The demyelination neurophysiological criteria can be misleading in Campylobacter jejuni-related Guillain–Barré syndrome

ObjectiveThe exclusive association of Campylobacter jejuni infection with the axonal variant of Guillain–Barré syndrome (GBS) is debatable. The current study aims to elucidate the GBS subtypes of patients with an antecedent C. jejuni infection.MethodsNerve conduction study results of 73 patients with GBS were reviewed. Patients were defined as having a recent C. jejuni infection when there was a positive stool culture or serological evidence of C. jejuni in the presence of preceding diarrhea.ResultsA total of 23 patients had evidence of a recent C. jejuni infection. At the early stage, patients were classified as AMAN (n = 9; 39%), AIDP (n = 3; 13%) or equivocal (n = 9) using existing electrophysiological criteria. Prolonged distal latencies and conduction slowing that were seen in 11 patients rapidly normalized within 3 weeks in seven, whereas four had minor abnormalities throughout the course. Subsequently, all patients showed either acute motor axonal neuropathy pattern or reversible conduction failure.ConclusionSerial neurophysiology suggests that C. jejuni infections are exclusive to axonal GBS.SignificanceOur findings suggest that AMAN can demonstrate the full complement of demyelinating features at the early stages of disease.

► Serial nerve conduction study is essential for the classification of Guillain–Barré syndrome subtypes.
► Axonal Guillain–Barré syndrome can demonstrate the full complement of demyelinating features at the early stages of disease.
► A new classification of Guillain–Barré syndrome subtypes should take into account the concept of “reversible conduction failure” at the early stage of disease based on serial neurophysiology.