Guillain-Barré syndrome (GBS) is an acute disease with progressive muscle weakness or paralysis. It is an autoimmune disorder in which the body’s immune system attacks its own nervous system and damages the nerve sheath ( myelin sheath ) , leading to inflammation . This damage (called demyelination) slows or stops nerve transmissions. Disruption of nerve transmissions to the muscles may cause complaints such as muscle weakness, paralysis, spasms, loss of sensation, tingling, pins and needles and/or sensitivity. Patients may become so weak that they have difficulty in breathing, and their heartbeat may become abnormal.
Guillain-Barré syndrome is very rare. It can affect anyone of any age. It is an unusual neuropathy that heals spontaneously and most patients regain most of their lost nerve and muscle function.
The cause of GBS and why it affects one person and not another is not well understood. The autoimmune process may either occur spontaneously or be triggered by a certain disease. GBS has been seen in people with a variety of viral and bacterial infections, including HIV infection, chronic diseases such as lupus (SLE) , Hodgkin’s lymphoma (or other malignant diseases), and those who have been recently vaccinated (eg against rabies or swine flu).
Patient history is important in diagnosis. Typically, paralysis starts in the feet or hands and progresses to the upper parts of the body. About 50% of the cases also have a recent history of a mild infection such as sore throat, flu or diarrhea. Several tests are often used to diagnose or confirm the disease, and sometimes to monitor the patient’s recovery period.
- Nerve conduction velocity – is the rate at which messages traverse a nerve. For nerve conduction velocity, the rate of transmission between the electrodes is measured by using electrodes placed on the surrounding nerves.
- Electromyography (EMG) – measures the electrical activity of muscle fibers. The EMG test measures the electrical activity of that muscle with a needle electrode placed directly into the muscle fibers through the skin. It is usually done in conjunction with a nerve conduction velocity test.
- Evaluation of the cerebrospinal fluid (CSF) – applied to identify the increase in protein levels. For this test, a needle is inserted between the vertebrae and some fluid is drawn. Although some protein is normally present, an increase in the amount of protein without an increase in white blood cells (WBC-leukocytes) in the CSF may indicate GBS.
Guillain-Barré syndrome usually goes away on its own. In most cases, the findings will stabilize and then reverse within weeks or months. However, up to 30% of patients will feel powerless even after 3 years. The goals of treatment are to try to help reduce the severity of symptoms, accelerate healing, prevent and/or minimize complications. Many patients may require hospitalization for careful monitoring and supportive care. If symptoms are severe, the patient may need a device for breathing.
In the early stage of the disease, two approaches are sometimes used to reduce the severity of the disease and accelerate recovery. Both aim to reduce the effectiveness of antibodies that attack the myelin sheath . Plasmapheresis (the process of taking blood from the patient, filtering the liquid plasma containing antibodies that may play a role in the autoimmune disorder and then returning the red and white blood cells to the patient) has proven to be effective. Immunoglobulin injections may be helpful for some patients to block the activity of damaging antibodies.
During the recovery period, most patients receive physical therapy to help regain muscle strength.