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Neurology 2003;60:1514-1518
© 2003 American Academy of Neurology

Anti-GM1 antibody IgG subclass

A clinical recovery predictor in Guillain–Barré syndrome

M. Koga, MD PhD, N. Yuki, MD PhD, K. Hirata, MD PhD, M. Morimatsu, MD PhD, M. Mori, MD and S. Kuwabara, MD

From the Department of Neurology (Drs. Koga, Yuki, and Hirata), Dokkyo University School of Medicine, Tochigi; Department of Neurology and Clinical Neuroscience (Drs. Koga and Morimatsu), Yamaguchi University School of Medicine; and Department of Neurology (Drs. Mori and Kuwabara), Chiba University School of Medicine, Japan.

Address correspondence and reprint requests to Dr. Michiaki Koga, Department of Neurology, Dokkyo University School of Medicine, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi 321-0293, Japan; e-mail: kogamrk{at}dokkyomed.ac.jp

Objective: To determine whether the anti-GM1 antibody IgG subclass (IgG1 to 4) is associated with clinical profiles and patterns of recovery in Guillain–Barré syndrome (GBS).

Methods: The IgG subclassification of anti-GM1 antibody was examined and compared with clinical data on 42 GBS patients positive for the antibody.

Results: Frequent anti-GM1 antibody subclasses were IgG1 (76%) and IgG3 (31%). IgG1 antibody was associated with preceding gastroenteritis and Campylobacter jejuni serology, whereas IgG3 antibody was associated with preceding respiratory infection. Although the severity at nadir was similar for IgG1- and IgG3-positive patients, the percentage of patients who could not walk independently was greater for the IgG1-positive group 1 month (42 vs 0%; p = 0.02), 3 months (28 vs 0%), and 6 months (25 vs 0%) after onset. Rapid recovery within 1 month occurred frequently in the patients with the IgG3 antibody but rarely in those with the IgG1 antibody (67 vs 11%; p = 0.003).

Conclusions: The IgG1 subclass of anti-GM1 antibody is a major subtype indicative of slow recovery, whereas isolated elevation of IgG3 subclass antibody titer suggests rapid recovery. Variation in subclass patterns may depend on which pathogen precipitates GBS.






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