Anti‐ganglioside antibodies and elevated CSF IgG levels in Guillain‐Barré syndrome

Anti‐ganglioside antibody production and dysfunction of blood‐cerebrospinal fluid (CSF) barrier (BCB) are frequent findings in dysimmune neuropathy patients, whereas intrathecal synthesis of immunoglobulins is still a matter of debate. We examined the CSF, immunological and electrophysiological characteristics from a cohort of patients with Guillain‐Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP), and from patients with other neurological diseases as control. Thirty‐eight percent of GBS patients and 28% of CIDP patients had detectable serum titers of anti‐ganglioside antibodies, which were associated with a high incidence of motor conduction block and increased F wave latencies. In GBS patients, but not in CIDP or control patients, there was an association between anti‐ganglioside antibodies and increased CSF immunoglobulin‐G (IgG) levels as determined by the IgG index. However, none of the GBS patients had CSF oligoclonal bands (OBs) or indications of intrathecal anti‐ganglioside antibody synthesis. The possibility of an abnormal CSF concentration of immunoglobulins from serum through dysfunctional BCB or damaged nerve roots, and the role of serum anti‐ganglioside reactivity in this process are discussed.