Commentary: Malnutrition and nutritional deficits as aggravating factors in Guillain-Barré syndrome: a call for nutritional intervention in the Gaza Strip

We thank our reviewers for their comments and consideration of this commentary. Our responses to specific points raised by our reviewers are as follows:1. Per Frontiers guidelines, for this type of publication unpublished data is not allowed, and one of the references (Biswas) is listed as in press -This paper has now been published, and the relevant reference [ ref 2] has been modified.there.-The last line has been modified to : "Finally, we would like to thank Dr El Bilbeisi and his colleagues for their sterling work in the catastrophic and preventable famine conditions of Gaza."The changes made to the original text have been underlined in the re-submitted manuscript, for reference.We welcome the publication of this poignant paper (El Bilbeisi AH 2025). It has added to the growing literature on the importance of malnutrition in determining the outcome of patients with Guillain-Barre syndrome (GBS) in under-resourced settings (Biswas PP. 2025). We had previously written on the mimicry of GBS by acute beriberi neuropathy (Saini 2019).Malnourished individuals, especially if they are given a large and sudden carbohydrate load, may develop acute flaccid paralysis resembling GBS. We would like to remind your readers the need to consider this differential diagnosis and timely administer large amounts of parenteral thiamine.The key points that favor beriberi neuropathy over GBS are longer than 3 weeks progression of symptoms, alterations in mental state, nystagmus, vocal cord dysfunction, heart failure [ volume overload], unexplained raised serum lactate, nil cytoalbuminergic dissociation, and the absence of the sural sparing pattern on nerve conduction studies (Umapathi 2019). Finally, we would like to thank Dr El Bilbeisi and his colleagues for their sterling work in the catastrophic and preventable famine conditions of Gaza.