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Guillain-Barre Syndrome (GBS)

Saturday, 11 February 2012

Guillain-Barre syndrome is an autoimmune disease in which the body's immune system attacks the nerves. It is usually monophasic (happens only once). Recurrence occurs in patients less than 30 years old, with milder symptoms and in Miller Fisher syndrome (MFS).

It occurs after a respiratory infection or stomach flu. The infection causes production of antibodies against the myelin sheath of the nerves and causes demyelination.

Symptoms start after 1-3 weeks from the respiratory or GIT infection.

Numbness in the peripheries and limb pains precede a rapidly ascending muscle weakness (starts in the lower limbs and ascends to affect trunk, respiratory muscles and upper limbs).
The patient may experience difficulties in facial movement, speaking, chewing or swallowing. 
Some patients may develop respiratory difficulties and may progress to respiratory failure due to paralysis of the respiratory muscles. When this happens, it is an EMERGENCY and the patient will have to be put on mechanical ventilation till recovery occurs.

The diagnosis is established on clinical grounds and confirmed by nerve conduction tests.

- The respiratory functions are monitored closely for early detection of deterioration in the respiration. 
- To prevent pressure sores, the patient is frequently repositioned every 2 hours.
- Intravenous immunoglobulins.
- Therapeutic plasma exchange.

About 80% of the patients will fully recover after 3-6 months. 15% will suffer from residual neurological disability.

- Some patients will suffer from residual weakness or numbness which may take up to one year for full recovery.
- Blood pressure fluctuation and cardiac arrhythmia.
- Blood clots. If the patient is bed-ridden, he/she is liable to suffer from thrombotic events. These patients will have to take anticoagulants and wear support stockings.

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