Recurrence of Guillain-Barre syndrome rare

DEAR DR. ROACH

>> You have written about immunocompromised people before, but what about those of us who have immune systems that overreact instead of underperform, such as with Guillain-Barre syndrome? What is the likelihood of this happening again, and what precautions should one take? I didn’t recover completely and fear having the myelin sheath stripped from my nerves again.

DEAR READER >> There are many autoimmune diseases, such as GBS, where the body attacks one, or more, specific cell types of the body. With GBS, it’s the myelin, a protein that surrounds and protects nerves, that is the target of the body’s attack. The major symptom is progressive weakness, which sometimes includes paralysis of the respiratory muscles, requiring ventilatory support (i.e., a ventilator or breathing machine).

Most cases (about 75%) have a trigger that occurs about four weeks prior to their attack of GBS. A respiratory infection (such as influenza) is most common, followed by gastroenteritis. Vaccination is often considered a risk, but the risk of being diagnosed with GBS after vaccination is about one person per million vaccinations.

I can’t answer how to prevent recurrence of all autoimmune diseases, as the strategies are specific to each disease, but for GBS, recurrence is rare, with only about 5% of patients who’ve made a recovery experiencing a recurrence.

The Miller Fisher variant of GBS, consisting of paralysis in the eye muscles and dizziness, is more likely to reoccur than

GBS.

Treatment is indicated for severe or progressive symptoms during the acute event, but I don’t know of any treatment specifically for preventing reoccurrence.

Most experts believe that the risk of relapse following an influenza infection is so much larger than the risk from vaccination.

So, patients with GBS should get regular vaccines, but that is ultimately a discussion between you and your neurologist.