Journal of Neurology

, Volume 266, Issue 2, pp 476–479 | Cite as

Characteristics of single ocular motor nerve palsy associated with anti-GQ1b antibody

  • Kwang-Dong Choi
  • Seo Young Choi
  • Jae-Hwan Choi
  • Seong Hi Kim
  • Seong-Han Lee
  • Seong-Hae Jeong
  • Hyo-Jung Kim
  • Jeong-Yoon Choi
  • Ji-Soo KimEmail author
Original Communication


To define the prevalence and characteristics of single ocular motor nerve palsy (OMNP) associated with positive serum anti-GQ1b antibody. We performed a prospective multicenter study that recruited 82 patients with single OMNP without identifiable causes from the history and neuroimaging in six neurology clinics of university hospitals. We measured serum anti-GQ1b antibody in all participants. Twelve patients with multiple OMNP and 30 with identifiable causes served as the controls. Overall, the prevalence of anti-GQ1b antibody syndrome was 10% (8/82) in patients with single OMNP and 6% (5/78) in those with single OMNP in isolation. None of the 14 patients with OMNP with identifiable causes showed positive serum anti-GQ1b antibody. The prevalence of anti-GQ1b antibody syndrome was much higher in patients with multiple OMNP than in those with single OMNP (50% vs. 10%, p < 0.01). Patients with single OMNP and positive anti-GQ1b antibody are younger (42 ± 16 vs. 58 ± 15, p < 0.05) and had a significantly higher frequency of preceding infection (75 vs. 19%, p < 0.05) and other neurological signs (38 vs. 1%, p < 0.05) than those with negative antibody. Eight patients with single OMNP and positive serum anti-GQ1b antibody involved the abducens (n = 6), trochlear (n = 1), or oculomotor nerve (n = 1). Single OMNP accompanying other neurological signs and multiple OMNP are more likely to be associated with anti-GQ1b antibody. Anti-GQ1b antibody syndrome should be considered even in patients with single OMNP, especially when antecedent infection was associated in younger patients.


Acquired ocular motor nerve palsy Isolated ocular motor nerve palsy Anti-GQ1b antibody Anti-ganglioside antibody Fisher syndrome 


Compliance with ethical standards

Conflicts of interest

We have no disclosure of any competing interest.

Ethical approval for research involving human participants and/or animals

All experiments followed the tenets of the Declaration of Helsinki, and this study was approved by the Institutional Review Board of Pusan National University Hospital (1605-001-041).


  1. 1.
    Odaka M, Yuki N, Hirata K (2001) Anti-GQ1b IgG antibody syndrome: clinical and immunological range. J Neurol Neurosurg Psychiatry 70:50–55CrossRefGoogle Scholar
  2. 2.
    Ito M, Kuwabara S, Odaka M, Misawa S, Koga M, Hirata K, Yuki N (2008) Bickerstaff’s brainstem encephalitis and Fisher syndrome form a continuous spectrum: clinical analysis of 581 cases. J Neurol 255:674–682CrossRefGoogle Scholar
  3. 3.
    Snyder LA, Rismondo V, Miller NR (2009) The Fisher variant of Guillain-Barre syndrome (Fisher syndrome). J Neuroophthalmol 29:312–324CrossRefGoogle Scholar
  4. 4.
    Shahrizaila N, Yuki N (2013) Bickerstaff brainstem encephalitis and Fisher syndrome: anti-GQ1b antibody syndrome. J Neurol Neurosurg Psychiatry 84:576–583CrossRefGoogle Scholar
  5. 5.
    Lee SH, Lim GH, Kim JS, Oh SY, Kim JK, Cha JK, Yun CH, Kang JK, Lee H, Song HK, Chung KC (2008) Acute ophthalmoplegia (without ataxia) associated with anti-GQ1b antibody. Neurology 71:426–429CrossRefGoogle Scholar
  6. 6.
    Yuki N, Odaka M, Hirata K (2001) Acute ophthalmoparesis (without ataxia) associated with anti-GQ1b IgG antibody: clinical features. Ophthalmology 108:196–200CrossRefGoogle Scholar
  7. 7.
    Sakurai Y, Mannen T, Kusunoki S (1998) Acute isolated ophthalmoplegia as a variant of Miller-Fisher syndrome. Muscle Nerve 21:1107CrossRefGoogle Scholar
  8. 8.
    Tatsumoto M, Odaka M, Hirata K, Yuki N (2006) Isolated abducens nerve palsy as a regional variant of Guillain-Barre syndrome. J Neurol Sci 243:35–38CrossRefGoogle Scholar
  9. 9.
    Kinno R, Ichikawa H, Tanigawa H, Itaya K, Kawamura M (2011) Unilateral abducens nerve palsy as an early feature of multiple mononeuropathy associated with anti-GQ1b antibody. Case Rep Neurol 3:82–85CrossRefGoogle Scholar
  10. 10.
    Choi KD, Choi JH, Choi HY, Huh YE, Kim HJ, Oh SY, Jeong SH, Hwang JM, Kim JS (2013) Inferior rectus palsy as an isolated ocular motor sign: acquired etiologies and outcome. J Neurol 260:47–54CrossRefGoogle Scholar
  11. 11.
    Ueno T, Kon T, Kurihara AI, Tomiyama M (2017) Unilateral oculomotor nerve palsy following campylobacter infection: a mild form of Miller Fisher syndrome without ataxia. Intern Med 56:2929–2932CrossRefGoogle Scholar
  12. 12.
    Spatola M, Du Pasquier R, Schluep M, Regeniter A (2016) Serum and CSF GQ1b antibodies in isolated ophthalmologic syndromes. Neurology 86:1780–1784CrossRefGoogle Scholar
  13. 13.
    Chou KL, Galetta SL, Liu GT, Volpe NJ, Bennett JL, Asbury AK, Balcer LJ (2004) Acute ocular motor mononeuropathies: prospective study of the roles of neuroimaging and clinical assessment. J Neurol Sci 219:35–39CrossRefGoogle Scholar
  14. 14.
    Tamhankar MA, Biousse V, Ying GS, Prasad S, Subramanian PS, Lee MS, Eggenberger E, Moss HE, Pineles S, Bennett J, Osborne B, Volpe NJ, Liu GT, Bruce BB, Newman NJ, Galetta SL, Balcer LJ (2013) Isolated third, fourth, and sixth cranial nerve palsies from presumed microvascular versus other causes: a prospective study. Ophthalmology 120:2264–2269CrossRefGoogle Scholar
  15. 15.
    Chiba A, Kusunoki S, Obata H, Machinami R, Kanazawa I (1997) Ganglioside composition of the human cranial nerves, with special reference to pathophysiology of Miller Fisher syndrome. Brain Res 745:32–36CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurology, Biomedical Research InstitutePusan National University Hospital, Pusan National University School of MedicineBusanSouth Korea
  2. 2.Department of Neurology, Biomedical Research InstitutePusan National University Yangsan Hospital, Pusan National University School of MedicineBusanSouth Korea
  3. 3.Department of NeurologyKyungpook National University School of MedicineDaeguSouth Korea
  4. 4.Department of NeurologyChonnam National University Medical School, Chonnam National University HospitalGwangjuSouth Korea
  5. 5.Department of NeurologyChungnam National University School of MedicineDaejeonSouth Korea
  6. 6.Department of Neurology, Dizziness CenterSeoul National University Bundang HospitalSeongnamSouth Korea
  7. 7.Research Administration TeamSeoul National University Bundang HospitalSeongnamSouth Korea
  8. 8.Department of NeurologySeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamSouth Korea

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