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Guillain-Barre Syndrome


Overview, Causes, & Risk Factors

Guillain-Barré syndrome, or GBS, is believed to be an autoimmune disorder in which the body creates antibodies against its own tissue. In people with GBS, the antibodies generally attack the myelin sheath, or lining of the nerves. They may also attack part of the nerves themselves.

What is going on in the body?

Guillain-Barré syndrome is thought to be an autoimmune disorder that is triggered by an infection, vaccination, or other factors. It causes a severe inflammatory reaction around the nerves. The myelin sheath becomes swollen. Impulses and messages cannot travel along the course of the nerve. In time, nerve impulses are blocked.

What are the causes and risks of the condition?

Most cases of Guillain-Barré syndrome are triggered by an infection. Two-thirds of the individuals with GBS have had an upper respiratory infection or gastrointestinal infection 1 to 3 weeks before weakness develops. Other infections that may trigger GBS include:

  • Chlamydia trachomatis\. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. ',CAPTION,'Chlamydia');" onmouseout="return nd();">chlamydia infections
  • cytomegalovirus infections
  • hepatitis B
  • HIV infections, which cause AIDS
  • mononucleosis
  • Mycoplasma pneumoniae\ is a bacteria that causes infections in the respiratory system. Less often, it causes an infection of the central nervous system, heart, or skin. ',CAPTION,'Mycoplasma Infections');" onmouseout="return nd();">mycoplasma pneumonia
  • Some vaccinations may also trigger Guillain-Barré syndrome. These include:

  • flu vaccine
  • immunization against group A streptococcal infections
  • rabies vaccine
  • swine flu immunizations
  • Certain medicines have been identified as triggers for GBS. These include:

  • captopril, used to treat high blood pressure
  • danazol, a hormone derivative
  • gold, which is injected for diseases such as rheumatoid arthritis
  • heroin, a highly addictive illegal drug
  • penicillamine, which is used for chelation and to treat rheumatoid arthritis
  • streptokinase, used to dissolve blood clots
  • GBS may be triggered by a variety of other factors, such as:

  • blood cancers, especially Hodgkin lymphoma
  • pregnancy
  • surgery
  • No one knows for sure why these factors trigger Guillain-Barré syndrome in some people but not in others. More research is needed in this area.


    Symptoms & Signs

    What are the signs and symptoms of the condition?

    People with GBS usually have muscle weakness or paralysis that starts in the legs and feet. It progresses up toward the arms and head. Sometimes the weakness starts in the arms and moves downward. Occasionally, it starts in the arms and legs at the same time. The spread from feet to head can occur within 24 to 72 hours but can take longer.

    Muscle weakness can lead to the following symptoms:

  • blurred vision
  • constipation
  • difficulty breathing
  • difficulty swallowing and chewing
  • difficulty urinating or even starting to urinate
  • dizziness
  • fainting
  • loss of bowel and/or bladder control
  • muscle pain and contractions
  • numbness and decreased sensation
  • painful or tingling sensations in the arms and legs
  • palpitations, or an unusual awareness of the heart beating in the chest
  • uncoordinated movements

  • Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of Guillain-Barré syndrome begins with a medical history and physical exam. A test called a nerve conduction velocity (NCV) test can detect damage to the myelin sheath.

    An electromyograph (EMG) is a test that may be done to show if there is a lack of nerve signals to the muscles. During an EMG, wires are connected to the skin, and the activity of nerves and muscles is measured. An electrocardiogram, or EKG, may also be ordered.


    Prevention & Expectations

    What can be done to prevent the condition?

    Most cases of Guillain-Barré syndrome cannot be prevented. Following safer sex guidelines may prevent some cases that are triggered by sexually transmitted diseases, such as HIV. Illegal drugs, such as heroin, should not be used.

    What are the long-term effects of the condition?

    About 95% of those with Guillain-Barré syndrome survive. About 75% completely recover. For some, mild weakness or chronic pain will continue throughout life. GBS can be fatal if it causes problems with breathing. Full recovery can be expected if symptoms go away not long after they appear. This usually happens within 3 weeks.

    Weakness and decreased sensation can cause contractures. Contractures occur because muscles become thick and tight when they are not used. They shrink and shorten, causing joint deformities. There can also be loss of movement in the affected areas.

    Blood clots may develop because of loss of motion and muscle contractions. Blood-thinning medicines, such as warfarin or heparin, can be given to help prevent blood clots. There is an increased risk of infection, including pneumonia.

    What are the risks to others?

    Guillain-Barré syndrome is not contagious and poses no risk to others. If GBS is triggered by an infection, the infection itself may be contagious.


    Treatment & Monitoring

    What are the treatments for the condition?

    Initial treatment of GBS focuses on life support. A ventilator, or artificial breathing machine, may be needed. Fluids can be given through an intravenous line. Food can be given through a tube into the stomach.

    A procedure called plasmapheresis can be effective if used early in the course of the illness. Plasmapheresis removes antibodies that may be present in the bloodstream. It also provides the person with fluids or plasma that is free of the antibodies that trigger GBS.

    Immunoglobulin therapy is also used to treat GBS. High doses of immunoglobulins, or proteins from the immune system of normal donors, are given to the person with GBS. For some unknown reason, these globulins reduce the body's attack on its own nerves.

    Corticosteroids, such as methylprednisolone, are sometimes given together with plasmapheresis or immune serum globulin. However, their effectiveness is questionable, and they may worsen the disease.

    What are the side effects of the treatments?

    Plasmapheresis is associated with a small risk of getting bloodborne infectious diseases. Corticosteroids and immune globulins may increase the person's risk for many types of infection.

    What happens after treatment for the condition?

    Physical therapy may be ordered to prevent contractures and other complications. Along with occupational therapy, it can be helpful in restoring the person's normal level of function. Pain medicines and physical therapy may be needed if the person has chronic pain.

    How is the condition monitored?

    After the acute phase of GBS, the individual will have regular visits with the healthcare provider. Any new or worsening symptoms should be reported to the provider.


    Attribution

    Author:James Broomfield, MD
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:09/30/01
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:09/04/01


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