Understanding the pathogenesis of guillain-barre syndrome through neurophysiology and serological analyses / Nortina Shahrizaila

Nortina , Shahrizaila (2016) Understanding the pathogenesis of guillain-barre syndrome through neurophysiology and serological analyses / Nortina Shahrizaila. PhD thesis, Universiti of Malaya.

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Abstract

Guillain-Barré syndrome (GBS) is the leading cause of post-infectious flaccid paralysis worldwide. Over the years, research on the neurophysiological characteristics and serological profile of GBS patients has contributed towards our greater understanding of its pathogenesis. GBS can be classified into demyelinating and axonal subtypes, based on their neurophysiological features. In axonal GBS, antibodies against several glycolipids have been identified whereas target antigens in demyelinating GBS remain unknown. In this thesis, a series of published original work addressing the current limitations in GBS electrodiagnosis and serological associations with disease features are presented. In the first series of publications, prospective serial nerve conduction studies (NCS) in a cohort of multi-ethnic Malaysian GBS patients are described. We found that in order to make a true electrodiagnosis of GBS, at least two sets of NCS were required performed with the first 2 weeks of disease onset and 3 to 8 weeks later. Based on NCS, we also found an almost exclusive involvement of sensory fibres in patients with the GBS variant, Miller Fisher syndrome irrespective of their symptoms. The second series of publication investigated the presence of antibodies against glycolipid complexes in GBS patients from Asian and Western cohorts. The relationship between these antibodies and the clinical features as well as neurophysiological characteristics of GBS based on serial NCS was also investigated. Our studies provided robust evidence that antibodies to single glycolipids and glycolipid complexes are associated with axonal forms of GBS and not acute inflammatory demyelinating polyneuropathy. Future studies incorporating standardized methods of neurophysiological assessment and serological analyses in heterogeneous populations are required to better understand GBS pathophysiology. Existing on-going international research collaboration is one platform in which findings from the current work can be further validated.

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