Guillain-Barre syndrome is a rare inflammatory disorder of the peripheral nerves. These are the nerves outside of the brain and spinal cord. Guillain-Barre is characterized by numbness, tingling, weakness, or paralysis in the legs, arms, breathing muscles, and face. 

Causes

The exact cause of Guillain-Barre syndrome is unknown. However, in about 70% of patients, a recent infection or surgery serves as a trigger, which causes 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 chances of getting a disease or condition. Risk factors for Guillain-Barre syndrome may include:

• Recent bacterial or viral infection

• Recent vaccine

• • The swine flu vaccine administered in 1976-77 was associated with excess cases of Guillain-Barre syndrome (since then, no other influenza virus vaccines have been associated with Guillain-Barre syndrome)

• Recent surgery

• History of lymphoma, lupus, or AIDS

Symptoms

The first symptoms of Guillain-Barre syndrome include:

• Progressive muscle weakness on both sides of the legs, arms, and face

• Prickly, tingling sensations (paresthesias), usually in feet or hands

• Loss of normal reflexes

Symptoms may develop over a period of hours, days, or weeks. They will vary in severity. The symptoms grow progressively worse. Most people experience the greatest weakness during the second or third week. Most patients recover fully, but as many as 25% will have some residual symptoms. For 5% of patients, Guillain-Barre syndrome is fatal.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. 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 a certain protein are detected, and there is no infection, this is an indication that you may have Guillain-Barre syndrome. Electrodiagnostic studies may also be done. These test the electrical conduction in the peripheral nerves, and help differentiate Guillain-Barre 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. Most patients need to be in the hospital for at least 1 month. Common treatments include:

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-Barre syndrome.

High-Dose Immunoglobulin Therapy

Injections with immunoglobulin (IVIg) may help reduce the severity of a Guillain-Barre 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.

Prevention

There are no guidelines for the prevention of Guillain-Barre syndrome.

RESOURCES:

Guillain-Barre Syndrome Foundation International
http://www.guillain-barre.com

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

References:

National Institute of Neurological Disorders and Stroke

Textbook of Clinical Neurology, 1st ed. W.B. Saunders Company; 1999.