{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T08:45:39Z","timestamp":1794645939941,"version":"4.9.1"},"reference-count":43,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2019,12,18]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:p>Areflexia or hyporeflexia is a mandatory clinical criterion for the diagnosis of Guillain-Barr\u00e9 syndrome (GBS). A systematic review of the literature from 1 January 1993 to 30 August 2019 revealed 44 sufficiently detailed patients with GBS and hyper-reflexia, along with one we describe. 73.3% of patients were from Japan, 6.7% from the USA, 6.7% from India, 4.4% from Italy, 4.4% from Turkey, 2.2% from Switzerland and 2.2% from Slovenia, suggesting a considerable geographical variation. Hyper-reflexia was more frequently associated with antecedent diarrhoea (56%) than upper respiratory tract infection (22.2%) and the electrodiagnosis of acute motor axonal neuropathy (56%) than acute inflammatory demyelinating polyneuropathy (4.4%). Antiganglioside antibodies were positive in 89.7% of patients. Hyper-reflexia was generalised in 90.7% of patients and associated with reflex spread in half; it was present from the early progressive phase in 86.7% and disappeared in a few weeks or persisted until 18 months. Ankle clonus or Babinski signs were rarely reported (6.7%); spasticity never developed. 53.3% of patients could walk unaided at nadir, none needed mechanical ventilation or died. 92.9% of patients with limb weakness were able to walk unaided within 6 months. Electrophysiological studies showed high soleus maximal H-reflex amplitude to maximal compound muscle action potential amplitude ratio, suggestive of spinal motoneuron hyperexcitability, and increased central conduction time, suggestive of corticospinal tract involvement, although a structural damage was never demonstrated by MRI. Hyper-reflexia is not inconsistent with the GBS diagnosis and should not delay treatment. All GBS variants and subtypes can present with hyper-reflexia, and this eventuality should be mentioned in future diagnostic criteria for GBS.<\/jats:p>","DOI":"10.1136\/jnnp-2019-321890","type":"journal-article","created":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T17:33:50Z","timestamp":1579023230000},"page":"278-284","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Hyper-reflexia in Guillain-Barr\u00e9 syndrome: systematic review"],"prefix":"10.1136","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8131-8912","authenticated-orcid":false,"given":"Antonino","family":"Uncini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Notturno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4716-8578","authenticated-orcid":false,"given":"Satoshi","family":"Kuwabara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,1,14]]},"reference":[{"key":"2024111108100636000_91.3.278.1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410090703"},{"key":"2024111108100636000_91.3.278.2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410030628"},{"key":"2024111108100636000_91.3.278.3","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410270707"},{"key":"2024111108100636000_91.3.278.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2010.06.003"},{"key":"2024111108100636000_91.3.278.5","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410330402"},{"key":"2024111108100636000_91.3.278.6","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1993.00540070050014"},{"key":"2024111108100636000_91.3.278.7","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.clinph.2017.03.048","article-title":"Optimizing the electrodiagnostic accuracy in Guillain-Barr\u00e9 syndrome subtypes: criteria sets and sparse linear discriminant analysis","volume":"128","author":"Uncini","year":"2017","journal-title":"Clin Neurophysiol"},{"key":"2024111108100636000_91.3.278.8","doi-asserted-by":"crossref","first-page":"2586","DOI":"10.1016\/j.clinph.2018.09.025","article-title":"The electrodiagnosis of Guillain-Barr\u00e9 syndrome subtypes: where do we stand?","volume":"29","author":"Uncini","year":"2018","journal-title":"Clin Neurophysiol"},{"key":"2024111108100636000_91.3.278.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"2024111108100636000_91.3.278.10","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.67.2.180"},{"key":"2024111108100636000_91.3.278.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-011-6330-4"},{"key":"2024111108100636000_91.3.278.12","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.1093\/brain\/awy232","article-title":"Regional variation of Guillain-Barr\u00e9 syndrome","volume":"141","author":"Doets","year":"2018","journal-title":"Brain"},{"key":"2024111108100636000_91.3.278.13","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/S0140-6736(78)92644-2","article-title":"Controlled trial of prednisolone in acute polyneuropathy","volume":"312","author":"Hughes","year":"1978","journal-title":"The Lancet"},{"key":"2024111108100636000_91.3.278.14","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.64.2.253"},{"key":"2024111108100636000_91.3.278.15","doi-asserted-by":"publisher","DOI":"10.1177\/0883073814528377"},{"key":"2024111108100636000_91.3.278.16","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4103\/1817-1745.181264","article-title":"Guillain\u2013Barr\u00e9 syndrome with hyperreflexia and bilateral papillitis in a child","volume":"11","author":"Incecik","year":"2016","journal-title":"J Pediatr Neurosci"},{"key":"2024111108100636000_91.3.278.17","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2017-317192"},{"key":"2024111108100636000_91.3.278.18","first-page":"215","article-title":"Guillain Barre syndrome with brisk reflexes-another variant","volume":"54","author":"Somarajan","year":"2006","journal-title":"Neurol India"},{"key":"2024111108100636000_91.3.278.19","doi-asserted-by":"crossref","unstructured":"Delwaide PJ . 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