Guillain-Barre syndrome (GBS)

What is Guillain-Barre syndrome?

Guillain-Barre syndrome is a disorder caused by damage to the myelin sheath around nerves. The myelin sheath is a fatty substance that surrounds nerve fibres, it increases the speed at which signals travel along the nerves. Guillain-Barre syndrome results in progressive muscle weakness or paralysis. It often follows an infectious chest or intestinal illness.

Statistics on Guillain-Barre syndrome?

Guillain-Barre syndrome is a rare disorder; it affects 1 or 2 people in every 100,000 people per year.

Risk Factors for Guillain-Barre syndrome

The exact cause of Guillain-Barre syndrome is unknown. It may follow a minor infection, usually a respiratory (lung) infection or gastrointestinal (gut) infection. Signs of the original infection have usually disappeared before the signs of Guillain-Barre begin.Guillain-Barre syndrome may occur in association with viral infections like glandular fever , AIDS, and herpes simplex or after infections with bacteria. Sometimes Guillain-Barre occurs after recent surgery or vaccinations (such as rabies and swine flu vaccines) or in association with other medical problems such as systemic lupus erythematosus or Hodgkin's disease.Race: GBS has been reported throughout the international community. Sex: Males have a slightly greater risk of developing GBS especially in the elderly age group.Age: GBS cases have been reported in all age groups from infancy through old age with the largest number of cases occuring in the elderly population, followed by young adults. Infants appear to be at the lowest risk for developing GBS.

Progression of Guillain-Barre syndrome

The phases of the illness include an initial phase of rapid worsening that may take only a few hours in which to reach the most severe symptoms. This phase can last up to 3 weeks and is followed by a plateau phase of no change, this is then followed by a recovery phase.Recovery will begin within several days to 3 weeks after the onset of GBS and is a gradual process with some patients taking several months to achieve full function again.A person can only have GBS once - once they have had the illness they can't get it again.

How is Guillain-Barre syndrome Diagnosed?

The diagnosis is made primarily on the basis of the patient's symptoms and findings on examination. Certain tests such as nerve conduction studies can help to confirm a diagnosis of Guillain Barre syndrome.

Prognosis of Guillain-Barre syndrome

Almost all cases (95%) survive and the majority recover completely. Mild weakness may persist for some people. The outcome is most likely to be very good when symptoms remit within 3 weeks of their onset.

How is Guillain-Barre syndrome Treated?

GBS is considered a medical emergency and most patients are admitted to hospital soon after diagnosis. Although patients may recover by themselves, there are a number of treatments that may help recovery.

Plasmaphoresis may decrease the severity of the symptoms and facilitate a more rapid recovery. In this procedure, the blood plasma, which contains antibodies, is removed from the body and replaced with intravenous fluids or antibody-free donated plasma.

Intravenous immune globulin (IVIg) is equally effective in reducing the severity and duration of the symptoms.

Additional treatments are directed at prevention of complications such as choking during feeding (through positioning or use of a nasogastric feeding tube), blood clots (through mobilising the patient and sometimes the use of drugs to thin the blood ), intermittent bladder catheterization, and effective treatment of pain.

Guillain-Barre syndrome References

[1] Albers JW, Kelly JJ Jr: Acquired inflammatory demyelinating polyneuropathies: clinical and electrodiagnostic features. Muscle Nerve 1989 Jun; 12(6): 435-51[2] Brown WF, Feasby TE, Hahn AF: Electrophysiological changes in the acute "axonal" form of Guillain- Barre syndrome. Muscle Nerve 1993 Feb; 16(2): 200-5[3] eMEDICINE[4] Hahn AF: Guillain-Barre syndrome. Lancet 1998 Aug 22; 352(9128): 635-41[5] Kumar and Clark, Clinical Medicine 5th edition, WB Saunders, 2002, page 1214[6] MEDLINE Plus