Guillain-Barre Syndrome

Guillain-Barre Syndrome happens to be a grave and rapidly developing neurological and autoimmune disorder where the immunological system erroneously turns upon itself-assaulting sections of the peripheral nervous system. The PNS, a component of the nervous system (the other being the central nervous system), comprises the neural network lying bordering the spinal cord and the brain. The effects of GBS can be mild typified by tingling sensations in the hands and feet, muscular numbness and pain.

How does it affect the Body?

Aggravation of the symptoms above could eventually lead to incapacitating paralysis, making it difficult for the individual to breathe, and could even become life-threatening. Luckily, the majority of GBS patients gradually recuperate even from the gravest form of the syndrome. Though the syndrome does not discriminate between the genders and strikes individuals of all ages, the condition is largely predominant in aged people.

Guillain-Barre Syndrome Incidence

GBS tends to be a relatively rare syndrome-out of every 1,00,000 Americans, just about one person is affected. The disorder is incurable, but there is some treatment options that could help in relieving the graveness of the symptoms and expediting recovery.

Types

Initially, it was believed to be a disorder brought about a single gene. However, continuous research on GBS has established that the syndrome has numerous variants. Following are some of the most common forms of GBS:

  • Miller Fisher Syndrome: MFS originates in the eyes, adversely affecting the manner in which the individual walks. It is more prevalent in Asia compared to North America.
  • Acute Motor Axonal Neuropathy (AMAN)/Acute Motor-Sensory Axonal Neuropathy (AMSAN): AMSAN and AMAN affect more people in Asian countries in comparison to the USA.
  • Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP): It is the most widespread form of GBS, characterized by muscular weakness and numbness that develops from the lower extremity and shoots upward. Majority of affected Americans are diagnosed with the AIDP.

Symptoms

GBS initiates with a slight stinging or prickling sensation in the lower extremity, particularly the legs, feet, and toes. The sensation is transmitted upwards, to the fingers, forearms, and arms. The onset and development of symptoms are remarkably rapid with the condition taking a serious turn in a matter of hours in several cases. The commonly observed signs and symptoms include:

  • Prickly sensation in the toes, feet, legs, and hands
  • Inability to maintain gait
  • Muscle numbness and weakness that shoots upwards and worsens with the passage of time
  • Breathing difficulty
  • Paralysis
  • Increased heart rate
  • Having problems with chewing, swallowing, talking, rolling the eyes or moving the face
  • Very high blood or low blood pressure
  • Inability to control bladder

Individuals affected by GBS experience aggravation of symptoms in 3-4 weeks following their onset where they become incredibly weak and are unable to perform even routine tasks.

Causes

The exact etiology of GBS remains idiopathic. As per CDC’s version (Center for Disease Control), nearly 75% of those afflicted with GBS exhibit symptoms are mostly after convalescing from a respiratory infection or a severe bout of diarrhea. This means the syndrome is activated because of a poor or compromised reaction to the preceding affliction. Campylobacter jejuni, the bacterium most responsible for causing diarrhea in the US is related to Guillain-Barre Syndrome.

Diarrhea brought about by Campylobacter jejuni also happens to be the most extensive risk factor for the neurological condition. Sometimes an immunization or a surgery conducted recently could set off GBS, but such instances are rare. Of recent, some individuals infected with the Zika virus became vulnerable to the disorder. The below-mentioned infections or contagions too have been found to be correlated to GBS:

  • HIV/AIDS
  • Mycoplasma pneumonia
  • Mononucleosis-an infection caused by Epstein Barr virus
  • Cytomegalovirus-a herpes virus strain
  • Influenza

Diagnosis

Correctly diagnosing GBS could be difficult as the primary symptoms nearly match signs of various other autoimmune/neurological syndromes like meningitis, lupus, multiple sclerosis, and ankylosing spondylitis to name a few. Neurologists, neurosurgeons, and physical medicine specialists employ the following diagnostic assays to confirm their deductions:

Electromyography

Electromyography or EMG is an electrodiagnostic medicinal technique for analyzing electrical activity of skeletal muscles. The EMG is carried out using an ‘electromyograph’ that delivers an electromyogram report which enables the diagnostician or physician to establish if muscle or neural damage is behind the muscular numbness and frailty.

NCV investigation

An NCV or nerve conduction velocity test helps the medical professional to assess the speed with which electrical impulses conduct through the peripheral nerves. Smoothly functioning nerves will transmit electrical signals faster and more effectively compared to damaged or injured nerves.

Spinal Tap Test

Spinal tap, variously called ‘lumbar puncture,’ entails aspirating a minimal amount of cerebrospinal fluid from the lumbar section of the spinal cord for checking the protein levels. The level in the cerebrospinal fluid of individuals suffering from GBS is above the normal range.

Treatments

An effective remedial therapy for GBS is yet to be discovered. Nevertheless, there are a few treatment options that can help in alleviating the intensity of the symptoms as well as expedite convalescence. Anyone diagnosed with the neurological disorder must be admitted in the hospital’s intensive care unit (ICU) so that the neurologist can observe complications arising out muscular weakness. Also, due care for GBS patients can be provided only in an infirmary or hospital equipped with state-of-the-art medical equipment.

Treatments are available at two distinct levels:

Acute or Intensive Care

Two different modes of therapy can be availed of at the intensive care level, namely, plasma exchange (plasmapheresis)’ and ‘intravenous immunoglobulin therapy’ (IVIg).

  • Plasmapheresis involves getting rid of the antibodies generated by the immune system which turn upon the healthy nerves instead of combating the harmful pathogens. After removing the antibodies from the blood withdrawn from the patient, the same is transfused back into the individual’s body.
  • The IVIg process entails transferring immunoglobulin obtained from healthy donors into the patient’s bloodstream. The healthy immunoglobulin is replete with antibodies that help neutralize the malfunctioning antibodies responsible for triggering GBS.

Rehabilitative Care

Once the patient undergoing treatment shows signs of recovery, the doctor shifts him/her to a rehabilitative care. Patients are also offered medications for checking blood clots and reducing pain. Physical therapy is provided as well for improving and maintaining flexibility of upper and lower limb.

Complications & Risk Factors

  • Bed Sores
  • Blood clots
  • Compromised bladder function
  • Acute hypertension or hypotension
  • Abnormal heart rate
  • Muscle pain and weakness
  • Tingling sensations or numbness even after recuperation

Possible risk factors

GBS affects anybody regardless of age or sex. However, males in particular above 40 years are more vulnerable to the condition.

References

  1. https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symptoms-causes/syc-20362793
  2. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Guillain-Barr%C3%A9-Syndrome-Fact-Sheet
  3. https://www.healthline.com/health/guillain-barre-syndrome#diagnosis

 

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