Guillain-Barre Syndrome

General Illness Information

Medical Term:
GUILLAIN-BARRE SYNDROME (Infectious polyneuropathy, Acute Idiopathic polyneuritis).

Common Name:

Description: Guillain-Barre syndrome is an inflammatory disorder of the peripheral nervous system that produces rapidly worsening muscle weakness, sometimes leading to paralysis. Causes generalized and symmetrical weakness involving muscles at the extremities and on the trunk, as well as sensory symptoms. Weakness appears either rapidly or over 1-2 weeks, and can produce failure of breathing muscles over several days.

It is a rare illness. Incidence 1 per million per month. Most common between age of 30-50. Both sexes equally affected.

Causes: Exact cause unknown, but all available evidence point to an auto-immune disorder. The body’s immune system attacks the myelin sheath (layers of insulation around the nerve fibers). Myelin sheath permits electrical impulses to be conducted along the nerve fibers with speed and accuracy. When myelin is damaged, nerves do not conduct impulses properly.

In about 80% of the people, symptoms begin about 5 days to 3 weeks after a mild infection, surgery or immunization.

Prevention: Cannot be prevented at present.

Signs & Symptoms

Early stages:

  • Muscle weakness in hands and feet, arms and legs, abdomen and chest. The weakness spreads within 72 hours; it may create life-threatening breathing difficulty
  • Progressive, symmetrical weakness in all four limbs, usually with an ascending pattern.
  • Muscle pain is common, but does not predict course of disease.
  • Gait disorder is common in all age groups, and is the commonest presenting symptom in children.
  • Respiratory muscle paralysis in 30% of cases.
  • Autonomic neuropathy in 50% of cases. This may manifest as extreme changes in BP, cardiac rhythm changes, bowel and bladder paralysis.
  • 50% of cases exhibit cranial nerve involvement, especially facial nerve paralysis.
  • There are a number of variants, which may point to the prognosis.

Risk Factors

Infections: Infections, especially with Campylobacter jejuni, are important, and this usually presages a worse prognosis.

Diagnosis & Treatment

General Measures:

  • Because of rapidly progressive muscle weakness, hospitalization in an ICU is necessary for close monitoring.
  • Diagnostic tests such as lumbar puncture for spinal fluid analysis and electromyography (studying of nerve and muscle disorders by recording electrical activity of muscles), CT scan and MRI are required.
  • A respirator may be necessary if muscles of respiration become greatly weakened.
  • Plasmapheresis in severe cases (blood plasma is withdrawn from the patient, treated to remove antibodies, and replaced). Intravenous immune globulin may be used.
  • Remain mentally and socially active during recovery.
  • Encourage coughing to rid lungs of mucus, physiotherapy.
  • Use warm compresses or heating pad to help relieve pain and permit early physical therapy.
  • Use a cradle for bedclothes to protect from pressure.

Medications:

  • Laxatives to prevent constipation.
  • Cortisone drugs, although they are not usually effective.
  • Heparin to prevent clotting disorders.
  • IV immune globulin (IVIG) is as effective as Plasmapheresis.
  • Beta-blockers may be used to counter significant hypertension.

Activity:

No limitations, unless severely affected. Prevent contractures, and assist with weakness in affected limbs.

Diet:

No special diet.

Possible Complications :

  • Paralysis, permanent weakness.
  • Paralysis of eyelid muscles, resulting in eye damage.
  • Thrombophlebitis.
  • Pneumonia.
  • Respiratory failure.
  • Pressure sores, if the person if immobilized.
  • Constipation.
  • Depression.

Prognosis

There is a 2% mortality rate.

45 to 50% of patients make a complete recovery.

45 to 50% of patients are left with some residual disability.