GBS Education & Treatment
Guillain Barre Syndrome (GBS) is a disorder characterized by progressive symmetrical paralysis and loss of reflexes, usually beginning in the legs. The paralysis characteristically involves more than one limb (most commonly the legs), is progressive, and usually proceeds from the end of an extremity toward the torso. Areflexia (loss of reflexes) or hyporeflexia (diminution of reflexes) may occur in the arms and legs.
Guillain-Barre syndrome is not associated with fever, an important fact in differentiating Guillain-Barre from other diseases. Guillain-Barre usually occurs after a respiratory or gastrointestinal infection, and is apparently caused by a misdirected immune response that results in the direct destruction of the myelin sheath surrounding the peripheral nerves or of the axon of the nerve itself. The syndrome sometimes follows other triggering events, including vaccinations. Among the vaccines reportedly associated with Guillain-Barre syndrome are the 1976-1977 swine flu vaccine, oral poliovirus vaccine, and tetanus toxoid.
The first symptoms of Guillain-Barre Syndrome (pronounced Ghee-lan Bar-ray) are usually tingling and numbness in the fingers and toes. These symptoms then progress and cause progressive weakness in the arms and legs during the next few days. In the mildest of cases, the weakness may arrest and cause only moderate difficulty in walking, requiring sticks, crutches or a walking frame.
In some cases the weakness progresses and leads to complete paralysis of the legs, the arms may also be affected. In a quarter of GBS cases, the paralysis progresses up the chest and the patient is unable to breathe on his or her own and needs to rely on a mechanical breathing machine (ventilator). The throat and face may be affected making swallowing impossible and so the patient needs to be fed by tube up the nose or directly into the stomach. Most patients will reach their worst point within two weeks.
GBS can be diagnosed clinically. However, two additional tests are usually performed to confirm the diagnosis. An EMG/NCS allows the neurologist to see how the nerves are working to support the diagnosis. A lumbar puncture allows the neurologist to rule out other diseases that can mimic GBS.
There is much research into the causes of Guillain-Barre Syndrome. About sixty percent of patients suffer from a throat or intestinal infection within the week or two prior to developing GBS. It is believed that one’s immune system tries to fight this infection but develops antibodies which also react against the nerve. In some cases in which the preceding infection is a intestinal illness with campylobacter jejuni specific antibodies against GM-1 can be identified in the blood of patients. In other patients no specific antibody is discovered. In either case there is a direct attack on the insulation around the nerves, which is called myelin. This myelin is stripped off of the nerves and therefore the nerves cannot conduct electricity which leads to weakness.
The treatment in the early stages of Guillain-Barre Syndrome is designed to shorten the course of the disease. There are two ways to treat GBS. One can use plasmaphresis. This is a process of removing the antibodies from a patient’s blood in a manner very similar to dialysis. Most patients receive five courses of plasmaphresis and then no additional treatment. The other treatment involves receiving intravenous gammaglobulin. Most studies indicate that these two treatments have essentially the same efficacy.
GBS improves spontaneously. However, certain factors can assist recovery:
- good nursing and medical/intensive care;
- physiotherapy to relieve discomfort and prevent stiffness;
- immunoglobulin — the infusion of immunoglobulin proves successful with similar results to plasmapheresis;
- plasmapheresis — the exchange of blood plasma generally reduces the duration of the disease in severe cases if carried out in the first few days; and
- counselling to reassure the patient and encourage the patient towards recovery
Left untreated, patients will regrow their myelin around their nerves over the course of three months to three years depending on the severity of the disease. Once the patient has had a chance to recover, Guillain-Barre Syndrome almost never occurs again; however small percentages may later develop CIDP.
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