Recent Concepts of Guillain-Barré Syndrome

Abstract

Guillain-Barré syndrome (GBS) is a representative form of post-infectious autoimmune neuropathy with heterogenous manifestations. It was originally considered as an ascending demyelinating polyneuropathy in Western countries. However, the discovery of anti-ganglioside antibodies on the basis of molecular mimicry theory could help us better understand various kinds of focal and regional variants as well as axonal type of GBS those were frequently found from Asian countries. Recent development of new techniques about anti-ganglioside complex antibodies is making more detailed descriptions for specific or unusual clinical manifestations. It has been regarded that GBS has good prognosis if treated properly as early as possible, but it still shows high mortality and morbidity rate with frequent long term neurologic and medical complications. Unfortunately, there are only two options for medical treatment, intravenous immunoglobulin and plasmapheresis, for the last 100 years. Several clinical studies on new immunotherapy targeting complement activating system with background of molecular mimicry using animal model are underway. We hope that these new treatments will be helpful for the future patients.

Clinical and laboratory findings in scrub typhus associated Guillain‐Barré syndrome in South Korea

“…The preceding infection in the occurrence of GBS is mainly caused by C. jejuni and influenza, which can cause diarrhea and URI. 3,5,7 As GBS can occur even after COVID-19 infection and vaccination, the relationship between COVID-19 infection and is an important topic. 8,20,21 Among the preceding infections, GBS occurring after scrub typhus has not been reported yet, and the association with the disease and the characteristics of the disease itself are poorly understood.…”

“…The preceding infection in the occurrence of GBS is mainly caused by C. jejuni and influenza, which can cause diarrhea and URI 3,5,7 . As GBS can occur even after COVID‐19 infection and vaccination, the relationship between COVID‐19 infection and GBS is an important topic 8,20,21 .…”

“…The most common infections are gastroenteritis and upper respiratory infections, which are mainly caused by C. jejuni , influenza, cytomegalovirus, and Epstein–Barr virus 1,5 . Although the absence of an antecedent illness does not rule out GBS diagnosis, clinically determining the relationship between a possible disease and immunological stimulation is difficult 1,3,5 . Moreover, widespread infection with COVID‐19, Middle East respiratory syndrome coronavirus, and Zika or influenza or COVID‐19 vaccination can cause GBS 3,6–8 …”

“…It occurs within a few weeks after the occurrence of an antecedent infection in 60%–70% of cases. The most common infections are gastroenteritis and upper respiratory infections, which are mainly caused by C. jejuni , influenza, cytomegalovirus, and Epstein–Barr virus 1,5 . Although the absence of an antecedent illness does not rule out GBS diagnosis, clinically determining the relationship between a possible disease and immunological stimulation is difficult 1,3,5 .…”

Two possible etiologies of Guillain-Barré syndrome: mRNA-1273 (Moderna) vaccination and scrub typhus: A case report

“…Although it is difficult to identify the actual source of the syndrome in most cases, Campylobacter jejuni infection accounts for the highest number of cases, and it has been reported to occur even after infection with cytomegalovirus, Epstein-Barr virus, human immunodeficiency virus, and influenza virus. [1] There are reports of GBS occurring after infection as well as after vaccination with a weakened toxin. Recently, with the worldwide spread of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, various vaccines are being used to combat the disease, and cases of GBS as neurological side effects of such vaccinations have been reported.…”