Guillain-Barre Syndrome

Guillain-Barre syndrome is a rare but serious autoimmune disorder in which the immune system attacks healthy nerve cells of the peripheral nervous system. This leads to weakness, numbness, and tingling, and can eventually cause paralysis. This cause of this condition is unknown, but it is typically triggered by infectious illnesses like the stomach flu or a lung infection.

Guillain-Barre is uncommon. According to the Mayo Clinic, only one or two out of every 100,000 people are affected (Mayo, 2011).

In Guillain-Barre syndrome, a person’s immune system attacks his or her own peripheral nervous system. The nerves in your peripheral nervous system connect your brain to the rest of your body and transmit signals to your muscles. If these nerves are damaged, the muscles will not be able to respond to signals they receive from your brain.

The precise cause of Guillain-Barre is unknown. Sixty percent of cases have followed a lung infection or a gastrointestinal infection (Mayo, 2011). The following infections have been associated with Guillain-Barre:

• Campylobacterjejuni infection. Campylobacteris the most common bacterial cause of diarrhea in the United States. Campylobacterinfection is also the most common risk factor for Guillain-Barre. It is often found in undercooked food, especially poultry.
• influenza (the flu)
• cytomegalovirus (a strain of the herpes virus)
• Epstein-Barr virus infection (mononucleosis)
• mycoplasma pneumonia (‘atypical pnueumonia’ caused by bacteria-like organisms)
• HIV or AIDS

Anyone can get Guillain-Barre; however young adults and the elderly are at higher risk.

In extremely rare cases, people can develop the disorder days or weeks after receiving a vaccination. The Centers for Disease Control and Prevention (CDC) along with the Food and Drug Administration (FDA) have systems in place to monitor the safety of vaccines and to detect early warning signs of side effects. The tracking systems record any cases of Guillain-Barre that occur following vaccinations (CDC).

The first symptom is usually a tingling sensation in the toes, feet, and legs. The tingling spreads upward to the arms and fingers. The symptoms can progress very rapidly. In some people, the disease can become serious in just a few hours.

Symptoms of Guillain-Barre include:

• tingling or prickly sensations in the fingers and toes
• muscle weakness in the legs that travels to the upper body and gets worse over time
• difficulty walking steadily
• difficulty moving the eyes or face, talking, chewing, or swallowing
• severe lower back pain
• loss of bladder control
• fast heart rate
• difficulty breathing
• paralysis

Guillain-Barre is difficult to diagnose at first. This is because the symptoms are very similar to those of other neurological disorders or conditions that affect the nervous system such as botulism, heavy metal poisoning, or meningitis.

Your doctor will ask questions about specific symptoms and your medical history. Be sure to tell your doctor about any unusual symptoms you are experiencing and if you have had any recent or past illnesses or infections.

The following tests are used to help confirm a diagnosis:

Spinal Tap

This test is also referred to as a lumbar puncture. A spinal tap involves taking a small amount of fluid from the spine in the lower back. The fluid is then tested to detect protein levels. People with Guillain-Barre typically have higher-than-normal levels of protein in their cerebrospinal fluid.

Electromyography

An electromyography is a nerve function test. It reads electrical activity from the muscles to help your doctor learn if the muscle weakness is caused by nerve damage or muscle damage.

Nerve Conduction Tests

Nerve conduction studies may be used to test how well your nerves and muscles respond to small electrical pulses.

All patients with Guillain-Barre should be admitted to a hospital for close observation. The symptoms can progress rapidly and can be fatal if not treated. In severe cases, paralysis can affect the entire body. Death can occur if paralysis affects the diaphragm or chest muscles, preventing a person from breathing.

Guillain-Barre cannot be cured. However, for most people (approximately 85 percent), the symptoms of the disorder will stabilize and they will fully recover within six to 12 months (Newswanger, at al., 2004).

Treatment is aimed at reducing the severity of symptoms. Treatment may include:

Physical Therapy

Before recovery, a caregiver may need to manually move your arms and legs. This will help keep the muscles strong and mobile. After recovery, physical therapy will help you to strengthen and flex the muscles again. Therapy includes massages, exercises, and frequent position changes.

Plasmapheresis

The immune system produces proteins called antibodies that normally attack harmful foreign substances, such as bacteria and viruses. Guillain-Barre occurs when the immune system mistakenly makes antibodies that attack the healthy nerves of the nervous system.

Plasmapheresis is intended to remove the antibodies attacking the nerves from the blood. During this procedure, blood is removed from the body by machine that removes the antibodies from the blood and then the blood is returned to the body.

Intravenous Immunoglobulin

High doses of immunoglobulin can also help to block the antibodies causing Guillain-Barre. Immunoglobulin contains normal, healthy antibodies from donors.

A 2004 study published in American Family Physician found that both plasmapheresis and immunoglobulin were equally effective therapies. Immunoglobulin is generally easier to administer, more comfortable for the patient, and has fewer complications. Early treatment with plasmapheresis was also found to decrease hospitalization time (Newswanger, et al., 2004).

Guillain-Barre affects your nerves. The weakness and paralysis that occurs can affect multiple parts of your body. Complications may include:

• difficulty breathing when the paralysis or weakness spreads to muscles that control breathing; if this occurs, a machine called a respirator may be required to help you breathe
• lingering weakness, numbness, or other odd sensations even after recovery
• heart or blood pressure problems
• pain
• slow bowel or bladder function
• blood clots and bedsores due to paralysis

In general, symptoms will worsen for two to four weeks before they stabilize. Most people (approximately 85 percent) fully recover within six to 12 months. (Newswanger, at al., 2004)

For some people, recovery will take years. Others will have an incomplete recovery and the minor weakness and tingling will persist. Up to 10 percent of Guillain-Barre patients will experience a relapse of the condition.

The fatality rate is less than five percent for patients under the care of medical professionals. Factors that may lead to a poor outcome include old age, severe or rapidly progressing illness, delay of treatment, and prolonged use of a respirator (Newswanger, at al., 2004).