ACUTE MOTOR AXONAL NEUROPATHY WITH HIGH-TITER IGG AND IGA ANTI-GD1A ANTIBODIES FOLLOWING CAMPYLOBACTER-ENTERITIS

We describe the first two European cases of acute axonal motor neuropa thy with both IgG and IgA anti-GD1a antibodies following Campylobacter enteritis. Both patients acutely developed severe weakness without se nsory involvement, had antibodies to Campylobacter jejuni and polyclon al IgG and IgA titers greater than or equal to 12 800 to GD1a at onset , which decreased during follow-up. Serial electrophysiologic studies showed: 1, normal or only slightly slowed motor conductions; 2, eviden ce of a progressive loss of excitability and conduction failure in ner ve fibers undergoing axonal degeneration in intermediate nerve segment s and evidence of distal axonal involvement in one nerve; 3, normal se nsory conductions, sensory potential amplitudes and somatosensory evok ed potentials. Although we cannot exclude that axonal degeneration fol lowed demyelination, we think that anti-GD1a antibodies account for th e axonal involvement because GD1a is present in the axolemma and expos ed at the node of Ranvier and in nerve terminals. The exclusive motor involvement could be explained by the fact that GD1a has a different i nternal structure in motor and sensory fibers. (C) 1997 Elsevier Scien ce B.V.