Definition
Guillain-Barré syndrome is a rare condition that causes the immune system to attack the nerves outside of the brain and spinal cord. It is characterized by numbness, tingling, weakness, or paralysis in the legs, arms, breathing muscles, and face. It can affect all ages.
Causes
The exact cause of Guillain-Barré syndrome is unknown. However, in about 70% of patients, a recent infection or surgery is a trigger to an autoimmune response. This autoimmune response attacks the peripheral nerves, leading to weakness and a loss of sensation.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for Guillain-Barré syndrome may include:
- Age: 15-35 and 60-75 years old
- Men (somewhat more likely than women)
- Recent gastrointestinal or respiratory infection by viruses or bacteria
- Recent vaccination (especially influenza and meningococcal)
- The swine flu vaccine given from 1976-1977 was linked to excess cases of Guillain-Barré syndrome. (Since then, influenza virus vaccines have been associated with only a marginally increased risk of Guillain-Barré syndrome.)
- Recent surgery
- History of lymphoma, lupus, or AIDS
Symptoms
The first symptoms of Guillain-Barré syndrome include:
- Pain (Lower back pain is the most common complaint.)
- Progressive muscle weakness on both sides of the legs, arms, and face
- Prickly, tingling sensations, usually in the feet or hands
- Loss of normal reflexes
Symptoms may develop over a period of hours, days, or weeks. They will vary in severity from minimal to total paralysis including respiratory weakness. The symptoms grow progressively worse. Most people experience the greatest weakness during the second or third week.
Related complications include:
- Facial weakness
- Blood pressure instability
- Heart rate changes
- Sweating abnormalities
- Cardiac arrhythmias
- Urinary/gastrointestinal dysfunction
- Breathing difficulty
Most patients recover fully, but as many as 25% will have some residual symptoms. 5%-10% have permanent, disabling deficits. For 5% the condition is fatal.
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is dependant on the physical exam and history, cerebrospinal fluid findings, and nerve conduction studies.
You may have a lumbar puncture, also called a spinal tap. For this test, a needle is inserted into your lower back to remove a sample of cerebrospinal fluid for testing. If high levels of protein are detected, and there is no infection, this is an indication that you may have Guillain-Barré syndrome. Electrodiagnostic studies are usually done, which test the electrical conduction in the peripheral nerves and help differentiate Guillain-Barré from other disorders with similar symptoms.
Treatment
Treatment aims to reduce the body’s autoimmune response and decrease complications that result from immobility. Hospitalization is important because symptoms may rapidly become more severe, including respiratory failure, cardiacarrhythmias, and blood pressure instability. Most patients need to be in the hospital for a while. Common treatments include:
Plasmapheresis
During plasmapheresis, blood is removed from your body and passed through a machine that separates blood cells. The separated cells are then returned to your body with new plasma. This procedure may help shorten the course and severity of Guillain-Barré syndrome.
High-dose Immunoglobulin Therapy
Intravenous infusion with immunoglobulin (IVIg) may help reduce the severity of a Guillain-Barré attack. Immunoglobulins are proteins that are naturally produced by the body’s immune system.
Mechanical Ventilation
In 30% of cases, muscles necessary for breathing become paralyzed. This is treated with immediate emergency support from a mechanical ventilator.
Pain Control
Your doctor may prescribe medication to reduce the pain. These may include nonsteroidal anti-inflammatory drugs, gabapentin, carbamezepine, or narcotic analgesics.
If you are diagnosed with Guillain-Barré syndrome, follow your doctor’s instructions .
Prevention
There are no guidelines for the prevention of Guillain-Barré syndrome.