Prevalence of Anti-Ganglioside Antibodies and Their Clinical Correlates with Guillain-Barré Syndrome in Korea: A Nationwide Multicenter Study

Abstract

Background and PurposeNo 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.MethodsSerum 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.ResultsAmong 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.ConclusionsAnti-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.

Acute bulbar palsy as a variant of Guillain-Barré syndrome

“…An ELISA was used to detect immunoglobulin G (IgG) and immunoglobulin M antibodies against the gangliosides GM1, GM2, GD1a, GD1b, GD3, GT1a, GT1b, and GQ1b, as described previously. 12,13 The presence and types of antiganglioside antibodies were analyzed by researchers who were blinded to the patients' clinical information.…”

Acute Motor-dominant Polyneuropathy as Guillain-Barré Syndrome and Multiple Mononeuropathies in a Patient with Sjögren's Syndrome

“…Regarding the antiganglioside antibodies detected in our patient, anti-GD1a antibody is considered to be related to axonal degeneration, facial palsy, and hyperreflexia (9, 10). Anti-GD1b antibody is related to segmental demyelination, although anti-GT1b antibody has not been reported in relation to specific clinical features (10,11). In our case, the patient showed both axonal degeneration and segmental demyelination as confirmed from the nerve biopsy, along with hyperreflexia and cranial neuropathy.…”

Autoimmune inflammatory neuropathies

“…Exact antigenic targets in acute inflammatory demyelinating polyneuropathy (AIDP) and CIDP have not been identified. The seropositivity of antibodies to gangliosides in GBS is 36-50%, according to recent multicentre studies [6,7]. Anti-GM1 IgM antibodies are found in 40-50% of MMN patients [8,9].…”