• Guillain
• Barr
• syndrome
• clinical variant
• Campylobacter jejuni
• ;
• antiganglioside antibody

Landry’s 19th century report gives the impression that Guillain–Barré syndrome (GBS) is characterised by ascending weakness. This clinical picture now is called “Landry’s ascending paralysis.”¹ Indeed, muscular weakness in GBS does usually begin in the legs, progressing to the trunk, arms, and cranial regions.² However, several clinical variants are now recognised in which weakness initially begins in other areas.² Four patients with acute polyneuropathy were reported initially to have had muscle weakness in the hands.³ In two of these, Campylobacter jejuni infection had preceded the neurological symptoms, and serum anti-GM1 antibody was detected in the others.

To determine the frequency and clinical features of hand onset GBS, we reviewed the medical records of 464 consecutive patients with the disease. Eleven had been treated at our hospital, the others were referred to our laboratory from other hospitals for antiganglioside antibody tests. Hand onset GBS was diagnosed when the first symptom that a GBS patient recognised was hand weakness. Paraesthesiae and other sensory symptoms may have preceded hand weakness, but patients who developed weakness in both the hands and legs on the first day of illness were …