Pleocytosis and immunoglobulin changes in cerebrospinal fluid and herpesvirus serology in patients with Guillain-Barré syndrome.

In a follow-up study of 24 patients with Guillain-Barré syndrome, 55% developed a cerebrospinal fluid (CSF) mononuclear pleocytosis, which persisted for 4 months or more. Raised index values of CSF-immunoglobulin G (IgG), CSF-IgA, and CSF-IgM, indicating synthesis of the immunoglobulin in question in the central nervous system, were found in 63, 35, and 25%, respectively. Agarose gel eletrophoresis revealed oligoclonal immunoglobulin in CSF in 21% and in both CSF and serum in another 21% of the patients. Twenty-five percent had abnormally low kappa/lambda ratios of CSF and/or serum, indicating synthesis of oligoclonal immunoglobulin, mainly of the lambda light-chain type. The inflammatory reaction in the central nervous system, as reflected by pleocytosis, immunoglobulin synthesis, and oligoclonal immunoglobulin, was not correlated to the severity or course of Guillain-Barré syndrome. A raised CSF-IgM index and oligoclonal immunoglobulin were found more often in the Guillain-Barré syndrome patients who displayed pleocytosis. All patients had or developed antibodies to Epstein-Barr virus. Three patients had serology indicating a primary infection, 11 patients had antibody changes indicating a reactivated infection, and 10 had serology indicating previous exposure. Two patients showed serological evidence for a primary cytomegalovirus infection, 2 had serology indicative of a reactivated infection, 12 had titers as caused by previous exposure, and 8 remained seronegative. Virus-specific IgM was measurable in all cases of primary infection. Neither primary or reactivated Epstein-Barr virus nor cytomegalovirus infections were obviously related to CSF pleocytosis.