What is Guillain-Barré Syndrome (GBS)?

  • GBS is a rare, acute inflammatory disorder of the peripheral nerves. It is characterized by the rapid onset of weakness, accompanied by abnormal sensations like tingling or pain, usually starting in the toes or fingers and ascending up the limbs.
  • GBS is considered an autoimmune disorder in which the body’s immune system attacks part of the peripheral nervous system.
  • No one knows exactly what causes Guillain-Barré Syndrome. There does not seem to be just one specific disease-causing agent; rather, the immune system may be triggered inappropriately by various situations:
    • Most cases occur within days or weeks after having an infection (viral, bacterial, or parasitic).
    • Occasionally, other situations like pregnancy, surgery, insect bites, or injections like vaccinations or spinal anesthesia will trigger the symptoms.
  • GBS affects people of both genders, regardless of age or ethnic background. Its prevalence, however, is less than 2 cases per 100,000 people each year in North America and Europe.
  • GBS is sometimes also called Acute Inflammatory Demyelinating Polyneuropathy (AIDP) – that is, the acute form of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) – or Landry’s Ascending Paralysis.

What are the symptoms of GBS?

  • GBS is characterized by a relatively sudden, unexpected onset of symptoms. They usually develop over the course of about 3 weeks, but can develop as rapidly as days or hours.
  • The sensations—weakness, tingling, numbness, and sometimes paralysis—usually begin in the legs, but may then spread to the arms and upper body (breathing muscles and face). The sensations are ascending, meaning that they start in the extremities and travel up the limbs toward the torso.
  • The nerves usually lose their reflexes (e.g., knee jerks).
  • The weakness and nerve sensations usually affect both sides of the body similarly.
  • There is a wide range of symptom severity, from mild cases with brief weakness that may not even be enough for the person to seek medical care, to life-threatening paralysis with an inability to swallow and use breathing muscles. It depends on which particular nerves are affected by the demyelination.
  • In addition to paralysis and abnormal sensations, patients with GBS may also have symptoms of damage to the autonomic nerves, such as abnormal heartbeat or blood pressure, impotence, urine retention, or bowel paralysis.

How is GBS treated?

  • GBS in its early stages is unpredictable, so most newly diagnosed patients are hospitalized. It is extremely important to keep the patient's body functioning while the nervous system gradually recovers. This is usually done in the Intensive Care Unit (ICU), where changes in heart rate, breathing, and other functions can be carefully monitored.
  • GBS is usually self-limited, with recovery occurring on its own, eventually, as long as the patient’s vital functions (e.g., breathing) are supported during the recuperation time. GBS usually does not occur more than once in the same patient.
  • There is no known cure for Guillain-Barré syndrome, but there are treatments that can shorten its course:
    • Plasmapheresis (plasma exchange)
    • High-dose immunoglobulin therapy (IVIG)
  • The acute phase of GBS can vary from days to months, but over 90% of patients move into the rehabilitative phase by 4 weeks. Then a stable time of lower-level impairment (e.g., weakness) can linger for additional days or weeks or months.
  • Patient care involves the coordinated efforts of a team, such as:
    • Neurologist
    • Physiatrist (rehabilitation physician)
    • Internist
    • Family physician
    • Physical therapist
    • Occupational therapist
    • Social worker
    • Nurse
    • Psychologist or psychiatrist
    • Speech therapist if speech muscles have been affected
  • The rehabilitative phase is important, but rehabilitation itself does not improve nerve regeneration. The main goal is to help the patient with optimal use of their muscles as their nerve supply returns, and to adapt to a lifestyle within their functional limitations. In addition, rehabilitation centers can treat minor medical conditions and help prevent complications, such as high blood pressure, infections, blood clots, etc.
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