Background
: Guillain-Barre syndrome(GBS) is a neurologically emergent condition, leading to respiratory insufficiency without an early and appropriate treatment. Thus, the treatment of GBS requires early diagnosis but it is difficult due to the low sensitivity of laboratory tools in the initial stage. Hoffman reflex (H-reflex) and its facilitation by Jendrassik maneuver (JM) are sensitive tools evaluating the central circuit of motor system on the spinal cord level. The aim of this study is to test whether the change of H-reflex and F-wave under the JM is able to detect the early stage of GBS and whether GBS involves the central nervous system (CNS). Material and Methods : All 7 GBS patients who showed normal or nearly normal nerve conduction study were included. The facilitation of H-reflex and changes of F-wave were calculated by measuring the percent difference f H-reflex or F-wave amplitude under JM compared to basal H-reflex of F-wave amplitude. The changes of F-wave and H-reflex in the GBS patients were compared with them of 8 healthy controls. Results : The F-wave amplitudes of both healthy controls and GBS patients did not changed under the influence of JM (102.4

Background
Miller-Fisher syndrome (MFS) is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia,and is considered a variant form of Guillain-Barre syndrome. Although some cases of delayed-onset facial palsy in MFShave been reported, the characteristics of this facial palsy are poorly described in the literature. Methods: Between 2007and 2010, six patients with MFS were seen at our hospital. Delayed facial palsy, defined as a facial palsy that developedwhile the other symptoms of MFS began to improve following intravenous immunoglobulin treatment, was confirmed in fourpatients. The clinical and electrophysiological characteristics of delayed facial palsy in MFS, as observed in these patients,are described here. Results: Four patients with delayed-onset facial palsy were included. Delayed facial palsy developed 8-16days after initial symptom onset (5-9 days after treatment). Unilateral facial palsy occurred in three patients and asymmetricfacial diplegia in one patient. The House-Brackmann score of facial palsy was grade III in one patient, IV in two patients,and V in one patient. None of the patients complained of posterior auricular pain. Facial nerve conduction studies revealednormal amplitude in all four patients. The blink reflex showed abnormal prolongation in two patients and the absence ofaction potential formation in two patients. Facial palsy resolved completely in all four patients within 3 months. Conclusions:Delayed facial palsy is a frequent symptom in MFS and resolves completely without additional treatment. Thus, standardtreatment and patient reassurance are sufficient in most cases.

Recently, we encountered a man with isolated bilateral sixth nerve palsies and areflexia whose titer of anti-GQ1b IgG antibody waselevated. We propose that bilateral sixth nerve palsies can be the sole manifestation of