Definition and Overview

Guillain-Barré syndrome (GBS) is a rare disorder. However, it can be very serious in many cases. It occurs when the immune system attacks parts of the peripheral nervous system that transmit brain signals to the muscles. This makes the muscles weak. It also makes patients feel tingling sensations all over their body. The symptoms affect the legs first. Then, they spread to other parts of the body. They can quickly worsen and cause paralysis just days or weeks after they first occur.

This syndrome can affect any nerve in the body. Thus, it can interfere with heart rate, blood pressure, and even breathing. These can lead to a number of serious problems. These include an abnormal heartbeat and blood clot formation. Blood clots can increase the risk of a heart attack or stroke. The syndrome can also trigger infections and an abnormal blood pressure. Because of these, GBS is treated as a medical emergency.

There is currently no cure for this syndrome. But therapies that treat its symptoms and help patients recover faster are available.

GBS can affect anybody of any age or gender. However, it is very rare. It affects just one in every 100,000 people. Scientists are not sure as to what causes the syndrome. However, many cases occur following certain viral infections.

Causes of Condition

GBS occurs when the immune system mistakenly attacks various nerves in the body. What causes this immune response is unknown.

Normally, the immune system attacks foreign organisms. This helps protect the body against many illnesses. In GBS, the immune system attacks the myelin sheath as well as the axons. Axons are extensions of nerve cells that carry signals to the brain. The myelin sheath, on the other hand, helps transmit nerve signals to the brain faster. It also helps transmit signals over long distances. If the myelin sheath is damaged, nerve signals coming from the legs and arms will take time to reach the brain. This is the reason why symptoms, such as tingling, affect the limbs first.

In many cases, GBS develops in people who have had some types of infections. These include HIV (the virus that causes AIDS) as well as Epstein-Barr and influenza viruses. Some researchers believe that such infections change the nature of certain cells so much so that the immune system can no longer recognise them. Other risk factors are surgery and mycoplasma pneumonia as well as certain childhood vaccines.

Key Symptoms

In GBS, the nerves that transmit signals to the muscles and connect the brain to the rest of the body are damaged. This prevents brain signals from reaching the muscles. This leads to muscle weakness. In severe cases, this can cause paralysis.

Often, GBS does not have warning signs. Its symptoms can develop very fast and tend to worsen in just a couple of days. In some cases, symptoms get worse in a matter of hours. Its first symptom is a tingling sensation in the legs. This occurs as the nerves fail to transmit signals from the brain to the farthest parts of the body. This symptom then quickly spreads upwards. It can then be felt in the hands and arms. It is followed by:

  • Problems with breathing

  • Problems with swallowing, chewing, and speaking. Patients also experience abnormal eye and facial movements.

  • Whole body pain - The pain is often worse at night.

  • Leg weakness - This can cause the patient to limp. When the condition gets worse, patients will not be able to walk or climb up the stairs on their own.

  • Problems with bladder control - This can cause involuntary urination. Patients may not be able to make it to the bathroom in time when they feel the urge to pee.

  • A fast heart rate - Patients may feel their heart is racing.

  • Severe lower back pain

  • Paralysis - This can occur in severe cases.

Who to See and Types of Treatments Available

GBS shares many symptoms with other disorders that affect the nervous system. This can make it difficult for doctors to quickly diagnose it in the early stages.

During the assessment, patients are asked about their:

  • Symptoms - The doctor would need a complete list of symptoms. These include those that may not seem related to the disorder. Patients must also indicate the first time their symptoms appeared.

  • Medical history - It is important for doctors to know if there is a recent history of certain viral or bacterial infections or surgery.

Doctors suspect GBS if symptoms affect both sides of the body and if they progress too quickly.

A spinal tap is used to confirm the diagnosis. This test can detect any changes in the amount of substances found in the cerebrospinal fluid (CSF). In this test, a special type of needle is inserted into the lower back. A small amount of CSF is then withdrawn for lab analysis. Other studies that measure nerve activity in muscles (electromyography and nerve conduction studies) are also used.

There is no known cure for GBS. Available treatments are used to reduce the intensity of symptoms as well as help patients recover faster. These treatments include high-dose immunoglobulin and plasma exchange therapies.

In plasma exchange therapy, blood drawn from the patient’s body is processed so its liquid portion can be removed. The red and white blood cells are then returned to the body. The same process is used in immunoglobulin therapy. The only difference is that the blood is taken from donors instead of the patient’s body. Both therapies are believed to block antibodies that cause damage to the peripheral nerves.

The symptoms of GBS are treated with the following:

  • Pain relievers - These are useful because most patients suffer from intense pain.

  • Anticoagulants - Paralysed patients have a higher than average risk of blood clots. They are given medications to prevent blood clots from forming. This helps reduce their risk of a heart attack and stroke.

  • Physical therapy (PT) - This helps patients regain muscle strength faster.

With early treatment, as many as 80% of GBS patients fully recover six months after their diagnosis. This means that they regain their muscle strength and are able to move normally without assistance. However, up to 10% of them either take a very long time to recover or do not fully recover at all.

References:

  • Salmon DA, et al. Association between Guillain-Barre syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: A meta-analysis. The Lancet. 2013;381:1461.

  • National Institute of Neurological Disorders and Stroke. (2011). Guillain-Barré syndrome fact sheet [Fact sheet]. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Guillain-Barré-Syndrome-Fact-Sheet

  • Guillain-Barré syndrome. (2017). https://ghr.nlm.nih.gov/condition/guillain-barre-syndrome

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