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Guillain-Barré Syndrome

Evidence: Antibody

Names 

Guillain–Barré syndrome
Guillain-Barre syndrome

Description

Guillain–Barré syndrome (GBS) is a rare autoimmune disorder in which when the immune system attacks and damages the protective covering (myelin) of the nerves in the peripheral nervous system.  Damage to the myelin hinders communication between the brain and the body, leading to muscle weakness or tingling sensations in the arms and legs. The cause of GBS is unknown but may be associated with a viral or bacterial infection, injury, or surgery.  There are 6 types of GBS:

  1. Acute inflammatory demyelinating polyneuropathy is the most prevalently diagnosed form of GBS in the US and is often associated with a prior infection.  This type leads to damage to the nerve myelin, but prognosis is good and full recovery is expected.

  2. Acute motor axonal neuropathy is associated with a prior infection causing diarrhea and is most common in children.  This type primarily leads to weakness, which impairs movement and breathing and may lead to respiratory failure if untreated.  Patients receiving medical attention are expected to recover.

  3. Acute motor-sensory axonal neuropathy is associated with prior infection causing diarrhea and has a sudden, intense onset.  This type is most prevalent in adults.  In addition to severe muscle weakness, patients also experience impairments in the senses.  Prognosis is poor.

  4. Miller-Fisher syndrome is rare and results in difficulties with coordination, loss of reflexes, and paralysis around the eyes, along with impairments in the senses.  Recovery is expected in 1 to 3 months.

  5. Acute panautonomic neuropathy is very rare and impairs both voluntary and involuntary body functions, including drops in blood pressure when standing, incontinence, lack of sweating, dry eyes and mouth, and impaired pupil function.  Many patients experience heart problems, which can be fatal.  Patients may improve, but slowly and incompletely.

  6. Pure sensory GBS causes the sudden appearance of impairments in the senses and loss of reflexes caused by damage to the myelin.  Recovery is expected.

Prevalence

US cases: 3,200 [Nguyen 2019]

Typical Age of onset

Onset can occur at any age but most common in adults ages 30-50

Symptoms

  • Tingling in the extremities

  • Weakness spreading from legs to upper body

  • Facial droop

  • Double vision (diplopia)

  • Slurred speech (dysarthria)

  • Difficulty swallowing (dysphagia)

  • Paralysis of the eye (ophthalmoplegia)

  • Dysfunction of pupils

  • Rapid heartbeat (tachycardia)

  • Slow heartbeat (bradycardia)

  • Facial flushing

  • Episodes of high blood pressure (paroxysmal hypertension)

  • Drop in blood pressure when standing (orthostatic hypotension)

  • Inability to sweat (anhidrosis) or excessive sweating (diaphoresis)

  • Difficulty with bladder control, or having abnormal bowel function.

  • Difficulty breathing

  • Difficulty walking or climbing stairs

  • Severe pain, including. May be aching or cramping