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Guillain-barre Syndrome

This article explains the causes, symptoms and treatment for Guillain-Barre syndrome, which is a serious yet rare condition which affects the peripheral nervous system.

Guillain-Barre syndrome is a serious but rare condition that affects the peripheral nervous system.  It is named after two of three French doctors who described the condition first in 1916 – Georges Charles Guillain and Jean-Alexander Barre.

The Peripheral Nervous System
The peripheral nervous system is a network of nerves which control the senses and movements of the body.  The immune system attacks these nerves in Guillain-Barre syndrome, causing them to be inflamed.

This inflammation causes a tingly, numbing sensation in the arms and legs, which my eventually cause a short-termed loss of feeling and movement. 

In the UK, about 1,500 people are affected every year by Guillain-Barre syndrome.  It is a little bit more common in men than women and people of any age can be affected.

Symptoms
Usually Guillain-Barre syndrome develops quickly – over a few days.  It can sometimes develop gradually however, over a period of up to four weeks.

The symptoms first show one to three weeks after a minor infection, e.g. a cold or a sore throat.

When the symptoms reach their worst point, they normally stay at this level for a few days and then gradually get better.

Initial symptoms – the initial symptoms usually start in the feet and hands:

numbness
tingling
progressive muscle weakness
unsteadiness

The symptoms then spread to the legs and arms a few days later.

Some people only have a mild form of the condition and their symptoms do not get any worse than a general feeling of weakness.  In these cases, a walking frame or crutch may help with walking.

Possible later symptoms – in some people with Guillain-Barre syndrome, the muscle weakness can progress to the following:

temporary paralysis of arms, legs and face
temporary paralysis of the respiratory muscles (this can be life-threatening because it can stop you breathing.  You will need to be put on a ventilator if this happens)
problems with speech and eye movement

problems with chewing or swallowing
problems with bladder control or digestion
low blood pressure or slow heart rate

Some people with the condition have severe pain in their spine, arms and legs, while others have none.

The extent of the paralysis in Guillain-Barre syndrome varies with each case.

Causes
What causes Guillain-Barre syndrome is unclear but most people develop it after a recent illness.  Normally this is a viral infection, e.g. flu or a throat infection, or sometimes bacterial infection.

It is believed that the immune system may be triggered by the infection to attack the body.

The immune system produces antibodies by the use of white blood cells.  Antibodies are proteins that fight infection.  They travel around the body in the blood vessels and lymphatic vessels. 

The antibodies’ role is to attack the bacteria or virus which is causing the infection.  However with Guillain-Barre syndrome, the antibodies react to the protective covering of the peripheral nerves. 

This reaction causes damage to the nerves and stops them sending signals to the muscles.  This is the cause of the weakness, tingling and eventual short-term paralysis that some with Guillain-Barre syndrome experience.

Some cases of Guillain-Barre syndrome happen without a known cause but some cases are related to the following:

a bacterial infection, e.g. infection from Campylobacter bacteria
a virus, e.g. the HIV infection
Hodgkin’s lymphoma – a tumour of the lymph glands

Treatment
You will first be treat in hospital as an emergency.  Your respiration rate (breathing) will be monitored carefully.  Depending on your condition, you might be treated in:

a general ward
a neurology ward – this is a ward which specialises in neurological conditions
an intensive care unit – this is a special ward which provides intensive care for those in a critically ill or unstable condition
a high-dependency unit – this is one step down from ICU -more intense treatment is given in a high-dependency unit than a general ward

There are two main treatments to help reduce the severity of Guillain-Barre syndrome and help you to recover quicker.

Intravenous Immunoglobulin (IVIg)
Immunoglobulin is an alternative name for antibodies .  Antibodies are proteins in the blood that are produced by the immune system. 

Healthy immunoglobulin is taken from blood donors and given to you intravenously.  The harmful antibodies which are attacking your nerves are blocked and destroyed by the healthy antibodies.  You will normally receive a dose of IVIg every day for about five days.

Plasma Exchange
Plasma is a yellowish fluid.  It is found in blood and transports blood cells and platelets around the body. It also contains a number of substances, including proteins.  

During this treatment, you are connected to a machine which removes some of your blood.  The plasma is then separated from the blood cells and removed.  The blood cells are then put back into your body minus the harmful plasma cells which attack the nerves.  Your blood cells then go on to create healthy plasma to replace what was removed.

You might have several sessions of plasma exchange depending on severe your condition is.

You might need to spend several weeks in hospital if you are receiving treatment for Guillain-barre syndrome.  You will be monitored closely to check your breathing, heart rate and blood pressure.

As well as the two above treatments, you might be given painkillers and any other necessary medication.  For example, you may develop a problem with your blood pressure or heart rate and need further medication.

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