Guillain-Barre Syndrome

URL of this page: http://www.nlm.nih.gov/medlineplus/guillainbarresyndrome.html

Also called: Acute idiopathic polyneuritis, Acute inflammatory polyneuropathy, Infectious
polyneuritis, Landry-Guillain-Barre syndrome

Guillain-Barre syndrome is a rare disorder that causes your immune system to attack your
peripheral nervous system (PNS). The PNS nerves connect your brain and spinal cord with the
rest of your body. Damage to these nerves makes it hard for them to transmit signals. As a result,
your muscles have trouble responding to your brain. No one knows what causes the syndrome.
Sometimes it is triggered by an infection, surgery or a vaccination.

The first symptom is usually weakness or a tingling feeling in your legs. The feeling can spread
to your upper body. In severe cases, you become almost paralyzed. This is life-threatening. You
might need a respirator to breathe. Symptoms usually worsen over a period of weeks, then
stabilize. Most people recover. Recovery can take a few weeks to a few years. Treatment options
during the symptom period include medicines or a procedure called plasma exchange.

NIH: National Institute of Neurological Disorders and Stroke

Guillain-Barre Syndrome
Also known as: Infectious polyneuritis; Acute inflammatory demyelinating polyneuropathy;
Landry's ascending paralysis

What is it?
Guillain-Barre Syndrome (GBS) is an acute condition that involves progressive muscle weakness
or paralysis. It is an autoimmune disorder in which the body’s immune system attacks its own
nervous system, causing inflammation that damages the cover (myelin sheath) of the nerve. This
damage (called demyelinazation) slows or stops the conduction of impulses through the nerve.
The impairment of nerve impulses to the muscles leads to symptoms that may include muscle
weakness, paralysis, spasms, numbness, tingling or pins-and-needle sensations, and/or
tenderness. Affected patients may become so weak that they have trouble breathing and their
heart rate becomes abnormal.

Guillain-Barre Syndrome it is a relatively rare condition. According to the National Institute of

Neurological Disorders and Stroke (NINDS), about 1 person in 100,000 will have GBS. It can
affect anyone at any age. It is an unusual neuropathy in that it spontaneously reverses and most
patients recover most or all of the lost nerve and muscle function.
The exact cause of GBS and why it affects one person and not another is not well understood.
The autoimmune process may be spontaneous or may be triggered by some specific disease or
exposure. Cases have been seen in patients who have had various viral and bacterial infections
including HIV infection, in patients with chronic diseases such as lupus (SLE), Hodgkin
lymphoma (and some other malignancies), and in patients who recently had a vaccination (such
as for rabies or swine flu).

Tests
Patient history is important in diagnosis. The progression of ascending paralysis – starting with
feet or hands and advancing upward - is a typical presentation. About 50% of cases also include
a history of a recent mild infection or illness like a sore throat, a cold, the flu or diarrhea. Several
tests are commonly used to diagnose or confirm the disease and, sometimes, to monitor recovery.

• Nerve conduction velocity – tests the speed at which impulses travel through a nerve. The
nerve conduction velocity test uses electrodes placed on the skin over peripheral nerves
and measures the amount of time it takes for an impulse to travel between electrodes.
• Electromyography (EMG) - measures the electrical activity of muscles fibers. The EMG
test measures the electrical activity within muscle fibers by placing a needle electrode
through the skin directly into the muscle and measuring the electrical activity of that
muscle. It is usually done in conjunction with a nerve conduction velocity test.
• Cerebrospinal fluid (CSF) evaluation – to identify the presence of increased protein. For
this test, a needle is inserted into the spine between vertebrae and a small amount of fluid
is withdrawn. While some protein is normally present, an increased amount without an
increase in the white blood cells in the CSF may be indicative of GBS.

Treatment

Guillain-Barre Syndrome usually resolves on its own. In most cases, symptoms will
stabilize and then reverse within weeks or months, although, according to NINDS, as many as
30% of those affected may still have some persistent weakness 3 years later. The goals of
treatment are to try to help decrease the severity of symptoms, speed healing, and to prevent
and/or minimize complications. Many patients may require hospitalization for careful monitoring
and supportive care. If the symptoms are severe, the patient may require breathing assistance.

Two approaches are sometimes used early in the disease to lessen the severity and hasten
the recovery. Both are intended to decrease the effectiveness of the antibodies that attack the
myelin sheath. Plasmapheresis - removing blood, filtering out the liquid plasma which contains
antibodies that may be involved in the autoimmune disorder, and returning the red and white
blood cells to the patient - has proven effective in some patients. Immunoglobulin injections to
block the activity of the damaging antibodies have been beneficial to some patients.

In the recovery phase, most patients undergo physical therapy to help regain muscle
strength.
This article was last reviewed on February 11, 2007. | This article was last modified on
November 24, 2010.

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Guillain-Barre syndrome
By Mayo Clinic staff

Original Article:http://www.nlm.nih.gov/medlineplus/guillainbarresyndrome.html

Guillain-Barre syndrome is an uncommon disorder in which your body's immune system attacks
your nerves. Weakness and numbness in your extremities are usually the first symptoms. These
sensations can quickly spread, eventually paralyzing your whole body.

The exact cause of Guillain-Barre syndrome is unknown, but it is often preceded by an infectious
illness such as a respiratory infection or the stomach flu. Luckily, Guillain-Barre syndrome is
relatively rare, affecting only 1 or 2 people per 100,000.

In its most severe form, Guillain-Barre syndrome is a medical emergency requiring

hospitalization. There's no known cure for Guillain-Barre syndrome, but several treatments can
ease symptoms and reduce the duration of the illness. And most people do recover completely.

Symptoms

Guillain-Barre syndrome often begins with weakness, tingling or loss of sensation starting in
your feet and legs and spreading to your upper body and arms. These symptoms may begin —
often not causing much notice — in your fingers and toes. In some people, symptoms begin in
the arms or even the face. As the disorder progresses, muscle weakness can evolve into paralysis.

Signs and symptoms of Guillain-Barre syndrome may include:

 • Prickling, "pins and needles" sensations in your fingers, toes or both
• Weakness or tingling sensations in your legs that spread to your upper body
• Unsteady walking or inability to walk
• Difficulty with eye movement, facial movement, speaking, chewing or
swallowing
• Severe pain in your lower back
• Difficulty with bladder control or intestinal functions
• Very slow heart rate or low blood pressure
• Difficulty breathing

Most people with Guillain-Barre syndrome experience their most significant weakness within
three weeks after symptoms begin. In some cases, signs and symptoms may progress very
rapidly with complete paralysis of legs, arms and breathing muscles over the course of a few
hours.

When to see a doctor

Call your doctor if you have mild tingling in your toes or fingers that doesn't seem to be
spreading or getting worse.

Seek emergency medical help if you have any of the following severe signs or symptoms:

• Tingling that started in your feet or toes and is now ascending upward
through your body
• Tingling or weakness that's spreading rapidly
• Tingling that involves both your hands and feet
• Difficulty catching your breath
• Choking on saliva

Guillain-Barre syndrome is a serious disease that requires immediate hospitalization because of

the rapid rate at which it worsens. The sooner appropriate treatment is started, the better the
chance of a good outcome.

Causes

The exact cause of Guillain-Barre syndrome is unknown. In about 60 percent of cases, an

infection affecting either the lungs or the digestive tract precedes the disorder. But scientists
don't know why such an infection can lead to Guillain-Barre syndrome for some people and not
for others. Many cases appear to occur without any triggers.

In Guillain-Barre syndrome, your immune system — which usually only attacks foreign material
and invading organisms — begins attacking the nerves that carry signals between your body and
your brain. Specifically, the nerves' protective covering (myelin sheath) is damaged and this
interferes with the signaling process, causing weakness, numbness or paralysis.

Risk factors

Guillain-Barre syndrome can affect all age groups, but you're at greater risk if:
 • You're a young adult
• You're an older adult

Guillain-Barre may be triggered by:

• Most commonly, infection with campylobacter, a type of bacteria often found

in undercooked food, especially poultry
• Surgery
• Epstein-Barr virus
• Hodgkin's disease
• Mononucleosis
• HIV, the virus that causes AIDS
• Rarely, rabies or influenza immunizations

Complications

Complications of Guillan-Barre syndrome can include:

• Breathing difficulties. A potentially deadly complication of Guillain-Barre

syndrome is that the weakness or paralysis can spread to the muscles that
control your breathing. You may need temporary help from a machine to
breathe when you're hospitalized for treatment.
• Residual numbness or other sensations. Most people with Guillain-Barre
syndrome recover completely or have only minor, residual weakness or
abnormal sensations, such as numbness or tingling. However, full recovery
may be slow, often taking a year or longer.

Fewer than 1 in 10 people with Guillain-Barre syndrome experience long-term complications,

such as:

• Serious, permanent problems with sensation and coordination, including

some cases of severe disability
• A relapse of Guillain-Barre syndrome
• Rarely, death, from complications such as respiratory distress syndrome and
heart attack

Severe, early symptoms of Guillain-Barre syndrome significantly increase the risk of serious
long-term complications.

Preparing for your appointment

Call your doctor if you have mild symptoms that might represent Guillain-Barre syndrome, such
as a prickling sensation in your toes or fingers. In some cases, your doctor may recommend you
seek immediate medical care.

Seek emergency medical help if you experience:

 • Tingling or weakness that affects your feet and hands, is rapidly spreading,
or is spreading upward
• Difficulty breathing
• Choking on saliva

Here's some information to help you get ready for your appointment, and what to expect from
your doctor.

What you can do

• Write down any symptoms you're experiencing, and for how long. It will
help your doctor to have as many details as possible about when your
symptoms first appeared and how they may have worsened or spread over
time.
• Write down your key medical information, including any recent
infectious illness or medical procedures you've had, including vaccinations
and surgery. Also write down all medications you're taking.
• Take a family member or friend along. Guillain-Barre syndrome is a
medical emergency. Take someone who can soak up all the information your
doctor provides and who can stay with you if you need immediate treatment.
• Write down questions to ask your doctor.

Prepare a list of questions so that you can make the most of your time with your doctor. For
Guillain-Barre syndrome, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?

• Other than the most likely cause, what are possible causes for my symptoms
or condition?
• What kinds of tests do I need?
• Do I need to be hospitalized?
• What treatments do I need?
• How soon do you expect my symptoms will improve with treatment?
• How fully do you expect I will recover?
• How long will recovery take?
• Am I at risk of long-term complications from this condition?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask
questions during your appointment at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them will help
your doctor quickly determine next steps in making your diagnosis and starting care. Your doctor
may ask:

• What are your symptoms?

• What parts of your body are affected?
• When did you first begin experiencing symptoms?
• Did your symptoms come on gradually or suddenly?
 • Do your symptoms seem to be spreading or getting worse?
• If your symptoms include weakness, does it affect just one or both sides of
your body?
• Do your symptoms include any problems with bladder or bowel control?
• Have you had any vision problems?
• Have you had any difficulty chewing or swallowing?
• Are you having difficulty breathing?
• Have you recently had an infectious illness?
• Have you recently spent time in a forested area?
• Have you recently traveled abroad? Where?
• Have you recently had any medical procedures, including vaccinations?
• Have you been diagnosed with any other medical conditions?
• Is anyone else you know having similar symptoms?

Tests and diagnosis

Guillain-Barre syndrome can be difficult to diagnose in its earliest stages. Its signs and
symptoms are similar to those of other neurological disorders and may vary from person to
person.

The first step in diagnosing Guillain-Barre syndrome is for your doctor to take a careful medical
history to fully understand the cluster of signs and symptoms you're experiencing.

A spinal tap (lumbar puncture) and nerve function tests are commonly used to help confirm a
diagnosis of Guillain-Barre syndrome.

Spinal tap (lumbar puncture)

This procedure involves withdrawing a small amount of fluid from your spinal canal at your low
back (lumbar) level. This cerebrospinal fluid is then tested for a specific type of change that
commonly occurs in people who have Guillain-Barre syndrome.

Nerve function tests

Your doctor may want information from two types of nerve function tests — electromyography
and nerve conduction velocity:

• Electromyography reads electrical activity in your muscle to determine if

your weakness is caused by muscle damage or nerve damage.
• Nerve conduction studies assess how your nerves and muscles respond to
small electrical stimuli.

Treatments and drugs

Although some people can take months and even years to recover, most cases of Guillain-Barre
syndrome follow this general timeline:

• Following the first symptoms, the condition tends to progressively worsen for
about two weeks.
 • Symptoms reach a plateau and remain steady for two to four weeks.
• Recovery begins, usually lasting six to 12 months.

There's no cure for Guillain-Barre syndrome. But two types of treatments speed recovery and
reduce the severity of Guillain-Barre syndrome:

• Plasmapheresis. This treatment — also known as plasma exchange — is a

type of "blood cleansing" in which damaging antibodies are removed from
your blood. Plasmapheresis consists of removing the liquid portion of your
blood (plasma) and separating it from the actual blood cells. The blood cells
are then put back into your body, which manufactures more plasma to make
up for what was removed. It's not clear why this treatment works, but
scientists believe that plasmapheresis rids plasma of certain antibodies that
contribute to the immune system attack on the peripheral nerves.
• Intravenous immunoglobulin. Immunoglobulin contains healthy antibodies
from blood donors. High doses of immunoglobulin can block the damaging
antibodies that may contribute to Guillain-Barre syndrome.

Each of these treatments is equally effective. Mixing the treatments or administering one after
the other is no more effective than using either method alone.

Often before recovery begins, caregivers may need to manually move your arms and legs to help
keep your muscles flexible and strong. After recovery has begun, you'll likely need physical
therapy to help regain strength and proper movement so that you'll be able to function on your
own. You may need training with adaptive devices, such as a wheelchair or braces, to give you
mobility and self-care skills.

Coping and support

The emotional impact of Guillain-Barre syndrome can be devastating. In severe cases, Guillain-
Barre syndrome can transform you from healthy and independent to critically ill and physically
helpless — suddenly, and without warning.

Although most people eventually recover fully, a diagnosis of Guillain-Barre syndrome means
confronting the possibility of long-term disability or paralysis. And those who do develop these
complications must adjust to lasting, limited mobility and a dependence on others to help
manage daily activities.

Talking with a mental health provider can play a critically important role in helping you cope
with the mental and emotional strain of this illness. In some cases, your therapist may
recommend family counseling to help you and your loved ones adjust to the changes caused by
Guillain-Barre syndrome.

You may also benefit from talking with others who have experienced this illness. Ask your
doctor or mental health provider to recommend a support group for people and families coping
with Guillain-Barre syndrome.
Symptoms

References

DS00413

May 30, 2009

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