Guillain-Barre Syndrome

What is Guillain-Barre syndrome?
Guillain-Barre syndrome is a neurological disorder in which the body's immune system attacks part of the peripheral nervous system. It is a devastating disorder because of its sudden and unexpected onset. The disorder can develop over the course of hours or days, or it may take up to three to four weeks. The stage of greatest weakness is usually within the first two weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest.

What are symptoms of Guillain-Barre syndrome?
The first symptoms include varying degrees of weakness or tingling sensations in the legs, which sometimes spreads to the arms and upper body. The symptoms may increase in intensity until the following does or does not occur - in these cases, the disorder is considered a medical emergency:

• muscles cannot be used at all
• the patient becomes nearly paralyzed
• it may become difficult to breathe
• blood pressure and heart rate are affected

Although symptoms can become life threatening, partial recovery is possible from even the most severe cases of Guillain-Barre syndrome (however, some degree of weakness may still be present).

Who is affected by Guillain-Barre syndrome?
Although rare, afflicting about one person in 100,000, Guillain-Barre syndrome can affect anybody. It can affect people at any age and affects both sexes equally. The disorder usually occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally pregnancy, surgery, or vaccinations will trigger the syndrome.

Although the onset of Guillain-Barre syndrome is sudden and unexpected, recovery is often times not. Patients usually reach the point of greatest weakness or paralysis days or weeks after the first symptoms occur. In most cases, symptoms then stabilize at this level for days, weeks, or, sometimes, months. The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of patients still feel a residual weakness after three years, and 3 to 5 percent may suffer relapse of muscle weakness and tingling sensations many years after the initial attack.

What are causes of Guillain-Barre syndrome?
Currently, it is not known why Guillain-Barre strikes some people, or exactly what sets the disorder in motion. What is known is that the body's immune system begins to attack the body itself.

Normally, the cells of the immune system attack only foreign material and invading organisms, but in Guillain-Barre syndrome, the immune system starts to destroy the myelin sheath that surrounds the axons of many nerve cells, and sometimes the axons themselves.

The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances. When they are injured or degraded, nerves cannot send signals efficiently, and muscles begin to lose their ability to respond to the brain's commands. And, the brain also receives fewer sensory signals from the rest of the body, resulting in an inability to feel textures, heat, pain, and other sensations.

If Guillain-Barre is preceded by a viral infection, it is possible that the virus changes the nature of cells in the nervous system causing the immune system to interpret them as foreign cells. It is also possible that the virus makes the immune system itself less discriminating about what cells it attacks.

How is Guillain-Barre syndrome diagnosed?
According to the National Institute of Neurological Disorders and Stroke (NINDS):

Guillain-Barre is called a syndrome rather than a disease because it is not clear that a specific disease-causing agent is involved. A syndrome is a medical condition characterized by a collection of symptoms (what the patient feels) and signs (what a doctor can observe or measure). The signs and symptoms of the syndrome can be quite varied, so doctors may, on rare occasions, find it difficult to diagnose Guillain-Barre in its earliest stages.

Also, other disorders have symptoms similar to those found in Guillain-Barre, so doctors evaluate carefully before making a diagnosis. Signs and symptoms that may differentiate Guillain-Barre from other disorders include the following. With Guillain-Barre:

• symptoms appear on both sides of the body

• symptoms appear quickly -- days or weeks as opposed to months

• reflexes are usually lost

• cerebrospinal fluid that bathes the spinal cord and brain contains more protein than usual

How may Guillain-Barre syndrome be treated?
Currently, there is no known cure for Guillain-Barre syndrome. However, there are therapies that lessen the severity of the illness, as well as ways to treat symptoms and complications of the disorder.

Specific treatment for Guillain-Barre syndrome will be determined by your physician(s) based on:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Plasmapheresis and high-dose immunoglobulin therapy may be used in some cases of Guillain-Barre syndrome. Treatment for the syndrome mainly consists of keeping the patient's body functioning during recovery of the nervous system. This may require placing the patient on a respirator, heart machine, or other machines that assist body function.

Even before recovery begins, caregivers begin to manually move the patient's limbs to help keep the muscles flexible and strong. As soon as the patient begins to recover, physical therapy begins.

The need for sophisticated technology and close observation for complications in the paralyzed patients are reasons that Guillain-Barre syndrome is treated in hospitals.