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Guillain-Barre Symptoms (GBS), Causes, Types, Diagnosis, and Treatment


Guillain-Barre (gee-YAH-buh-RAY) syndrome is a rare disease with an incidence of one to two cases per 100,000 people per year. It affects all ages but is more common among adults, especially those over 50. There is a greater incidence among males than females. It is a rare, progressive neurological disorder in which the body's immune system attacks the neurons (nerve cells). It often begins with tingling and weakness in the feet and legs, spreading to the arms and hands. Some people notice facial symptoms first. Guillain-Barre syndrome progresses, causing general muscle weakness, which can turn into paralysis. Some synonyms for GBS include acute inflammatory neuropathy, acute polyneuritis, and acute inflammatory polyneuropathy. GBS has no cure.

Symptoms

  • Pricking or pins and needles sensations in feet and hands
  • Difficulty with eye muscles, inability to move eyes, double vision
  • Severe pain, usually at night, an achy, cramp-like or shooting type of pain
  • Unsteadiness when walking and coordination problems
  • Problems with chewing, swallowing, and speaking and general facial movements
  • Rapid heart rate or blood pressure that is abnormally high or low
  • Problems breathing
  • Problems with bowel and bladder function
  • Difficulty with digestion

People with Guillain-Barre syndrome often experience their most pronounced weakness within two weeks after symptoms begin. These sensations can rapidly spread, eventually paralyzing the whole body. Suppose the patient is experiencing rapidly spreading tingling and a widespread decrease in strength, difficulty breathing, or choking on saliva. In that case, it is considered serious and requires emergency care in a hospital. If breathing is affected, the person needs to be attached to a machine to help support breathing. GBS can worsen rapidly. The quicker interventions are initiated, the better the chance of a positive result.

Causes

The exact cause of Guillain-Barre syndrome is unknown; however, two-thirds of patients report symptoms of a specific infection in the six weeks prior. The following is a listing of potential bacterial and viral infections, according to rare diseases, that trigger an autoimmune response.

Bacteria

  • Campylobacter jejuni, which causes diarrhea (often from undercooked infected chicken)
  • Haemophilus influenza, which causes chest infection

Viruses

  • cytomegalovirus, which causes chest infection or glandular fever
  • Epstein-Barr virus, which causes glandular fever
  • Hepatitis E which causes jaundice
  • Zika virus which causes fever, rash, and joint pain
  • SARS-Cov-2, the cause of the COVID-19 pandemic: GBS has occurred after COVID-19, but it is not yet clear whether this is a coincidence

The hallmark cause is the inflammation that occurs in the peripheral nerves (those nerves outside of the brain and spinal cord) of individuals with Guillain Barre Syndrome. These nerves typically exchange messages to and from the skin and muscles to the spinal cord and brain. The immune system develops an immune response to an infection which cross-reacts with the neurons. It usually reacts with and damages the outer coating of the nerve fibers, known as the myelin sheath, which transmits nerve impulses. In more seriously affected people, this damage also affects the axon or the central conducting core of the neuron. In some people, the axon is the primary target of this autoimmune response.

Types of Guillain Barre

There are several varieties of GBS:

  • Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) primarily affects the myelin sheath. The most typical form is found in America and Europe. Muscle weakness starts in the lowest part of the body and moves upward.
  • Acute motor axonal neuropathy (AMAN), which has an effect on the axons of the neurons going to the muscles. This is the least common form in the US but the most form in some Asian countries.
  • Acute motor and sensory axonal neuropathy (AMSAN), which affects both the axons of the motor and sensory neurons, is more common in Mexico, China, and Japan but less prominent in the US.
  • Miller Fisher Syndrome (MFS) is characterized by an unsteady gait and paralysis of the eyes. Like AMAN, it is more frequent in Asia and less common in the US.

Diagnosis

It is hard to diagnose GBS in its earliest phases. The varieties of Guillain Barre have symptoms, courses, treatments, and results that are alike. Symptoms appear on both sides of the body and can occur in days or weeks. A nerve conduction velocity test will detect slow signals traveling along the nerve. A spinal tap may detect very few immune cells in the cerebrospinal fluid. Deep tendon reflexes may be absent in the arms and legs.

Key diagnostic findings include:

  • The point of the most weakness occurs within days to at most 4 weeks after the first symptoms occur, is symmetrical, and starts in the legs first.
  • Initial symptoms of pain, numbness, and tingling
  • Deep tendon reflexes in weak limbs are decreased or lost.
  • Elevated cerebrospinal fluid protein without increased cell count. This might take up to ten days from the symptoms' beginning.
  • Delayed signal transmission as indicated by abnormal nerve conduction velocity results.
  • Possibly, recent diarrhea or an infection that is viral in nature.

Treatment

  • General nursing and medical care in the acute phase because of the risk of breathing failure. An endotracheal tube attached to a breathing machine in an intensive care unit may need. May progress to a tracheostomy if breathing issues persist.
  • If swallowing difficulty is present may require a thin plastic tube through the nose into the stomach for foods and liquids.
  • Other nursing measures may be required to reduce pain and decrease the risk of bed sores, blood clots, and constipation.
  • Physical therapy reduces joint inflexibility and potential for muscle shortening and maximizes strength and functioning.
  • Plasmapheresis PE) can shorten recovery time. It removes harmful substances from the blood plasma, especially the antibodies underlying GBS.
  • Plasmapheresis PE) can shorten recovery time. It removes harmful substances from the blood plasma, especially the antibodies underlying GBS.
  • Once out of the acute phase, the patient is moved to a rehabilitation center where they can receive physical and occupational therapy.

Conclusion

Guillain-Barre syndrome is a rare disease with an incidence of one to two cases per 100,000 people per year. It is a rare, progressive neurological disorder in which the body's immune system attacks the neurons (nerve cells). It often begins with tingling and weakness in the feet and legs, spreading to the arms and hands. Guillain-Barre syndrome progresses, causing general muscle weakness, which can turn into paralysis. GBS can be treated in the acute phase by nursing and medical care and eventually in the rehabilitative phase by physical and occupational therapy, but it has no cure.

Takeaways

Guillain Barre is a rare but progressive disease.

Initial symptoms include pain, numbness, and tingling.

There are several kinds of GBS, some more common in one part of the world than others.

Timely treatment is important for a positive outcome.

There is no cure; however, recovery is possible in many people.

Resources:

Mayoclinic: Guillain barre syndrome

Ninds: Guillain barre syndrome

Rare Diseases: Guillain barre Syndrome

CDC: Vaccination

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