Guillain-Barre Syndrome Symptoms

Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy are the most common causes for acute weakness. The first symptoms of Guillain-Barre Syndrome (pronounced Ghee-lan Bar-ray) are usually tingling and numbness in the fingers and toes. These symptoms then progress and cause progressive weakness in the arms and legs during the next few days. In the mildest of cases, the weakness may arrest and cause only moderate difficulty in walking, requiring sticks, crutches or a walking frame. 

Acute inflammatory demyelinating polyneuropathy, or Guillain-Barré syndrome, is the most common cause of acute generalized weakness. Chronic inflammatory demyelinating polyneuropathy, characterized by progressive or relapsing weakness, is important to recognize because it represents a significant number of all initially undiagnosed acquired neuropathies 

In some severe cases the weakness progresses and leads to complete paralysis of the legs, the arms may also be affected. In a quarter of cases the paralysis progresses up the chest and the patient is unable to breathe on his or her own and needs to rely on a mechanical breathing machine (ventilator). The throat and face may be affected making swallowing impossible and so the patient needs to be fed by tube up the nose or directly into the stomach.  Most patients will reach their worst point within two weeks. Fortunately, most cases are not that severe. 

The disease can be diagnosed clinically. However two additional tests are usually performed to confirm the diagnosis. A EMG/NCS allows the physician to see how the nerves are working to support the diagnosis. A lumbar puncture allows the physician to rule out other diseases that can mimick GBS. 

There is much research into the causes of GBS. About sixty percent of patients suffer from a throat or intestinal infection within the week or two prior to developing GBS. It is believed that one’s immune system tries to fight this infection but develops antibodies which also react against nerve. In some cases in which the preceding infection is a intestinal illness with campylobacter jejuni specific antibodies against GM-1 can be identified in the blood of patients. In other patients no specific antibody is discovered.  In either case there is a direct attack on the insulation around the nerves, which is called myelin.  This myelin is stripped off of the nerves and therefore the nerves cannot conduct electricity which leads to weakness. 

The treatment in the early stages of Guillain-Barre Syndrome are designed to shorten the course of the disease. There are two ways to treat GBS. One can use plasmaphresis. This is a process of removing the antibodies from a patient’s blood in a manner very similar to dialysis. Most patients receive five courses of plasmaphresis and then no additional therapy. The other treatment involves receiving intravenous gammaglobulin. Most studies indicate that these two treatments have essentially the same efficacy. 

GBS improves spontaneously. However, certain factors can assist recovery:

•  good nursing and medical/intensive care;
•  hysiotherapy and hydrotherapy, therapies that relieve discomfort and prevent stiffness;
•  immunoglobulin — the infusion of immunoglobulin proves successful with similar results to plasmapheresis;
•  lasmapheresis — the exchange of blood plasma generally reduces the duration of the disease in severe cases if carried out in the first few days; and
• counselling to reassure the patient and encourage the patient towards recovery.