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    Guillain-Barre Syndrome

    GBS; Landry-Guillain-Barre syndrome; Acute idiopathic polyneuritis; Infectious polyneuritis; Acute inflammatory polyneuropathy; Acute inflammatory demyelinating polyneuropathy; Ascending paralysis

    Guillain-Barre syndrome is a serious health problem that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weaknessor paralysis and other symptoms.

    Causes

    Guillain-Barre syndrome (GBS) is an autoimmune disorder. With an autoimmune disorder, the body's immune system attacks itself.The exact cause is unknown.GBS canoccur at any age. It is most common in people of both sexes between ages 30 and 50.

    GBSoften follows a minor infection, such as a lung infection or gastrointestinal infection. Most of the time, signs of the infection have disappeared before the symptoms of GBS begin.

    The swine flu vaccination in 1976 may have caused rare cases of GBS. The swine flu and the regular flu vaccines used today have notcaused more cases of the illness.

    GBSdamages parts of nerves. This nerve damage causes tingling, muscle weakness, and paralysis. GBS most often affects the nerve's covering (myelin sheath).This damage is called demyelination. It causes nerve signals to move more slowly. Damage to other parts of the nerve can cause the nerve to stop working altogether.

    GBS may occur with viral infections such as:

    • AIDS
    • Herpes simplex
    • Mononucleosis

    GBSmay also occur with other medical conditions such as:

    • Systemic lupus erythematosus
    • Hodgkin disease
    • After surgery
    • Severe illness (GBS of this type is called neuropathy of critical illness)

    Symptoms

    Symptoms of GBS can get worse quickly. It may take only a few hoursfor the most severe symptoms to appear. But weakness that increases over several days is also common.

    Muscle weakness or loss of muscle function (paralysis) affects both sides of the body. In most cases, the muscle weakness starts in the legs and spreads to the arms. This is called ascending paralysis.

    If the inflammation affects the nervesof the diaphragm and chest and there is weakness in those muscles, the person may need breathing assistance.

    Other typical signs and symptoms of GBS include:

    • Loss of tendon reflexes in the arms and legs
    • Tingling or numbness (mild loss of sensation)
    • Muscle tenderness or pain (may be a cramp-like pain)
    • Uncoordinated movement (cannot walk without help)
    • Low blood pressure or poor blood pressure control
    • Abnormal heartrate

    Other symptoms may include:

    • Blurred vision and double vision
    • Clumsiness and falling
    • Difficulty moving face muscles
    • Muscle contractions
    • Palpitations (sensation of feeling the heart beat)

    Emergency symptoms (seek medical help right away):

    • Breathing temporarily stops
    • Cannot take a deep breath
    • Difficulty breathing
    • Difficulty swallowing
    • Drooling
    • Fainting
    • Feeling light-headed when standing

    Exams and Tests

    A history of increasing muscle weakness and paralysis may be a sign of GBS, especially if there was a recent illness.

    A medical exam may show muscle weakness. There may also beproblems with blood pressure and heart rate. These are functions that are controlled automatically by the nervous system. The examinationmay also show that reflexes such as the ankle or knee jerk are decreased or missing.

    There may be signs of decreased breathing caused by paralysis of the breathing muscles.

    The following tests may be ordered:

    • Cerebrospinal fluid sample (spinal tap)
    • ECG
    • Electromyography (EMG) tests the electrical activity in muscles
    • Nerve conduction velocity test
    • Pulmonary function tests

    Treatment

    There is no cure for GBS. Treatment is aimed at reducingsymptoms, treating complications, and speeding up recovery.

    In the early stages of the illness, treatment called apheresis or plasmapheresis may be given. This treatment involvesremoving or blocking the proteins, called antibodies, that attack the nerve cells. Other treatment helps reduce inflammation.

    When symptoms are severe, treatment in the hospital will be needed. There, breathing support will likely be given.

    Other treatmentsfocus on preventing complications:

    • Blood thinners may be used to prevent blood clots.
    • If the diaphragm is weak, breathing support or even a breathing tube and ventilator may be needed.
    • Pain is treated with pain medicines or other medicines.
    • Proper body positioning or a feeding tube may be used to prevent choking during feeding if the muscles used for swallowing are weak.
    • Physical therapy helps keep joints and muscles healthy.

    Support Groups

    Guillain-Barre Syndrome Foundation International|www.gbs-cidp.org

    Outlook (Prognosis)

    Recovery can take weeks, months, or years. Most people survive and recover completely. Mild weakness may persist for some people. Outcome is likely to be good when the symptoms go away within 3 weeks after they first started.

    • Breathing difficulty (respiratory failure)
    • Contractures of joints or other deformity
    • Deep vein thrombosis (blood clots that form when someone is inactive or confined to bed)
    • Increased risk of infections
    • Low or unstable blood pressure
    • Paralysis that is permanent
    • Pneumonia
    • Skin damage (ulcers)
    • Breathing infood or fluids into the lungs (aspiration)

    When to Contact a Medical Professional

    Seek immediate medical help if you have any of the following symptoms:

    • Are unable to take a deep breath
    • Decreased feeling (sensation)
    • Difficulty breathing
    • Difficulty swallowing
    • Fainting
    • Loss of strength in the legs that gets worse over time

    References

    Katri B, Koontz D. Disorders of the peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Elsevier Saunders; 2012:chap 76.

    Walling AD, Dickson G. Guillain-Barre syndrome. Am Fam Physician. 2013;87:191-197

    Yuki N, Hartung HP. Guillain–Barre syndrome. N Engl J Med. 2012;366:2294-2304.

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      A Closer Look

        Self Care

          Tests for Guillain-Barre Syndrome

            Review Date: 5/28/2013

            Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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