J Clin Neurol.  2014 Apr;10(2):94-100. 10.3988/jcn.2014.10.2.94.

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

• Kim JK
• Bae JS
• Kim DS
• Kusunoki S
• Kim JE
• Kim JS
• Park YE
• Park KJ
• Song HS
• Kim SY
• Lim JG
• Kim NH
• Suh BC
• Nam TS
• Park MS
• Choi YC
• Sohn EH
• Na SJ
• Huh SY
• Kwon O
• Lee SY
• Lee SH
• Oh SY
• Jeong SH
• Lee TK
• Kim DU

• KMID: 2287526
• DOI: http://doi.org/10.3988/jcn.2014.10.2.94

Abstract

BACKGROUND AND PURPOSE
No previous studies have investigated the relationship between various anti-ganglioside antibodies and the clinical characteristics of Guillain-Barre 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.
METHODS
Serum 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.
RESULTS
Among 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.
CONCLUSIONS
Anti-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.

Keyword

Guillain-Barre syndrome; ganglioside; antibodies; Korea; acute motor axonal neuropathy

MeSH Terms

Amantadine
Antibodies*
Axons
Cranial Nerves
Facial Nerve
Guillain-Barre Syndrome*
Humans
Immunoglobulin G
Immunoglobulin M
Korea
Male
Ophthalmoplegia
Prevalence*
Amantadine
Antibodies
Immunoglobulin G
Immunoglobulin M

Figure

• 

  Fig. 1 Various kinds of anti-ganglioside antibodies were detected in Korean patients with Guillain-Barré syndrome. The most frequent type was immunoglobulin G anti-GM1 antibody, followed by IgG anti-GT1a antibody (immunoglobulin M-type anti-ganglioside antibodies were not considered in this figure, and all patient numbers were calculated with overlapping). GA1: asialo-GM1, GalC: galactocerebroside.

• 

  Fig. 2 Patients who were IgG anti-GT1a-antibody positive frequently exhibited cranial nerve signs (n=17, 74%; not shown in the figure). The most prominent sign was oropharyngeal weakness (n=16, 70%). Ophthalmoplegia was also frequent, and was strongly correlated with oropharyngeal weakness and coexisting IgG anti-GQ1b-antibody positivity. However, four of the ten IgG anti-GQ1b-antibody-positive cases had no oculomotor palsy during the disease course. The numerals inside circles represent the numbers for each condition.

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