Hepatitis A virus immunoglobulin M antibody in acute neurological disease.

Sera from 167 patients with Guillain-Barré syndrome, 224 patients with other neurological diseases, and 10 normal subjects were tested for hepatitis A virus-specific immunoglobulin M antibodies. Two patients with classic Guillain-Barré syndrome and 1 patient with acute myeloradiculopathy had high titers of virus-specific IgM antibody. All three patients had jaundice and laboratory evidence of liver involvement before the onset of the neurological disease. None of the other sera from patients with Guillain-Barré syndrome or control subjects were positive for hepatitis A virus.

Serum immunoglobulins in Guillain-Barré syndrome.

Serum major class immunoglobulin concentrations were measured in 162 patients with Guillain-Barré Syndrome (GBS) and 85 normal controls. Significant elevations of IgM, A and G were found in the GBS group. Forty-four of 162 GBS patients (27%) had IgM concentrations greater than two standard deviations above the control mean. GBS patients with high serum IgM were young and 68% showed serologic evidence of recent infection with DNA core agents, cytomegalovirus, Epstein-Barr virus, or Mycoplasma pneumoniae. Longitudinal studies in seven patients with elevated serum IgM revealed that clinical improvement was accompanied by a marked decline in serum IgM. IgA and IgG changes were less consistent. Our findings indicate that the serum immunoglobulin response in GBS is polyclonal and follows the usual pattern seen in infections and other conditions with an immune component.

Cerebral and spinal somatosensory evoked potentials in children with CNS degenerative disease.

Spinal and cerebral somatosensory evoked potentials to peroneal nerve and median nerve stimulation were recorded in 17 children with CNS degenerative disease and compared with similar potentials obtained in a group of age-matched normal control subjects. Spinal potentials were increased in duration over caudal cord segments and were poorly defined or absent over the rostral cord in some patients. In 12 patients the conduction velocity of the spinal response was slow over spinal cord segments. However, conduction velocity over peripheral nerve and cauda equina was normal in all patients. The scalp recorded evoked potentials to both median and peroneal nerve stimulation which arise in neural structures rostral to the brain stem were absent in 14 patients. Cerebral responses and certain spinal potentials were greatly increased in amplitude in one patient with myoclonus. This study demonstrates that these methods permit an evaluation of the entire neuraxis from peripheral nerve to cerebral cortex and that they may be helpful in the evaluation of patients with diffuse or multifocal disease of the nervous system.

Possible beneficial effect of high-dose intravenous steroid therapy in acute demyelinating disease and transverse myelitis.

Intravenous steroid followed by oral prednisone was administered to patients with Guillain-Barré syndrome (five), acute transverse myelitis (three), and multiple sclerosis in acute relapse (seven). Preliminary experience with each of these disorders revealed prompt clinical improvement in some patients. The approach used in this uncontrolled study deserves further investigation.