GUILLAIN-BARRé SYNDROME (GBS): A COMPREHENSIVE GUIDE

Guillain-Barré Syndrome (GBS) is a challenging neurological disorder, affecting around 1 to 3 people per 100,000 annually, with a higher incidence of 3 to 4 cases per 100,000 in individuals over the age of 50.

In GBS, the immune system mistakenly attacks the nerves, starting with muscle weakness that can progress rapidly to complete paralysis. Without proper management, the condition can be life-threatening, but early treatment can lead to a significant degree of recovery. 

Though there is no known cure, treatment options can relieve symptoms and speed up recovery, though some may experience lasting effects such as weakness, numbness, or fatigue.

In this blog, you will learn more about the disease, types, symptoms, diagnosis, and treatment of this condition.

What is Guillain-Barré Syndrome?

Guillain-Barré Syndrome (GBS) is an autoimmune condition where the immune system mistakenly attacks the nerves. This leads to symptoms like muscle weakness, numbness, and, in some instances, paralysis. GBS often but not necessarily develops after infections, such as respiratory or gastrointestinal illnesses. In some cases, GBS can escalate into a medical emergency.

Types of Guillain-Barré Syndrome

GBS can be classified into different types based on its specific features. The main types include:

1. Acute Inflammatory Demyelinating Polyneuropathy (AIDP): The most common type, found in 85% of GBS cases in North America and Europe, AIDP targets the myelin sheath—the protective layer around nerve fibers. Damage to the myelin affects nerve function, leading to weakness, often starting in the lower limbs and spreading upward.
2. Miller Fisher Syndrome (MFS): This type, making up 5-10% of GBS cases, is characterized by ataxia (lack of coordination) and eye muscle paralysis, without widespread muscle weakness in the limbs. MFS is more common in Asia.

Other, less common types of GBS include:

• Acute Motor Axonal Neuropathy (AMAN): Affects motor nerves, causing muscle weakness without significant sensory nerve involvement, commonly linked to Campylobacter jejuni infections.
• Acute Motor Sensory Axonal Neuropathy (AMSAN): Affects both motor and sensory nerves, leading to muscle weakness and sensory issues, often after specific infections.
• Acute Panautonomic Neuropathy: A rare type involving the autonomic nervous system, responsible for involuntary functions like heart rate and digestion.

Causes of Guillain-Barré Syndrome

The exact cause of Guillain-Barré Syndrome (GBS) is not fully understood, but it is often triggered by an infection that causes the immune system to mistakenly attack normal nerve cells. The main causes and risk factors include:

Infections:

GBS is commonly preceded by infections, particularly respiratory or gastrointestinal ones, including:

• Campylobacter jejuni: A bacterium frequently associated with food poisoning.
• Cytomegalovirus (CMV): A common virus that spreads through body fluids like blood, saliva, urine, semen, and breast milk. CMV can lead to complications such as premature birth, low birth weight, jaundice (yellowing of skin and eyes), poorly functioning liver, a rash, pneumonia, and seizures.
• Epstein-Barr Virus (EBV): A virus that causes infectious mononucleosis, often spread through saliva (e.g., kissing or sharing food/drinks). Symptoms may include fatigue, sore throat (often misdiagnosed as strep throat), fever, swollen tonsils, headache, and a skin rash.
• Mycoplasma Pneumonia: A bacterial infection that affects the lungs.

Abnormal Immune Response:

GBS is considered an autoimmune disorder, where the immune system mistakenly attacks peripheral nerves. The exact mechanisms of this immune response remain complex.

Risk Factors of Guillain-Barré Syndrome (GBS)

• Infections: Infections, including those previously mentioned (e.g., Campylobacter, CMV, EBV), as well as other infections like hepatitis A, COVID-19, and Zika virus, have been linked to the development of GBS in some cases.
• Dysregulated Immunity: Individuals with a history of weakened immunity, such as recurrent infections or autoimmune diseases (e.g., HIV/AIDS, lupus), may have an increased risk of developing GBS.
• Age & Gender: GBS is more common in adults and slightly more prevalent in men.
• Vaccinations: Although rare, GBS has been reported in a small number of cases following vaccinations, such as the flu or swine flu vaccines. However, the risk from vaccination is significantly lower than the risk associated with infections.
• Surgery or Trauma: GBS can sometimes develop after surgery or physical trauma, though this connection is less well-established.

Symptoms of Guillain-Barré Syndrome

The symptoms of GBS usually develop quickly, over days or weeks, starting in the legs and possibly spreading to other parts of the body. Common symptoms include:

• Muscle Weakness: Typically starts in the legs and may progress to the arms.
• Tingling and Numbness: Sensations such as tingling, prickling, or numbness often begin in the feet or legs.
• Double Vision and Facial Movement Issues: Difficulty controlling eye movements or facial muscles.
• Coordination and Balance Problems: Difficulty walking or performing tasks requiring fine motor skills.
• Pain: Muscle pain or discomfort can also occur.
• Breathing and Swallowing Problems: In severe cases, GBS can affect the muscles used for breathing and swallowing, sometimes requiring mechanical ventilation.

The progression of symptoms can vary. While some people may experience rapid and severe symptoms, others may have a more gradual onset.

When to See a Doctor

Seek medical attention immediately if you have had an infection and experience any of the following symptoms:

• Tingling in your toes or fingers that spreads up your body.
• Rapidly worsening tingling or weakness.
• Trouble breathing, especially when lying flat.
• Difficulty swallowing or choking on saliva.

GBS can worsen quickly, so prompt treatment is crucial to improve the chances of recovery.

Diagnosis of Guillain-Barré Syndrome

Diagnosing GBS typically involves a medical evaluation, diagnostic tests, and possibly the following:

• Medical History & Physical Exam: Your doctor will assess your symptoms and examine your muscle strength, reflexes, and coordination.
• Blood Tests: To check for infections or triggers that may be linked to GBS.
• Electrodiagnostic Tests: Tests like nerve conduction studies (NCS) and electromyography (EMG) measure nerve and muscle function.
• Cerebrospinal Fluid Analysis: A lumbar puncture (spinal tap) can reveal elevated protein levels in the fluid surrounding the brain and spinal cord.
• Imaging Studies: MRI scans may help rule out other neurological conditions.

Treatment of Guillain-Barré Syndrome

There is no cure for GBS, but treatment can help manage symptoms and speed up recovery. Treatment options include:

• Intravenous Immunoglobulin (IVIg): This treatment involves administering antibodies from healthy donors to block the harmful antibodies attacking nerves.
• Plasma Exchange (Plasmapheresis): A procedure that removes harmful antibodies from the blood and replaces them with plasma or fluids.
• Corticosteroids: These may reduce inflammation and suppress the immune response.
• Pain Management: Medications like opioids may be used to manage pain.
• Supportive Care: Monitoring vital signs, preventing blood clots, and managing other complications.

Complications of Guillain-Barré Syndrome

GBS can lead to various complications, which may include:

• Respiratory Problems: GBS can affect the muscles responsible for breathing, potentially requiring mechanical ventilation.
• Cardiovascular Issues: Blood pressure and heart rate can fluctuate due to autonomic nervous system involvement.
• Muscle Atrophy: Prolonged weakness may cause muscle shrinkage.
• Pain: Both muscle and nerve pain can occur.
• Autonomic Dysfunction: Issues with involuntary functions like blood pressure and temperature regulation.
• Blood Clots: Reduced mobility can increase the risk.
• Postural Orthostatic Tachycardia Syndrome (POTS): An abnormal increase in heart rate when standing up.
• Recurrent GBS: In rare cases, GBS may return, sometimes in a different form.
• Long-term Neuromuscular Impairments: Some people may experience lasting weakness or fatigue, requiring ongoing rehabilitation.

Frequently Asked Questions About Guillain-Barré Syndrome

Q3. Can GBS be prevented?

It’s difficult to prevent GBS, as its cause is not fully understood. However, avoiding infections and seeking medical help when needed may reduce the risk.

Q4. Does GBS go away on its own?

GBS does not typically resolve on its own, but its progression can be halted or slowed with proper treatment.

Q5. How long does GBS last?

Recovery time varies, but some people recover in weeks, while others may take months or even over a year.

Q7. Is GBS contagious?

No, GBS is not contagious. It is an autoimmune disorder, not a transmissible disease.