The clinical features of patients concurrent with Guillain-Barré syndrome and myasthenia gravis

Objectives: To evaluate all the coincidence cases of Guillain-Barré syndrome (GBS) and myasthenia gravis (MG).

Methods: We performed web-based research of the overlapping incidence of GBS and MG in studies occurring from 1982 to 2016 and restricted to the English language.

Results: Among 15 cases, an elevated CSF protein level without pleocytosis was found in 10 cases (66.7%); reduced nerve conduction was found in 13 cases (86.6%); a positive repetitive nerve stimulation test occurred in 11 cases (73.3%); anti-AChR antibodies were found in 13 cases (86.6%); anti-GQ1b antibodies were found in 6 cases (40%); a positive edrophonium chloride test was present in 10 cases (66.7%); and a co-occurring thymoma or thymectomy occurred in 4 cases (26.6%). The MG co-occurred with acute inflammatory demyelinating polyneuropathy (AIDP) in 8 cases and with Miller Fisher Syndrome in 5 cases. Treatment in the assessed cases included pyridostigmine (10 cases), prednisolone (7 cases), intravenous immunoglobulin (9 cases), plasmapheresis (3 cases), combined intravenous immunoglobulin and plasmapheresis in one case, and immunosuppressive drugs in 2 cases (azathioprine). Functional outcome was mentioned in 13 patients. The prognosis was favorable in 8 of the 15 recorded patients (Hughes 0-1), and 2 cases resulted in death.

Conclusion: Although comorbidity of GBS and MG is extremely rare, early recognition of this combination of inflammation of peripheral nerves and the neuromuscular junction is of great importance for both initial treatment and a better prognosis.