Guillain-Barre syndrome
Introduction
Guillain-Barre syndrome (GBS) is an inflammatory disorder in which your body's immune system attacks the nerves outside the brain and spinal cord (peripheral nerves) and, rarely, parts of the brain itself. Severe weakness and numbness in your legs and arms characterize GBS. Loss of feeling and movement (paralysis) may occur in your legs, arms, upper body and face.
Guillain-Barre syndrome affects an estimated one to three in every 100,000 persons annually in the United States. It can strike any race at any age, but its incidence increases with age. Guillain-Barre syndrome may occur within days or weeks after a viral infection such as influenza (flu) or diarrhea. It may be triggered by pregnancy or a medical procedure, such as a vaccination or minor surgery, or have no evident reason for developing. Because the cause of Guillain-Barre syndrome is unknown, there's no way to prevent the disease from occurring.
In its most severe form, GBS is a medical emergency and may require hospitalization. Severe Guillain-Barre syndrome may result in total paralysis, potentially dangerous fluctuations in heart rate and blood pressure, and inability to breathe without respiratory assistance. The muscles you use for eye movement, speaking, chewing and swallowing also may become weak or paralyzed. People with severe Guillain-Barre syndrome often need long-term rehabilitation to regain normal independence, and as many as 15 percent experience lasting physical impairment. In some cases, GBS can be fatal.
Most people recover from even the most severe cases of Guillain-Barre Syndrome. Available treatments, if started soon after signs and symptoms appear, may lessen the severity of GBS and reduce recovery time.
Signs and symptoms
The signs and symptoms of Guillain-Barre Syndrome usually appear rapidly over the course of a single day. These may include:
- Weakness, tingling or loss of sensation that often begins in your feet and legs and spreads to your upper body and arms
- Moderate pain throughout your body
- Difficulty breathing
- Paralysis of your legs, arms, respiratory muscles and face
- Difficulty with eye movement, facial movement, speaking, chewing or swallowing
- Very slow heart rate or low blood pressure
- Difficulty with bladder control or intestinal functions
If Guillain-Barre Syndrome is mild, the signs and symptoms may not extend beyond a feeling of general weakness. GBS may improve on its own within a few weeks, and some people initially may think the signs and symptoms are due simply to a common virus.
The signs and symptoms of Guillain-Barre Syndrome may last days, weeks or months before muscle sensation begins to return. Regaining your pre-illness strength and functioning is slow, sometimes requiring months or years. However, most people with Guillain-Barre Syndrome return to normal within months.
Causes
Doctors and scientists don't know what causes Guillain-Barre Syndrome. However, they believe that GBS is a disorder of the immune system. Research indicates that the immune system may destroy the protective covering of the peripheral nerves (myelin sheath), which disables the nerves from transmitting signals to the muscles. When this happens, muscles become unable to respond to nerve commands. Weakness, numbness or paralysis may occur. The brain also receives fewer sensory signals, resulting in the inability to feel heat, cold, pain and other sensations.
The most recognized conditions that occur before Guillain-Barre Syndrome develops are bacterial or viral infections. Approximately two-thirds of people affected by GBS have had a recent infectious illness, such as sore throat, diarrhea, cold or flu, within one to four weeks before the onset of GBS. The Epstein-Barr virus or Hodgkin's disease also may precede Guillain-Barre Syndrome.
A bacterial infection such as campylobacteriosis — caused by campylobacter, bacteria commonly found in undercooked food, especially poultry — may be a possible cause of Guillain-Barre Syndrome. This form of the disorder is usually more severe because it directly attacks the nerves, instead of the nerve coverings.
Guillain-Barre Syndrome may also be triggered by medical procedures including surgery and, in rare cases, influenza immunizations. However, the connection between the flu vaccine and GBS is weak, and the risk the vaccine poses to your health is much less significant than your risk of serious flu-related illness.
Complications
The long-term outlook for most people with Guillain-Barre Syndrome is good. About 75 percent to 85 percent of those affected recover completely or have only minor, residual weakness or abnormal sensations such as numbness or tingling.
Up to 15 percent of people with Guillain-Barre Syndrome experience more serious, permanent problems with sensation and coordination, including some cases of severe disability. About one in ten of those affected is at risk of experiencing a relapse.
Guillain-Barre Syndrome may cause severe damage to your muscles and nervous system, weakening your heart and lungs. About one-third of people with Guillain-Barre Syndrome require assisted ventilation while they are ill. Up to one in 12 people with GBS die of related complications such as respiratory failure, pulmonary embolism and cardiac arrest. Older adults with other medical problems are at greatest risk of death from GBS.
Treatment
There's no cure for Guillain-Barre Syndrome. However, certain therapies can lessen the severity of the illness and accelerate recovery for most people. The general treatment for GBS is supportive care to help with activities of daily living, such as eating and using the bathroom. For some, recovery can take a long time — from several months to a year or more.
According to a guideline developed by the American Academy of Neurology (AAN), treating Guillain-Barre Syndrome early, within two to four weeks after signs and symptoms first appear, may speed recovery time. Two main treatments, both equally effective, have been shown to speed the recovery from and reduce the severity of Guillain-Barre Syndrome in adults:
- Plasmapheresis (plaz-muh-fuh-RE-sis). This treatment — also known as plasma exchange — is a type of "blood cleansing" in which damaging antibodies are removed from your blood. Plasmapheresis consists of removing the liquid portion of your blood (plasma) and separating it from the actual blood cells. The blood cells are then put back into your body, which manufactures more plasma to make up for what was removed. It's not clear why this treatment works, but scientists believe that plasmapheresis removes certain antibodies from plasma that contribute to the immune system attack on the peripheral nerves.
- Intravenous immunoglobulin (IVIg). Immunoglobulin contains healthy antibodies from blood donors. High doses of immunoglobulin can block the damaging antibodies in your blood that may contribute to GBS.
Your treatment also may include pain medications including acetaminophen and nonsteroidal anti-inflammatory drugs, possibly in combination with narcotic painkillers.
Often before recovery begins, caregivers may need to manually move your arms and legs to help keep your muscles flexible and strong. After recovery has begun, you'll likely need physical therapy to help regain strength and proper movement to be able to function on your own. Whirlpool therapy (hydrotherapy) may help relieve pain and retrain the movement of your affected limbs. After your symptoms subside, your rehabilitation team will prescribe an active exercise routine to help you regain muscle strength and independence. You may need training with adaptive devices, such as a wheelchair or braces, to give you mobility and self-care skills.
Informations obtained from National Institute of Health.