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Does Campylobacter jejuni infection elicit axonal or demyelinating Guillain–Barré syndrome, or both?
  1. Satoshi Kuwabara
  1. Correspondence to Professor S Kuwabara, Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan; kuwabara-s{at}faculty.chiba-u.jp

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Guillain–Barré syndrome (GBS) is currently divided into the two major subtypes, acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN).1 Whereas the gold standard for the classification of GBS subtypes is neuropathology, in clinical practice most neurologists use electrophysiology to identify nerve demyelination. Using current electrodiagnostic criteria, there is a considerable difference in geographical distribution of the subtypes; in western countries, >90% cases of GBS are diagnosed as having AIDP but in East Asia AMAN constitutes 38∼65% of cases. The geographical difference is expected to be related to environmental or genetic factors, and particularly preceding infections may determine the subtypes.

However, in both western and Asian countries, Campylobacter jejuni enteritis is the most common preceding infection in GBS.2 This is a mystery. It is now established that in certain patients AMAN …

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