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Definition of Guillain-Barre syndrome

Guillain-Barre syndrome or GBS is a rare disorder in which the body's immune system attacks the nerves with tingling sensations which spreads very rapidly, making one weak and eventually paralysing the whole body. In its most severe form, GBS is a medical emergency that requires immediate hospitalization to receive treatment.

The exact cause is still not known but is often preceded by an infectious illness such as a respiratory infection or the stomach flu.

Types of Guillain-Barre syndrome

GBS was earlier thought to be a single disorder but has the following forms:

  • Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common form of GBS which starts with muscle weakness that begins in the lower part of the body and spreads upward.
  • Miller Fisher syndrome (MFS) is characterised by paralysis in the eyes and unsteady gait.
  • Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN) are the other forms.

Symptoms of Guillain-Barre syndrome

In about 10 percent of people with GBS, symptoms begin in the arms or face. As GBS progresses, muscle weakness can transition into paralysis. Those with GBS usually experience their most significant weakness within two to four weeks after symptoms begin. Recovery usually begins two to four weeks after weakness subsides. Signs and symptoms of Guillain-Barre syndrome include the following

  • Tingling and Pricking, "pins and needles" sensations in fingers, toes, ankles or wrists
  • Weakness in legs that spreads to upper body
  • Unsteady gait or inability to walk or climb stairs
  • Difficulty with eye or facial movements, including speaking, chewing or swallowing
  • Severe pain that may feel achy or cramp-like which can worsen at night
  • Difficulty with bladder control or bowel function
  • Rapid heart rate
  • Low or high blood pressure
  • Difficulty breathing

Risks of Guillain-Barre syndrome

GBS can affect anyone but those at a slightly greater risk are

  • Men
  • Older adults

Guillain-Barre syndrome can be triggered by

  • Most commonly, infection with campylobacter, a type of bacteria often found in undercooked poultry
  • Influenza virus
  • Epstein-Barr virus
  • HIV, the virus that causes AIDS
  • Mycoplasma pneumonia
  • Surgery
  • Hodgkin's lymphoma
  • Rarely, influenza vaccinations or childhood vaccinations

Diagnosis of Guillain-Barre syndrome

GBS is difficult to diagnose in the early stages. The signs and symptoms mimic other neurological disorders and can vary from case to case. The doctor will ask for -

  • A complete medical history and thorough physical examination
  • Spinal tap (lumbar puncture) test where a sample of fluid from the spinal canal is tested to confirm GBS
  • Electromyography where thin-needle electrodes are inserted into the muscles to measure nerve activity in the muscles
  • Nerve conduction studies where electrodes are taped to the skin above the nerves and small shocks are passed to measure the speed of nerve signals

Treatment of Guillain-Barre syndrome

There's no known cure for GBS but most people recover from it though some may experience lingering effects like weakness, numbness or fatigue. There are several effective treatments to ease symptoms and reduce the duration and severity of the illness -

  • Plasma exchange (plasmapheresis) where the liquid portion of the plasma is removed and separated from blood cells and put back into the body to manufacture more plasma to make up for what was removed. This will work by removal from the plasma, certain antibodies that contribute to the immune system's attack on the peripheral nerves.
  • Immunoglobulin therapy where Immunoglobulin containing healthy antibodies from blood donors is given through IV to block the damaging antibodies which contribute to GBS.
  • Medications to relieve severe pain, and to prevent blood clots
  • Physiotherapy before and during recovery to keep muscles strong and flexible, regain strength and proper movement and training with adaptive devices like wheelchair or braces for self-care skills and to cope with fatigue.
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