What is Guillain-Barré syndrome?

Guillain-Barré syndrome (GBS) is also known as acute inflammatory demyelinating polyradiculoneuropathy (AIDP). It is a neurological disorder in which the body’s immune system attacks the peripheral nervous system, part of the nervous system outside the brain and spinal cord. The onset of GBS can be very sudden and unexpected and requires immediate hospitalization. It develops within a few days or may take several weeks with great weakness within the first two weeks of the onset of symptoms.

GBS attacks males and females of all ethnicities and ages. Treatment is available for this condition and 80% of those affected recover with minor or neurological disorders (permanent damage to the nervous system). More severe cases of the condition require emergency medical treatment, hospitalization, and a longer period of rehabilitation. Between 10 and 15% of patients suffer significant damage to the nervous system. Neurological damage can range from difficulty walking or breathing to breathing; some patients require permanent respirator use. 5% of the affected people die.

Causes of Guillain-Barré syndrome

Guillain-Barré syndrome is believed to be caused by a problem with the immune system, due to the body’s natural defenses against disease and infection.

GBS can be caused by infections such as viruses or bacteria:

• Influenza
• Some gastrointestinal illnesses
• Mycoplasma pneumonia
• HIV, the virus that causes HIV/AIDS (very rare)
• Herpes simplex
• Mononucleosis

GBS may also include other medical problems, such as:

• Systemic lupus erythematosus
• Hodgkin disease
• After surgery

Symptoms for Guillain-Barré syndrome

The symptoms of Guillain-Barré syndrome include:

• Muscle instability and paralysis affecting both sides of the body
• Jerky, uncoordinated movements
• Numbness
• Muscle aches, pains, or cramps
• Odd thoughts such as vibrations, buzzing, or ‘crawling’ under the skin
• Blurred vision
• Dizziness
• Breathing problems.

These symptoms progress up the body and become more severe, leading to paralysis of the arms and legs. After symptoms persist and peak for a time, the person begins to recover. The renewal can last between six months and two years or more.

Diagnosis of Guillain-Barré syndrome

Diagnosis is difficult in the early stages of the disease due to the opacity of the initial symptoms. Diagnosis can be easier if the onset is quick and even on both sides of the body.

Your doctor will know about your medical history and symptoms.

Two tests are done to prove the diagnosis: electromyography and lumbar puncture. You may also have blood tests to rule out other causes.

• Electromyography (EMG): Electromyography (EMG) measures the health of your muscles and the nerves that control them.

To assess the muscle, a needle electrode is inserted into the muscle through the skin to obtain an electrical recording of muscle activity. This helps you know if your muscles respond when certain nerves are stimulated. In Guillain-Barré syndrome, the muscles may not react due to nerve damage.

To examine the nerves, a surface electrode (a small metal disk) is placed on the skin to stimulate the nerves with a small electrical shock. Measure the response coming from your nerves (how fast your nerves handle electrical signals). If you have Guillain-Barré syndrome, your nerve circulation is slower than normal.

• Lumbar puncture: Lumbar puncture is a local anesthesia procedure in which a needle is inserted into a lumbar spinal canal. This is the space at the bottom of the column (below the end of the spinal cord).

It is used to measure protein levels (a measurement of inflammation) and the number of cells in the cerebrospinal fluid and to rule out other causes of nerve inflammation.

Treatment for Guillain-Barré syndrome

Many patients with Guillain-Barré syndrome are hospitalized because the disorder weakens the chest muscles, making it difficult or impossible to breathe. In a hospital, patients can be monitored and, if necessary, placed on a respirator. If Guillain-Barré syndrome creates a paralysis of the muscles in the leg or arm, the victim may need help with actions of daily living, such as eating and eliminating waste. Close monitoring of heart function and blood pressure and other supportive care (including psychological support, pain management, skin care, prevention of blood clotting, and physical therapy) are also important.

Two treatments have been shown to decrease the hardness of Guillain-Barré syndrome and speed recovery:

Plasma exchange (plasmapheresis)

This treatment involves drawing some of the blood through a needle in the arm or hand. Blood is divided into plasma and red blood cells. The plasma is discarded and the red blood cells return to the body with donated or “clean” plasma. This process is repeated several times a day over a period of several days. Plasmapheresis is believed to remove antibodies from the body’s plasma that aid in an autoimmune attack on the nervous system.

Immunoglobulin (gamma globulin) therapy

It is a special protein that the immune system uses naturally. It is believed to help reduce the autoimmune attack on the nervous system when administered in high doses by dripping into the bloodstream.

Recovery

The largest people (about 80%) with Guillain-Barre syndrome gain a full recovery. However, you may need to spend several weeks in the hospital and take a year or more to fully recover.

Complications

Most people make a full recovery from GBS, but some have chronic nerve damage. Residual weakness is seen in 30% of GBS cases after three years. Patients with GBS can die from complications, including:

• Paralysis of the muscles that control breathing
• Sepsis (blood infection)
• Pulmonary embolism (lung clots)
• Cardiac arrest

Prognosis

Generally, for most GBS patients, nerve damage rapidly worsens over a period of weeks and worsens over about 4 weeks. The normal recovery time is 6 to 12 months.

Recovery is very slow. It also requires a lot of support, physical therapy, counseling, and occupational therapy.

When to contact the doctor

• Trouble taking a deep breath
• Decreased feeling (sensation)
• Difficulty breathing
• Difficulty swallowing
• Fainting
• Loss of strength in the legs that gets worse over time

Departments to consult for this condition

• Department of Neurology