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Guillain-Barré Syndrome

What is Guillain-Barré Syndrome (GBS)?

Guillain-Barré Syndrome (GBS) pronounced “gee-yah-buh-ray” is an autoimmune rare disorder where the immune system attacks the body’s nerves. The immune system attacks the peripheral nervous system – the nerves located outside the brain and spinal cord. GBS can be a mild attack to a severe case where the person is paralyzed and requires hospitalization and intensive care. Most people usually recover even from severe attacks but may experience mild symptoms even after the attack. People usually complain of weakness in the arms and legs and fatigue.

GBS can affect any age group and any gender. Every year, 1 in 100,000 people globally are diagnosed with GBS. There is no cure as such though the condition is manageable.

The exact cause of GBS is still unknown. It is thought to occur after a viral or bacterial infection. In India, many patients affected by Chikungunya also presented with GBS after 1-2 years. Globally, some patients affected by Zika also presented with GBS.

Other risk factors include:

  • Flu virus
  • Cytomegalovirus
  • Epstein-Barr virus
  • Hepatitis A, B, C and E
  • HIV
  • Mycoplasma pneumonia
  • Infections due to surgeries
  • Certain childhood vaccinations

GBS begins with mild symptoms like weakness and tingling in the feet and lower limbs often making its way up to the palms, hands, arms and upper body. Many patients report a ticklish feeling on the face. These should not be ignored as it can get progressively worse.

Do not ignore any of the following symptoms:

  • Numbness, tingling and pricking pins in the soles of the feet, ankles, legs, palms, wrists, arms and upper body
  • Tickling sensation on the face
  • Weakness in lower limbs and upper body
  • Sudden inability to work steadily or climb stairs
  • Trouble with facial and eye movements with loss of sensation or stiffness
  • Trouble with speaking, chewing and swallowing
  • Joint pains
  • Trouble with bladder and bowel function
  • Rapid heart rate
  • Low or high blood pressure
  • Breathing issues
GBS presents with symptoms similar to other neurological disorders and may often be difficult to diagnose in the early stages. Doctors use a variety of tests to check for GBS including:
  • Nerve conduction studies – to measure the speed of the nerve signals
  • Electromyography – to measure nerve activity in the muscles
  • Cerebrospinal fluid analysis – to check for changes commonly found in GBS
The main types of GBS include:
  • Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
  • Miller Fish Syndrome (MFS) where paralysis first begins in the eye. MFS can cause unsteady gait. This type is quite common in Asia
  • Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN)

Currently, no permanent cure is available for GBS. Treatment is aimed at preventing complications and enhancing quality of life as long as possible. An interdisciplinary team of doctors including neurologists, ophthalmologists and physiotherapists will be required to take care of the clinical needs of the individual. Main treatment types include:

  • Immunoglobulin therapy – which has healthy antibodies is given via intravenous drip in high doses. This therapy blocks out the harmful antibodies involved in GBS
  • Plasma exchange (plasmapheresis) – blood plasma is given to provide healthy antibodies and block the damaging antibodies

It is usually preferred to go for one treatment type than mixing the two since both are equally effective.

Other medications include supplements like B12, thiamine and painkillers. Compression stockings are given to prevent blood clots in the legs due to immobility. People with GBS may require physiotherapy to regain movement in the limbs.

Most people make a total recovery from GBS in a few months time. When the symptoms appear, it gradually worsens over a month and then begins to subside with treatment. Full recovery make take anywhere between six months to one year depending on the severity of the attack. Children usually recover faster than adults.

GBS symptoms may recur after a few years.

People with GBS should connect with other affected individuals to gain a sense of solidarity. Patient groups often provide such group support.

People with GBS must get adequate nutrition with a healthy diet and sufficient calories. People with GBS usually get back to normal living, education, employment and social life. It is important to stay physically active and keep fit.