Guillain-Barré syndrome (GBS)

Guillain-Barre syndrome [GBS] is an acute fulminant polyneuropathy.

It is autoimmune in nature. In simple words, the body’s own immunity attacks its nerves, resulting in tingling to muscle weakness/paralysis.

Why to read about Guillain-Barre syndrome?

• Awareness and early recognition: GBS is a rare but serious condition, and early recognition can improve outcomes.

• Understanding triggers: GBS is triggered by infections, and vaccinations knowing these triggers can help in managing risk and educating patients.

• Rehabilitation and long-term care: Recovery can take weeks to years, learning about GBS prepares caregivers and patients for physical therapy, psychological support, and lifestyle adjustment.

What is Guillain-Barre syndrome?

• It is a rare autoimmune condition.

• It occurs at a rate of between 1 to 4 cases per 100,000 annually.

• In this neurological disorder, a person’s immune system mistakenly attacks the network of nerves that carries signals from the brain and spinal cord to the rest of the body.

• Nerves getting damaged leads to muscle weakness/paralysis.

• Some cases of GBS are very mild and only marked by brief weakness. Others cause nearly devastating paralysis.

• Secondary complications like respiratory failure due to muscle weakness, and hypotension may be life-threatening.

• Approximately 85% of patients with GBS achieve a full functional recovery within several months to a year, although minor findings may persist.

How did Guillain-Barre occur?

Triggers 

• Approximately 70% of cases of GBS occur 1 -3 weeks after an acute infection Usually respiratory or gastrointestinal. 

• Noticed triggers are Campylobacter jejune , Epstein-Barr virus , Mycoplasma , Zika , and CMV .

• The fact that GBS often begins after a viral or bacterial infection suggests that certain features of some viruses and bacteria may activate the immune system inappropriately. Researchers are searching for what those triggers may be. Certain proteins or peptides in viruses and bacteria may appear similar to the immune system as those found in myelin, and the production of antibodies to neutralize the invading viruses or bacteria could trigger the attack on the myelin sheath. 

• The body’s nerves have a central conducting core called the axon that carries an electric signal. The axon is surrounded by a sheath called myelin. The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances.
• In the most common type of GBS, called acute inflammatory demyelinating polyradiculoneuropathy (AIDP), the immune system damages the myelin sheath. 
• In two other types of GBS, called acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN), the immune system may damage the axons themselves. 
• Because of all the above the nerves cannot transmit signals efficiently and the muscles begin to lose their ability to respond to the brain’s commands, which causes weakness and abnormal or no reflexes.

Symptoms 

• Guillain-Barre syndrome starts with pins and needles in lower limb 
• Muscle weakness in the legs spreads to the upper body

• Difficulty with eye muscles unable to move or double vision

• Difficulty swallowing, speaking, or chewing

• Pain that can be severe, particularly at night

• Unable to walk or climb stairs

• Trouble breathing

• Bladder and bowel dysfunction 

• Increased heart rate

Diagnosis  : 

Diagnosis is done on the basis of following points

1] history and physical examination.

2] CSF cerebrospinal fluid analysis.

3]Nerve conduction velociy test.

Treatment : 

Two treatments are mostly used for immune-related nerve damage. Both show effective result if started within two weeks of GBS symptoms.

• Plasma exchange (PE), also called plasmapheresis, involves removing some blood through a catheter. Plasma (the liquid part of the blood) is separated from the blood cells. These cells, along with replacement fluid, are returned to the body. PE may work by removing the bad antibodies in the plasma that have been damaging the nerves.
• Intravenous immunoglobulin therapy (IVIg) involves injections of immunoglobulins—proteins that your immune system naturally makes to attack infecting organisms. The immunoglobulins are developed from a pool of thousands of healthy donors. IVIg can lessen the immune attack on the nervous system and shorten recovery time. Researchers believe this treatment also reduces the effectiveness of antibodies that attack the nerves by both “diluting” them with non-specific antibodies and reducing the number of harmful antibodies.
• Supportive and intensive care to treat complications due to muscle weakness.
• Physical therapy to regain muscle strength.