Guillain-Barre syndrome can be serious

GUILLAIN-BARRE syndrome (GBS) is a disease that affects nerves throughout the body and limbs. It is usually triggered by an infection. GBS is rare but may affect anyone. It occurs more commonly in early adulthood and the elderly. It is also more common in women immediately after they have given birth.

CAUSES

Most cases of GBS start within three weeks of an infection. Some of the infections that are known to be related to GBS include:

- Campylobacter jejuni (which can cause bowel infection and diarrhoea).

- Epstein Barr virus (which causes glandular fever - also called infectious mononucleosis).

- Cytomegalovirus (usually causes no symptoms).

- Mycoplasma pneumoniae infection (a bacterial infection that can cause a cough, cold or pneumonia).

GBS has also been reported after certain vaccinations.

GBS is an autoimmune disease. In autoimmune diseases, the immune system makes antibodies that can attack tissues of the body and cause damage to them. In GBS, the preceding infection stimulates the body to produce antibodies to attack bacteria. But, it is thought that a tiny part of the infecting bacteria and tiny parts of the nerves within the body have similar structures.

In some people, the antibodies that attack the bacteria also mistake the nerves as bacteria and so, the antibodies subsequently attach to, and damage, the nerves, causing inflammation of the nerves. This then leads to GBS. If a nerve is damaged then the muscles which the nerve supplies stop working.

SYMPTOMS Weakness. This starts in the extremities such as the feet and hands, and moves upwards towards the center of the body. The legs are affected more often than the arms. If the nerves in the head, neck and chest are affected, there may be difficulty with swallowing, eye movements and breathing. Reflexes, such as the way the leg moves when the knee is tapped, are also lost early in most people.

Sensory symptoms. These may include tingling or numbness. These symptoms usually begin in the toes and/or the fingertips.

Pain. About 1 in 2 people with GBS develop either nerve pain or deep aching muscle pain. This tends to be worse with movement and at night.

Autonomic symptoms. The autonomic nervous system is responsible for body functions like sweating, breathing, the heart beating and digestion. In GBS, nerves within this system may be affected, causing problems with blood pressure, pulse, vision and lack of sweating.

Usually, the weakness and sensory symptoms gradually become worse and spread up the body. Symptoms typically peak in severity 1-4 weeks after first starting. ]The severity of symptoms and when they peak can vary from person to person. However, symptoms can often be severe. In many cases, both arms and legs become so weak that they cannot be used at all.

TREATMENT

If your doctor suspects that you may be suffering from GBS, you will be sent to hospital. This is because the disease may progress quickly within a few days to affect your breathing and heart. Some specific treatments that may be given include one or more of the following:

Immunoglobulin - an antibody that is q present in blood and is collected from blood given by blood donors, is given as an injection directly into a vein. The precise way that it works is not clear. It may work to alter your immune system and help to clear the abnormal antibodies responsible for GBS.

Plasma exchange - involves taking your q blood out of your body and separating the blood into cells and plasma. The plasma is then removed and the blood cells are returned to the body with a plasma substitute. A special machine is used for this treatment and only a small amount of blood is actually outside the body at any time. Again, the sooner treatment is started after symptoms begin, the better the effect this treatment is likely to have. Plasma exchange is done less commonly these days since treatment with immunoglobulin has been shown to be just as effective. It is easier to give and seems to cause fewer side-effects.

OUTLOOK

Due to improvements in managing GBS, around 7-8 in 10 people will make a full recovery within 6-12 months. About 1-2 in 10 people with GBS will be left with some degree of permanent problems such as some weakness, muscle wasting, difficulty walking or pain.

It is rare to have GBS a second time.