Guillain-Barré Syndrome

A majority of people with Guillain-Barré syndrome will make a complete recovery. Symptoms will gradually improve over several months.

• Guillain-Barré syndrome is a nerve disorder.
• It is an acute and rapidly progressive inflammation of nerves that causes loss of sensation and muscle weakness.
• This syndrome causes the destruction, removal, or loss of the myelin sheath of a nerve. Myelin is the substance of the cell membrane that coils to form the myelin sheath. The myelin sheath serves as an electrical insulator to nerve fibers.
• Guillain-Barré syndrome is also known as polyneuropathy, which is a disease that involves several nerves.

The cause of the disease is unknown. Many speculate that this is an immune-system disorder. Symptoms often begin 5 days to 3 weeks after a viral infection, immunization, or surgery.

The disease affects peripheral nerves, nerve roots, and cranial nerves. Evaluation of the peripheral nerves reveals sections of the nerve with demyelination. Under microscopic exam, the nerve tissue is infiltrated with certain types of white blood cells.

• A viral infection, such as herpes, cytomegalovirus, or Epstein-Barr virus is the cause of over two-thirds of the new cases each year.
• In 1977, there were over 500 cases of Guillain-Barré syndrome associated with a United States flu vaccination program. The cause of this outbreak was never discovered.
• Other causes of GBS include Zika virus, hepatitis A, B, C virus, HIV, and COVID-19.
• About 5%-10% of new cases will occur up to 4 weeks after surgery.

• Weakness on both sides of the body may develop with numbness that starts in the legs and progresses into the trunk and moves upward to the arms and neck.
• Muscles that are controlled by nerves in the head may be involved. Muscle weakness near the involved nerves can be the most prominent sign.
• Deep tendon reflexes are decreased or absent.
• People can have weakness of facial muscles and some muscles in the throat.
• Some may have respiratory failure due to muscle weakness. These people need to have a breathing tube put in and be placed on a ventilator to help them breathe. Five percent of people die from respiratory failure.
• Rapid heartbeat (tachycardia), sweating, facial flushing, and variable blood pressure are signs the nervous system is affected.
• The severity of symptoms peaks by the second or third week.
• In certain forms of Guillain-Barré syndrome, people have weakness of eye muscles or unsteady gait. These symptoms overlap other syndromes such as botulism, thiamine deficiency, and myasthenia gravis. It is important to rule out other causes for these symptoms.

If you think you may have symptoms of this condition, call your doctor for an evaluation.

If you lose feeling in an arm or a leg or feel that your arm or leg has become weak, this is a medical emergency. Go to a hospital's emergency department. This may be the sign of a stroke.

Diagnosis is based on a medical history and physical exam. The person will have weakness in their arms and legs. There may be weakness in muscles controlled by cranial nerves. The weakness progresses from the lower extremity to the trunk, upper extremity, and neck. The deep tendon reflexes may be diminished or absent.

• There is no specific blood test to diagnose Guillain-Barré syndrome.
• A lumbar puncture (spinal tap in which fluid is taken) can evaluate the cerebrospinal fluid. The analysis will show increased protein without the increase in the number of cells.
• Nerve conduction analysis will reveal slow nerve conduction velocities due to the damage to the nerve.
• Lab work that screens for the following diseases should be performed to rule them out: mumps, rubella, cytomegalovirus, and myasthenia gravis.

There is no home care for this syndrome. Once diagnosed, follow your doctor's instructions.

• People with Guillain-Barré syndrome should have continuous heart monitoring, which includes pulse oxygenation, blood pressure, and pulse.
• They need continuous evaluation of their airway, breathing, and circulation.
• Fluid intake needs to be monitored.
• The main focus of treatment, however, is supportive care and prevention of any problems. The person needs to be protected against the development of bedsores.
• The treatment of choice for Guillain-Barré syndrome is plasmapheresis, a process in which a person's blood is removed, the plasma separated, and the blood put back into the body to build new antibodies for immunity. When used early in the disease process, plasmapheresis has been beneficial. It decreases death rates, lowers the probability of permanent problems, and shortens the length of the illness.

Certain drugs such as heparin may be used to prevent blood clotting. Corticosteroids are not used.

Physical therapy should be started as soon as the person can tolerate the activity. Physical therapy should include heat, which provides pain relief. The person should do range-of-motion exercises to prevent joint and muscle stiffness.

A majority of people with Guillain-Barré syndrome will make a complete recovery. Symptoms will gradually improve over several months.

• Any lasting problems may be addressed through additional physical therapy. Some people might need orthopedic devices to assist with activities of daily living.
• Some people are at risk for relapsing. They will develop chronic neuropathy (nerve problems). For these people, drugs that suppress the immune system and plasmapheresis may be helpful.