Guillain-barre syndrome

Guillain-Barre Syndrome (GBS)

A rare neurological disease characterized by loss of reflexes and temporary paralysis.

Guillain-barré syndrome - Nerve Damage

Symptoms

• Symptoms include weakness, numbness, tingling and increased sensitivity that spreads over the body.
• Muscle paralysis starts in the feet and legs and moves upwards to the arms and hands.
• Sometimes paralysis can result in the respiratory muscles causing breathing difficulties.
• Symptoms usually appear over the course of one day and may continue to progress for 3 or 4 days up to 3 or 4 weeks.
• Recovery begins within 2-4 weeks after the progression stops.
• While most patients recover, approximately 15%-20% experience persistent symptoms.
• GBS is fatal in 5% of cases.
• Guillain-Barré syndrome (GBS) is a rare disorder where the body’s immune system damages nerve cells, causing muscle weakness and sometimes paralysis.

Mild polyneuritis

Cause

• While its cause is not fully understood, the syndrome often follows infection with a virus or bacteria.
• Each year in the United States, an estimated 3,000 to 6,000 people develop GBS.
• Most people fully recover from GBS, but some have permanent nerve damage.
• GBS is rare.

Risk factors

• Anyone can develop GBS, but people older than 50 are at greatest risk.
• In addition, about two-thirds of people who get GBS do so several days or weeks after they have been sick with diarrhea or a lung or sinus illness.
• Infection with the bacteria Campylobacter jejuni, which causes gastroenteritis (including symptoms of nausea, vomiting and diarrhea), is one of the most common risk factors for GBS.
• People also can develop GBS after having the flu or other infections such as cytomegalovirus and Epstein Barr virus.
• On very rare occasions, people develop GBS in the days or weeks after getting a vaccination.

Diagnosis

Key diagnostic findings include:

• Recent onset, within days to at most four weeks of symmetric weakness, usually starting in the legs
• Abnormal sensations such as pain, numbness, and tingling in the feet that accompany or even occur before weakness
• Absent or diminished deep tendon reflexes in weak limbs
• Elevated cerebrospinal fluid protein without elevated cell count.This may take up to 10 days from onset of symptoms to develop.
• Abnormal nerve conduction velocity findings, such as slow signal conduction
• Sometimes, a recent viral infection or diarrhea.

Treatment

• There is no known cure for Guillain-Barré syndrome.
• Some therapies can lessen the severity of the illness and shorten recovery time.
• There are also several ways to treat the complications of the disease.
• Because of possible complications of muscle weakness, problems that can affect any paralyzed person (such as pneumonia or bed sores) and the need for sophisticated medical equipment, individuals with Guillain-Barré syndrome are usually admitted and treated in a hospital’s intensive care unit.

Acute care

• There are currently two treatments commonly used to interrupt immune-related nerve damage.
• One is plasma exchange (PE, also called plasmapheresis); the other is high-dose immunoglobulin therapy (IVIg).
• Both treatments are equally effective if started within two weeks of onset of GBS symptoms, but immunoglobulin is easier to administer. Using both treatments in the same person has no proven benefit.
• Corticosteroids have also been tried to reduce the severity of Guillain-Barré syndrome.
• Supportive care is very important to address the many complications of paralysis as the body recovers and damaged nerves begin to heal. Respiratory failure can occur in GBS, so close monitoring of a person’s breathing should be instituted initially.
• Sometimes a mechanical ventilator is used to help support or control breathing.
• The autonomic nervous system (that regulates the functions of internal organs and some of the muscles in the body) can also be disturbed, causing changes in heart rate, blood pressure, toileting, or sweating.

Rehabilitative care

As individuals begin to improve, they are usually transferred from the acute care hospital to a rehabilitation setting.

Complications

• Complications in GBS can affect several parts of the body. Often, even before recovery begins, caregivers may use several methods to prevent or treat complications.
• Injections of blood thinners can help prevent dangerous blood clots from forming in leg veins.
• Inflatable cuffs may also be placed around the legs to provide intermittent compression.
• Occupational and vocational therapy help individuals learn new ways to handle everyday functions that may be affected by the disease, as well as work demands and the need for assistive devices and other adaptive equipment and technology.

Treatment

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