In celebration of international Guillian Barre Syndrome Awareness Day I have summarized a few facts on the disease.

What is Guillain-Barré syndrome?

  • GBS is a condition where your immune system attacks healthy nerve cells. This leads to poor conduction in the nerves, leading to muscle weakness, numbness and tingling.
  • The message from the brain to the muscles can not be transmitted properly.
  • Many report having an infection just prior to the GBS, like flu or a stomach bug.
  • Some of the organisms associated with GBS are influenza, cytomegalovirus, Epstein-Barr virus infection, or mononucleosis mycoplasma pneumonia,HIV or AIDS.
  • GBS comes on very rapidly and is not uncommon for the symptoms to develop overnight.

The most common type is acute inflammatory demyelinating polyradiculoneuropathy (AIDP).

  • Acute – sudden onset
  • Demyelinating – loss of the sheath surrounding the nerve that “insulates” it
  • Poly– many or more than one
  • Radiculoneuropathy – a condition that affects the peripheral nerves (not the brain or spinal cord)

How does it present?

The symptoms might start in the lower extremities with tingling in the feet or toes. This can then spread and rapidly cause muscle weakness of the limbs. Patients will report being unable to stand or walk, unable to swallow and in some cases have difficulty breathing, as their respiratory muscles are becoming paralyzed. Patients will lose bladder control due to muscle weakness.

What will my doctor do to make a diagnosis?

Your doctor will perform a lumbar punch to take a small volume of cerebrospinal fluid from the space surrounding the spinal cord. This will be tested for protein. Elevated protein levels could indicate GBS.

Your doctor might perform an EMG (electro-myo-graphy). This tests measures the electrical activity in the muscles – in the same way a heart monitor  (ECG) measures electrical activity in the heart muscles.

Treatment

Most patients with GBS will be admitted to hospital for treatment which may include

  • mechanical ventilation – if patient is unable to breathe
  • Immunoglobulins – for example Polygam – which helps to block the antibodies causing the GBS. These immunoglobulins contain normal healthy antibodies that are obtained from healthy donors.

Physiotherapists assist in the following ways:

  • Passive stretches and positioning of limbs to stretch paralyzed muscles and prevent tightness of muscles and joints
  • Passive motions to prevent pain, swelling, blood clots and to improve circulation in the limbs.
  • Active mobilization and strength training to improve muscle strength
  • Chest physiotherapy to assist clearing of phlegm when patient is unable to cough
  • Positioning to avoid pressure sores
  • Education of the family
  • As soon as active movement of the muscles recover, the physical therapist will start assisting the patient in activities like sitting, standing and walking.

Recovery can then take anywhere from a few weeks to a few years. People with Guillain-Barré could potentially recover fully, but many will experience lingering symptoms like fatigue, sensory symptoms like tingling or weakness.

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