000068180:Aripiprazole
anti-GD1b antibody; anti-GM1 antibody; antiganglioside antibody; aripiprazole; bulbar palsy; cranial polyneuropathy; polyneuritis cranialis