Abstract
BACKGROUND/AIM—Serum antibody against ganglioside GQ1b is reported to be closely associated with immune mediated ophthalmoplegia in the Fisher and Guillain-Barré syndromes. Its presence against glycolipids, in particular ganglioside GQ1b, was investigated in patients with ophthalmoplegia of unknown origin. METHODS—16 patients with ophthalmoplegia, the cause of which could not be confirmed from clinical findings or diagnostic testing, were tested. 34 patients who had ophthalmoplegia of definite cause, 16 healthy people, and 23 patients with typical Fisher syndrome served as the controls. The ELISA was used to check for serum antibodies against glycolipids in all study participants. RESULTS—Two of the 16 patients with ophthalmoplegia of unknown cause had serum IgG antibody against GQ1b but not against other glycolipids, and 22 of the 23 patients with typical Fisher syndrome had this antibody. No anti-GQ1b antibodies were found in the patients with ophthalmoplegia of definite cause or in the normal controls. CONCLUSION—A common underlying cause appears to bring about the pathogenesis of palsy in Fisher syndrome and in the ophthalmoplegia with positive anti-GQ1b IgG antibody, called atypical Fisher syndrome. This antibody may prove a useful clinical marker for differentiating Fisher syndrome, typical and atypical, in patients with ophthalmoplegia. Keywords: GQ1b ganglioside; Fisher syndrome; Guillain-Barré syndrome; ophthalmoplegia
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Figure 1 .
Anti-GQ1b IgG antibody titres in patients with ophthalmoplegia. Serum antibodies were examined by the ELISA. Two of the 16 patients with ophthalmoplegia of undetermined cause and 22 of the 23 patients with typical FS had high anti-GQ1b antibody titres. Titres of the patients with ophthalmoplegia caused by vascular disorders, myasthenia gravis, etc, and those of the normal subjects were less than 1:10. Ophthal = ophthalmoplegia. Patient numbers are given in Table 1.
Figure 2 .
Profiles of the clinical manifestations and anti-GQ1b titre of patient 13 who had bilateral abducens palsy. The ophthalmoplegia schema shows the degree of ocular limitation towards abduction. The decrease in anti-GQ1b IgG titre paralleled the improvement of ocular movement.
Selected References
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