Topiramate Responsive Prominent Head Tremor as an Atypical Presentation of Guillain-Barré Syndrome

Neuropathic tremors are often encountered in both hereditary as well as acquired inflammatory demyelinating neuropathies, such as IgM paraproteinemic neuropathy and chronic inflammatory demyelinating polyradiculoneuropathy and occasionally during the recovery phase of Guillain-Barre syndrome (GBS). Acute motor axonal neuropathy (AMAN) accounts for up to 30–65% the patients with GBS in East Asia and is rarely associated with a neuropathic tremor. We report a patient with AMAN, who presented with pure motor quadriplegia with bulbar symptoms and a prominent atypical resting head tremor during the acute phase of illness, which showed an excellent response to topiramate therapy.