Guillain-Barré syndrome (GBS) is a rare but debilitating disorder of the immune system. It is characterized by weakness, numbness, and intense fatigue. Usually first noticed following an infectious illness, the syndrome may be extreme but patients most often recover.
Definition & Facts
Guillain-Barré syndrome usually appears in patients after a stomach flu, respiratory disease or other infection. Its exact cause is unknown and much is still being learned about this autoimmune disease.
As part of Guillain-Barré syndrome, the immune system attacks the myelin sheaths protecting the body's nerves. Those affected first notice weakness and tingling in their arms and legs. This spreads throughout the body and causes paralysis. Some people require emergency treatment and others must be hospitalized.
As with other autoimmune disorders, Guillain-Barré presents in a variety of forms and these variants of Guillain-Barré include:
- Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), characterized by muscle weakness starting at the feet or legs and spreading upward through the body
- Miller Fisher syndrome (MFS), with paralysis beginning in the eyes, along with trouble walking
- Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN), which are more prevalent in Asian and Central American geographies.
Symptoms & Complaints
Signs and symptoms commonly experienced by people with Guillain-Barré syndrome are:
- Tingling in fingers, toes, wrists and ankles
- Leg weakness which spreads to the upper body
- Trouble climbing stairs or difficulty walking
- Difficulty speaking, difficulty chewing, difficulty swallowing
- Aching, cramping pain which may be more prevalent at night
- Bladder dysfunction and bowel dysfunction
- Rapid pulse
- High blood pressure or low blood pressure
- Difficulty breathing
Patients who suffer from Guillain-Barré tend to notice their worst weakness at about two to four weeks after onset of symptoms. When weakness plateaus, improvement usually starts becoming noticeable in about two weeks to a month. Slow recovery of about six to 12 months usually occurs with some requiring as many as three years to make a full recovery.
The precise cause of this syndrome is not clear, although Guillain-Barré often shows itself within a short period following a digestive tract or respiratory illness. Surgery and immunization issues have also been known to trigger the syndrome. There are several risk factors associated with Guillain-Barré syndrome as well as populations that may be more susceptible to developing the syndrome than others. These include:
- Male gender
- Older adulthood
- Presence of campylobacter, a bacteria found in undercooked poultry
- Flu virus
- Epstein-Barr virus
- Recent surgery
- Mycoplasma pneumonia
- Hodgkin's lymphoma
- Flu vaccine or childhood vaccines, although rare
Diagnosis & Tests
Guillain-Barré syndrome is not easy to diagnose. There are many neurological disorders with similar symptoms. A medical history and physical examination is where fact-finding begins followed by the possibility of tests which may include:
- Lumbar puncture, also known as a spinal tap, as part of which cerebrospinal fluid is collected from the spine and tested
- Nerve conduction studies, as part of which electrodes are applied to the skin and a slight shock is administered to measure nerve signal speed
- Electromyography, muscular electrode application to measure muscle nerve activity
Treatment & Therapy
Although Guillain-Barré syndrome cannot be cured through medical treatment, there are options which help induce recovery and lessen severity. Those include:
- Plasma exchange, also called plasmapheresis, wherein blood liquid is extracted and separated from blood cells, with blood cells then being returned to the body. This rids plasma of harmful antibodies responsible for attacking nerves.
- Immunoglobulin therapy, as part of which antibody-rich donor immunoglobulin is intravenously administered to block GBS' harmful antibodies.
Both of these treatments are of equal positive effect. Generally, only one or the other will be applied. Medication may also be prescribed to relieve pain and prevent blood clots. Quite often, GBS patients also require physical therapy or assistance. This may include motion therapies to improve flexibility and strength, training in use of adaptive devices like wheelchairs, and exercise therapies to help with fatigue.
Prevention & Prophylaxis
Medical researchers are working diligently on discovery of new treatments, as well as in refinement of existing methods of treating the syndrome. The immune system suffers from a multitude of disorders similar to Guillain-Barré syndrome, so there are parallels between research for those illnesses and this one. One aspect of research includes investigation into the inner workings of the immune system to determine which cells initiate the attack on the body's own healthy nervous system.
Because viral infections and bacterial infections tend to occur prior to onset of Guillain-Barré syndrome, this suggests that these viruses or bacteria are triggering the immune system's malfunction. Such characteristics of these infections are being sought to help unlock the pathway between a patient's virus or bacterial illness and onset of their Guillain-Barré syndrome.