Guillain-Barre Syndrome or GBS is an acute polyneuropathy that affects the peripheral nervous system. GBS is also known as Guillain–Barre-Strohl syndrome or Landry’s paralysis. GBS is characterized by an ascending paralysis, which means that the patient affected by the disease experiences weakness and paralysis beginning in the feet and hands that spreads to the trunk or upper areas of the body.
Guillain-Barre syndrome is usually mild, but once it has affected the respiratory muscles, it can cause life-threatening events such as respiratory paralysis leading to death.
Causes of Guillain-Barre Syndrome
Guillain-Barre syndrome is usually preceded by an infection. Once the immune response is activated, the antigens are usually mistargeted at the nerve cells of the patient leading to destruction of the nerve cells in the peripheral nervous system. The most common infection that triggers GBS is cytomegalovirus infection and Campylobacter jejuni infections. Some patients may be triggered by influenza virus infection and some may also not have a known cause. During the pandemic in the 70s that caused swine flu infection, the mass influenza immunization increased the incidence of GBS.
Damage to the peripheral nerves eventually leads to loss of myelin sheath, which is a protective layer of the nerves that facilitates nerve conduction. When the myelin sheath is affected, the nerve conduction is blocked, hence muscles paralysis takes place.
Symptoms of Guillain-Barre Syndrome
Guillain-Bare syndrome usually leads to symptoms such as:
- Symmetrical muscle weakness starting on the limbs and ascends to the upper parts of the body
- Feeling of “rubbery legs”
- Numbness and tingling sensations in the extremities
- Absence of deep tendon reflexes
Some patients may also have sensory affectation aside from the motor affectations. Sensory disturbances may include:
- Loss of position sense
- Loss of pain and temperature sensation
- Sometimes deep, aching pain on the weakened muscle
- Loss of bladder sensation and control
The paralysis usually ascends over a period of hours to days. When the facial muscles are already affected, it can also affect the cranial nerves leading to:
- Difficulty of swallowing
- Bulbar weakness or changes in vision and eye movements
The most life-threatening effect of GBS is affectation of the respiratory muscles because it may eventually lead to respiratory failure. Autonomic affectation may also lead to hypotension and cardiac arrhythmias.
Diagnosis of Guillain-Barre Syndrome
The diagnosis of GBS is primarily done using physical examination and history taking indicating development of ascending muscle paralysis. Common laboratory and diagnostic testing include cerebrospinal fluid analysis and nerve conduction studies.
CSF analysis of patients suffering from GBS indicates elevated protein level with absence of increased cell count. Nerve conduction studies may indicate slowing of nerve conduction or blockage that causes muscle weakness and paralysis.
There are certain criteria to be present in order to diagnose GBS and these include:
- Progressive weakness in the legs and arms
- Absence of deep tendon reflexes
Treatment for Guillain-Barre Syndrome
GBS treatment focuses on supportive managements until the remyelinization of the nerves takes place that will indicate effective management. Once remyelinization occurred, the patient usually becomes well. Peripheral nerves have the tendency to remyelinate as opposed to CNS nerves that do not regenerate. Supportive measures for GBS include:
Oxygen therapy is usually given especially for patients with respiratory weakness. Intubation may be needed when patients have the tendency to go into respiratory failure.
Plasmaparesis is a procedure involving filtering the blood for antibodies in order to remove the antibodies responsible for attacking the peripheral nerves. Plasmaparesis improves the recovery period and should be employed within 4 weeks after the onset of the symptoms.
Immunoglobulins are also administered to neutralize the antibodies that tend to be harmful for the nerves.
Physical therapy is also employed to help patients resume their activities of daily living, including chiropractic care, as provided by Dr. Mohr, the top rated Wesley Chapel chiropractor.