Guillain-Barré syndrome (demyelinating) six weeks after bariatric surgery: A case report and literature review.

Obesity is a major health problem worldwide. Bariatric surgery has been increasingly used to manage obesity. Many acute as well as chronic neurological complications have been reported after bariatric surgery including Guillain-Barré syndrome (GBS). An autoimmune process has been postulated as the underlying pathophysiology. Most of the reported cases of GBS after bariatric surgery are of the axonal variety. Here, we report a case of a demyelinating variety of GBS in a young woman who presented with acute onset of progressive weakness and paresthesia of all limbs within six weeks after bariatric surgery. She was treated with intravenous immunoglobulin (IVIG) and rehabilitation. She had complete recovery on follow-up. We believe that onset of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), which is demyelinating variety of GBS, is associated with changes in immune system after bariatric surgery.

Ishaque N ，Khealani BA ，Shariff AH ，Wasay M ... -  《Obesity Research & Clinical Practice》

Clinical variants of Guillain-Barre syndrome: some aspects of differential diagnosis.

Dididze MN 《-》

Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS).

Guillain-Barré syndrome (GBS) is an acute polyneuropathy with a variable degree of weakness that reaches its maximal severity within 4 weeks. The disease is mostly preceded by an infection and generally runs a monophasic course. Both intravenous immunoglobulin (IVIg) and plasma exchange (PE) are effective in GBS. Rather surprisingly, steroids alone are ineffective. Mainly for practical reasons, IVIg usually is the preferred treatment. GBS can be subdivided in the acute inflammatory demyelinating polyneuropathy (AIDP), the most frequent form in the western world; acute motor axonal neuropathy (AMAN), most frequent in Asia and Japan; and in Miller-Fisher syndrome (MFS). Additionally, overlap syndromes exist (GBS-MFS overlap). About 10% of GBS patients have a secondary deterioration within the first 8 weeks after start of IVIg. Such a treatment-related fluctuation (TRF) requires repeated IVIg treatment. About 5% of patients initially diagnosed with GBS turn out to have chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with acute onset (A-CIDP). It is yet unknown whether GBS patients who remain able to walk ('mildly affected GBS patients'), or patients with MFS, also benefit from IVIg. Despite current treatment, GBS remains a severe disease, as about 25% of patients require artificial ventilation during a period of days to months, about 20% of patients are still unable to walk after 6 months and 3-10% of patients die. Additionally, many patients have pain, fatigue or other residual complaints that may persist for months or years. Pain can also be very confusing in making the diagnosis, especially when it precedes the onset of weakness. Advances in prognostic modelling resulted in the development of a simple prognostic scale that predicts the chance for artificial ventilation, already at admission; and in an outcome scale that can be used to determine the chance to be able to walk unaided after 1, 3 or 6 months. GBS patients with a poor prognosis potentially might benefit from a more intensified treatment. A larger increase in serum IgG levels after standard IVIg treatment (0.4 g/kg/day for 5 consecutive days) seems to be related with an improved outcome after GBS. This was one of the reasons to start the second course IVIg trial (SID-GBS trial) in GBS patients with a poor prognosis. This study is currently going on. The international GBS outcome study (IGOS) is a new worldwide prognostic study that aims to get further insight in the (immune)pathophysiology and outcome of GBS, both in children and adults. Hopefully these and other studies will further help to improve the understanding and especially the outcome in patients with GBS.

van Doorn PA 《-》

[Guillain-Barré syndrome with preserved reflexes].

Guillain-Barré is a rare, autoimmune disease of the peripheral nervous system. It can affect all ages beginning in the intrauterine or neonatal period. Clinical forms are diverse and include acute motor axonal neuropathy (AMAN). We report on a pediatric case of AMAN. A 2.5-year-old child presented with acute flaccid paralysis and preserved reflexes. Etiologic investigations argued in favor of Guillain-Barré syndrome in its AMAN form. Treatment based on IV immunoglobulins resulted in a total decline of paralysis and motor recovery. The AMAN form of Guillain-Barré syndrome should be considered as a potential diagnosis in all cases of acute flaccid paralysis with preserved reflexes.

Zouiri G ，Abilkassem R ，Zerhouni A ，Dini N ，Agadr A ... -  《-》

[A rare complication of bariatric surgery: Polyradiculoneuropathy as a type of Guillain-Barré syndrome].

Degterev DA ，Suponeva NA ，Bodunova NA ，Voronova МV ，Zorin ЕA ，Piradov МA ，Khatkov IE ... -  《TERAPEVTICHESKII ARKHIV》