The Relationship Between GBS and MG: A Systematic Review

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The Relationship Between GBS and MG: A Systematic Review

Journal Title: Journal of Medical Science And clinical Research - Year 2015, Vol 3, Issue 4

Abstract

Aim: The aim of our review was to find the association between the two autoimmune conditions Guillain Barre Syndrome and Myasthenia Gravis, whether these have ever coexisted in any patient, possible mechanisms of co-occurrence, the related clinical features, laboratory diagnosis and the treatment modalities for co-occurrence. Materials & Methods: We performed a literature search from PubMed database using the combinations of MeSH terms for Guillain Barre Syndrome and those for Myasthenia Gravis. We included only those papers which were original case reports, published in English language and had the publication dates ranging from 1980-2014. Relevant cross references were also reviewed. Results: A detailed study of 13 case reports (14 cases) was carried out. The age for the concurrence of GBS and MG varied from 17-84 years with most cases in 40-60 year age group. There were 9 male and 5 female patients. Also, among these 14 cases, 6 were Chinese, 3 were Americans, 3 were from Israel, 1 was white and 1 belonged to France. 10 patients had a history of some precipitating factor. All of the 14 patients had areflexia as well as ptosis. Limb weakness, Respiratory failure, opthalmoplegia, dysphagia, dysarthria and facial palsy were other common clinical features.10 out of 14 patients had considerably elevated CSF protein. Nerve conduction and RNS test was abnormal in most cases. 3 patients clearly had evidence of a mediastinal mass. 12 patients were positive for AChR antibody while 4 patients for anti-GQ1b and/or anti-GM. Pyridostigmine, corticosteroids, IVIG, plasmapheresis, immunomodulators were used in various combinations. Although, 2 of them died, prognosis was good in 8 out of 11 recorded patients. Patients, who died, had received treatment either for only GBS or for only MG. Conclusions: All the patients with coexistence syndrome of GBS and MG have areflexia and ptosis. Other clinical and laboratory features may vary in different patients. Treatment modalities used should belong to both the syndromes; otherwise we get a poor prognostic score. We suggest that the concurrence syndrome of GBS and MG occurs due to the antibodies against peripheral nerve (causing GBS) which also attack the neuromuscular junction leading to MG (and/or vice versa) based on enough evidence from literature. We propose that some part of the structure of Ach receptor or postsynaptic membrane at NMJ bears a close relationship to that of myelin sheath of the peripheral nerve and research work at molecular level in this context is suggested.

Authors and Affiliations

Adnan Bashir Bhatti

Keywords

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