Cerebrospinal fluid total protein in Guillain–Barré syndrome variants: correlations with clinical category, severity, and electrophysiology

  • Pierre R. BourqueEmail author
  • J. Brooks
  • J. Warman-Chardon
  • A. Breiner
Original Communication


The discriminative value of CSF total protein (CSF-TP) in subtypes of Guillain–Barré syndrome has not been well documented in North-American patients. We reviewed 173 cases from a single institution, comprising the following clinical categories of neuropathy: 134 Sensorimotor (SM) GBS, 13 Motor (M) GBS, 8 Localized (L) GBS, and 18 Miller Fisher syndrome (MFS). We grouped the electrophysiological interpretation in primarily demyelinating, primarily axonal and normal / equivocal categories. Mean CSF-TP were substantially higher for SM and L-GBS, as well as cases classified as Acute-onset chronic inflammatory demyelinating polyneuropathy. They were lower for M-GBS and L-GBS. The most statistically significant correlation was found for elevated CSF-TP in GBS cases showing an electrophysiologic pattern classified as demyelinating (1.56 g/L) compared with axonal (0.68 g/L) or normal/ equivocal patterns (0.65 g/L). There was a correlation between CSF-TP and time interval between symptom onset and lumbar puncture. There was a weak correlation between CSF-TP and maximal overall-clinical severity grade, which was likely mostly determined by the electorphysiological pattern. Though CSF-TP is a sensitive test for GBS in the second week after onset, it may not be a reliable predictor of clinical severity. There is a robust association of CSF-TP elevation and a demyelinative electrophysiologic pattern and a suggestion that lower mean CSF-TP values can be expected in GBS-spectrum disorders thought to represent nodo-paranodopathies.


Guillain–Barre syndrome Cerebrospinal fluid protein Albuminocytologic dissociation Immune neuropathy 


Compliance with ethical standards

Conflicts of interest

The authors of this manuscript have no conflicts of interest to disclose.

Ethical standard

This study was approved by the Institutional Ethics (Medical Research) Committee.


  1. 1.
    van den Berg B et al (2014) Guillain-Barre syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 10(8):469–482CrossRefGoogle Scholar
  2. 2.
    Fokke C et al (2014) Diagnosis of Guillain-Barre syndrome and validation of Brighton criteria. Brain 137(Pt 1):33–43CrossRefGoogle Scholar
  3. 3.
    Willison HJ, Jacobs BC, van Doorn PA (2016) Guillain-Barre syndrome. Lancet 388(10045):717–727CrossRefGoogle Scholar
  4. 4.
    Bourque PR, Brooks J, McCudden CR, Warman-Chardon J, Breiner A (2019) Age matters: impact of data-driven CSF protein upper reference limits in Guillain-Barré syndrome. Neurol Neuroimmunol Neuroinflamm 6:e576 (In press) CrossRefGoogle Scholar
  5. 5.
    Wakerley BR, Uncini A, Yuki N (2014) Guillain-Barre and Miller Fisher syndromes–new diagnostic classification. Nat Rev Neurol 10(9):537–544CrossRefGoogle Scholar
  6. 6.
    Van der Meche FG et al (2001) Diagnostic and classification criteria for the Guillain-Barre syndrome. Eur Neurol 45(3):133–139CrossRefGoogle Scholar
  7. 7.
    Rajabally YA et al (2015) Electrophysiological diagnosis of Guillain-Barre syndrome subtype: could a single study suffice? J Neurol Neurosurg Psychiatry 86(1):115–119CrossRefGoogle Scholar
  8. 8.
    Hughes RA et al (1978) Controlled trial prednisolone in acute polyneuropathy. Lancet 2(8093):750–753CrossRefGoogle Scholar
  9. 9.
    Group, P.E.S.G.-B.S.T (1997) Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barre syndrome plasma exchange/sandoglobulin Guillain-Barre syndrome trial Group. Lancet 349(9047):225–230CrossRefGoogle Scholar
  10. 10.
    Wilkinson GN, Rogers CE (1973) Symbolic description of factorial models for analysis of variance. J R Stat Soc Series C (Appl Stat) 22(3):392–399Google Scholar
  11. 11.
    Fox J, Weisberg S (2018) An R companion to applied regression. Sage, Los AngelesGoogle Scholar
  12. 12.
    Berlit P, Rakicky J (1992) The Miller Fisher syndrome review of the literature. J Clin Neuroophthalmol 12(1):57–63PubMedGoogle Scholar
  13. 13.
    Lyu RK et al (1997) Guillain-Barre syndrome in Taiwan: a clinical study of 167 patients. J Neurol Neurosurg Psychiatry 63(4):494–500CrossRefGoogle Scholar
  14. 14.
    Wong AH et al (2015) Cytoalbuminologic dissociation in Asian patients with Guillain-Barre and Miller Fisher syndromes. J Peripher Nerv Syst 20(1):47–51CrossRefGoogle Scholar
  15. 15.
    Nishimoto Y et al (2004) Usefulness of anti-GQ1b IgG antibody testing in Fisher syndrome compared with cerebrospinal fluid examination. J Neuroimmunol 148(1–2):200–205CrossRefGoogle Scholar
  16. 16.
    Hegen H et al (2016) Upper reference limits for cerebrospinal fluid total protein and albumin quotient based on a large cohort of control patients: implications for increased clinical specificity. Clin Chem Lab Med 54(2):285–292CrossRefGoogle Scholar
  17. 17.
    McCudden CR et al (2017) Cerebrospinal fluid total protein reference intervals derived from 20 years of patient data. Clin Chem 63(12):1856–1865CrossRefGoogle Scholar
  18. 18.
    Ruts L, van Koningsveld R, van Doorn PA (2005) Distinguishing acute-onset CIDP from Guillain-Barre syndrome with treatment related fluctuations. Neurology 65(1):138–140CrossRefGoogle Scholar
  19. 19.
    Alessandro L et al (2018) Differences between acute-onset chronic inflammatory demyelinating polyneuropathy and acute inflammatory demyelinating polyneuropathy in adult patients. J Peripher Nerv Syst 23(3):154–158CrossRefGoogle Scholar
  20. 20.
    Dionne A, Nicolle MW, Hahn AF (2010) Clinical and electrophysiological parameters distinguishing acute-onset chronic inflammatory demyelinating polyneuropathy from acute inflammatory demyelinating polyneuropathy. Muscle Nerve 41(2):202–207PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Ottawa Hospital, University of OttawaOttawaCanada
  2. 2.The Ottawa Hospital Research InstituteOttawaCanada

Personalised recommendations