Patterns and serial changes in electrodiagnostic abnormalities of axonal Guillain-Barre syndrome
Patterns and serial changes in electrodiagnostic abnormalities of axonal Guillain-Barre syndrome
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DOI：
10.1212/01.wnl.0000153071.71335.e9
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发表时间：
2005-03-08
期刊：
影响因子：
9.9
通讯作者：
Mori, M
中科院分区：
文献类型：
--
作者：
Hiraga, A;Kuwabara, S;Mori, M
背景资料：在格林-巴利综合征（GBS）中，抗神经节苷脂抗体与急性运动轴索神经病（AMAN）形式密切相关，但也有脱髓鞘形式的GBS（急性炎性脱髓鞘性多发性神经病[AIDP]）与抗神经节苷脂抗体相关的病例。目的：探讨抗神经节苷脂阳性GBS的电诊断异常的类型和顺序变化。方法：回顾性分析51例GBS患者的详细系列电诊断结果。ELISA法检测抗神经节苷脂抗体。结果：25例患者存在GM 1、GM 1b、GD 1a或GalNAc-GD 1a抗体。其中，12例（48%）在首次检查时显示AMAN模式，5例（20%）AIDP模式，3例（12%）孤立性F波缺如。所有5例AIDP患者均表现出延长的远端潜伏期，但3例最终表现出AMAN模式或快速正常化。其余2例在第4 ~ 6周仍有类似的远端延长，但系列变化与抗神经节苷脂阴性AIDP患者不同，后者在发病后2个月内远端延长呈进行性增加。结论：除了简单的轴突变性模式外，抗神经节苷脂阳性的格林-巴利综合征患者可在远端或近端神经节段中表现出一过性传导减慢/阻滞，模拟脱髓鞘，但抗神经节苷脂抗体似乎与急性炎性脱髓鞘性多发性神经病无关。
Background: In Guillain-Barre syndrome (GBS), anti-ganglioside antibodies are strongly associated with the acute motor axonal neuropathy (AMAN) form, but there are also cases of the demyelinating form of GBS ( acute inflammatory demyelinating polyneuropathy [AIDP]) with anti-ganglioside antibodies. Objective: To elucidate the patterns and sequential changes in electrodiagnostic abnormalities of anti-ganglioside-positive GBS. Methods: Detailed serial electrodiagnostic findings were reviewed for 51 patients with GBS. Anti-ganglioside antibodies were measured by ELISA. Results: Antibodies to GM1, GM1b, GD1a, or GalNAc-GD1a were present in 25 patients. Of these, 12 (48%) showed the AMAN pattern, 5 (20%) the AIDP pattern, and 3 (12%) isolated F-wave absence in the first examination. All five patients with the AIDP pattern showed prolonged distal latencies, but three eventually showed the AMAN pattern or rapid normalization. The remaining two still had similarly prolonged distal latencies in weeks 4 to 6, but the serial changes were distinct from those in the anti-ganglioside-negative AIDP patients who showed progressive increases in distal latencies over 2 months after onset. Conclusions: Besides the simple axonal degeneration pattern, patients with anti-ganglioside-positive Guillain-Barre syndrome can show transient conduction slowing/block in the distal or proximal nerve segments, mimicking demyelination, but anti-ganglioside antibodies do not appear to be associated with acute inflammatory demyelinating polyneuropathy.