Guillain-Barré Syndrome

The initial symptoms of Guillain-Barré syndrome (GBS) are seen in the feet and hands before they start spreading to the arms and legs. Usually, the symptoms appear on both sides of the body at the same time. The early symptoms include:

• Numbness in the hands and feet
• Pricking sensations like pins and needles in the hands and feet
• Muscle weakness
• Pain in the body which gets severe particularly at night
• Difficulty in maintaining balance and co-ordination

In most cases, people reach the greatest stage of weakness within the first two weeks after the symptoms start to appear. The symptoms seen in the later stages include:

• Difficulty in walking without help 
• Trouble breathing
• Inability to speak properly
• Blurred vision or double vision
• Difficulty in chewing and difficulty in swallowing
• Persistent, severe pain in the body
• Complete body paralysis 
• Paralysis of even the muscles of the eye (Ophthalmoplegia)
• Abnormal heart rate
• No bladder control
• Problems with digestion resulting in constipation

If the person gets completely paralysed, is gasping for breath or has abnormal heart rate and blood pressure, immediately call for medical help.

The exact cause of Guillain-Barré syndrome (GBS) is still not known. But it has been confirmed that GBS is neither contagious nor inherited. Doctors have found that it mostly occurs due to the attack of the body’s immune cells on the peripheral nervous system.

GBS is often reported a few days or weeks after getting a respiratory, gastrointestinal or viral infection such as flu, glandular fever, Epstein Barr virus or cytomegalovirus infection. Some countries have also reported cases of GBS after infection with the Zika virus.

Rarely, some surgeries have also been known to trigger the syndrome.

There have been some cases of GBS after receiving a vaccination for swine flu, however, the chances are minuscule.

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Since the cause of Guillain-Barré syndrome (GBS) is not known, this condition cannot be prevented. But once the signs of the disease start appearing, do not ignore them, seek medical help as soon as possible. 

Since the initial signs and symptoms of Guillain-Barré syndrome (GBS) are similar to that seen in various disorders, it can get difficult for the doctors to diagnose GBS in very early stages. The following diagnostic techniques may be used when you go in for a check-up: 

• Physical examination: The doctor would start by asking you about your symptoms and whether they appear on both sides of the body. The doctor would also note the rate at which the symptoms start to appear, as, in other disorders, muscle weakness may develop over months and not days or weeks. The doctor would also examine the patient's reflexes, as normally our leg twitches when the knee is tapped in a particular place, but with GBS, this reflex is gone.
• Nerve examination: The doctor would perform certain nerve tests to see if the signals are travelling along the nerves properly.
  • Electromyography (EMG): Electromyography, or EMG, is a technique in which the doctor inserts small needle-like electrodes into the muscles and then takes electrical recordings to visualise their reaction when the nearby nerves get activated.
  • Nerve conduction exam: In a nerve conduction exam, the doctor places small discs (electrodes) on the patient's skin. The discs give minor electric shocks to the body. This is done to activate the nerves and examine the rate at which the signals travel along the nerve fibres.
• Lumbar puncture: Lumbar puncture, also known as a cerebral spinal fluid test, is a procedure in which the doctor removes some fluid from the spinal cord using a needle—the needle is inserted into the lower part of the spine. This fluid is tested for examining specific signs of the disease such as an infection.

The main aim of the treatment is to reduce the symptoms and hasten recovery. The treatment of Guillain-Barré syndrome (GBS) may involve:

• Intravenous immunoglobulin (IVIG): This is the gold standard treatment for GBS, the immune system of GBS patients produces harmful antibodies to attack the nerves. In intravenous immunoglobulin treatment, the person is given healthy antibodies from donated blood. These new antibodies help in restricting the harmful antibodies that damage your nerves. These antibodies are delivered directly into the veins.
• Plasma exchange: Plasma exchange, also known as called plasmapheresis, is a treatment in which the patient is attached to a machine that removes blood from a vein, filters the harmful antibodies from the blood and returns the filtered blood back to the body.
• Supportive care is required to give symptomatic relief to the patients. Supportive care includes:
  • Giving painkillers to relieve pain
  • People with swallowing problems may need a feeding tube
  • Laxatives are given for constipation
  • Medications and leg stockings are given to prevent blood clots