Diseases and Disorders

Guillain-Barré Syndrome

Yasmeen Hmaidan


Introduction

Guillain-Barré Syndrome (GBS) is an autoimmune inflammatory disorder of the peripheral nervous system. According to the National Institute of Neurological Disorders and Stroke, 1 in 100,000 Americans are diagnosed with GBS annually [1]. This rare disorder causes your body's immune system to attack your nerves, leading to myelin breakdown and axonal degeneration. Because the affected nerves cannot transmit signals efficiently, those who are affected by GBS suffer from motor weakness. Eventually this leads to a subacute ascending paralysis. Guillain-Barré Syndrome occurs in several forms, the most common being Acute Inflammatory Demyelinating Polyneuropathy [2]. This will be discussed in detail further in the article. Whilst the exact cause of Guillain-Barré Syndrome is unknown, the disorder is usually preceded by a bacterial or viral infection such as gastroenteritis (stomach flu) or pneumonia two to four weeks beforehand. Notably, there have been increased worldwide reports of GBS after the zika virus epidemic in 2016. Unfortunately, there is no cure for Guillain-Barré Syndrome, but most people make a full recovery after treatment.


 

Symptoms

     Whilst GBS’s symptoms are similar to other paralytic disorders such as poliomyelitis, an infectious disease of the spinal cord, several unique symptoms such as symmetrical leg and arm weakness help distinguish GBS from these other disorders {4}. In the preliminary stages of GBS, symptoms begin with lower limb tingling, weakness, and numbness. This is because the signals that transmit from and to the legs have the longest distance in the nerve network, making them the most susceptible to interruption. The initial emergence of lower limb weakness is a common sign of a form of GBS known as Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP). After the initial phase of symptoms, the muscle weakness progresses to the upper body, arms, and face, eventually leading to paralysis [5]. During the progression to the upper limbs, the autonomic nervous system dysfunctions. Subsequently, the affected individual develops Autonomic Dysreflexia (AD) and cardiac arrhythmia.

     Additional symptoms include palsy (facial drooping/paralysis), difficulty breathing, and loss of tactile ability [6]. For Guillain-Barré Syndrome, the most significant symptoms occur during the three to four weeks following the initial manifestation of the disorder. After that stage, the syndrome’s severity typically plateaus and the symptoms begin to stabilize.
 

Diagnosis

     It is quite difficult to diagnose Guillain-Barré Syndrome in its early stages because its condition is characterized by a set of associated symptoms that correspond with multiple neurological disorders. However, there are numerous tests that can verify unique patterns and symptoms that distinguish GBS from other disorders. These tests include electromyography (EMG), nerve conduction studies (NCS), and lumbar punctures (spinal taps) [7]. If positive, the EMG will indicate that the muscle weakness is caused by nerve damage. Through the damaged nerves, the NCS will measure the speed of conduction of stimulated electrical impulses and conclude with polyneuropathy. The lumbar puncture would detect infection or abnormally high levels of protein in cerebrospinal fluid [8]. These test results would diagnose an individual with Guillain-Barré Syndrome.


 

Treatment

     Whilst there is no cure for Guillain-Barré Syndrome, there are several treatments which decrease the severity of the illness and catalyse recovery amongst most individuals. GBS treatments include plasmapheresis (plasma exchange), which is effective in removing antibodies that attack the nerves through a blood-filtering machine. Injecting high doses of Intravenous immunoglobulin (IVIG) is the most common treatment for GBS. The immunoglobulin provided by blood donors contains healthy antibodies which impede the harmful antibodies [9]. Other treatments used to relieve pain and limit blood clot formation include physiotherapy, ventilator use, and medication. In most cases, the recovery period for Guillain-Barré Syndrome lasts three months to up to three years depending on each individual's’ case [10]. In addition to these effective treatments, new research conducted by the Guillain-Barré Syndrome/CIDP Foundation International has shown potential for a cure for GBS. In essence, the ongoing collaborative efforts among research facilities, neurologists, and immunologists provide hope in discovering the etiology and pathology of Guillain-Barré syndrome.


 

Key Terms (in order of their mention)

Autonomic Nervous System - Nerves that control involuntary functions of the body such as blood pressure and heart rate.

Autonomic dysreflexia (AD)- A condition in which the Autonomic Nervous System overreacts to external or bodily stimuli.

Cardiac arrhythmia- An irregular heartbeat which is either too slow or too fast.

Polyneuropathy- The plural form of neuropathy, meaning that many nerves in different sections of the body are damaged.

Etiology - The causes of a disease’s manifestation.


References


  1. Newman, Tim. (23/3/2016). “Guillain-Barre Syndrome: Causes, Diagnosis and Treatment.” Medical News Today, MediLexicon International. www.medicalnewstoday.com/articles/167892.php. Retrieved: 15/9/2017.

  2. Ramachandran, Tarakad S. (30/8/2017). “Acute Inflammatory Demyelinating Polyradiculoneuropathy.” Edited by Nicholas Lorenzo, Background, Pathophysiology, Epidemiology. emedicine.medscape.com/article/1169959-overview. Retrieved: 15/9/2017.

  3. Mayo Clinic Staff. (1/1/2016). “Guillain-Barre Syndrome can cause Life-Threatening Paralysis.” Mayo Clinic, Mayo Foundation for Medical Education and Research. www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/basics/tests-diagnosis/con-20025832. Retrieved: 15/9/ 2017.

  4. National Institutes of Health. (12/9/2017). “Guillain-Barré syndrome - Genetics Home Reference.” U.S. National Library of Medicine. ghr.nlm.nih.gov/condition/guillain-barre-syndrome. Retrieved: 15/9/2017.

  5. Cafasso, Jacquelyn, and Lauren Reed-Guy. (23/8/2017). “Guillain-Barré Syndrome.” Healthline Media. www.healthline.com/health/guillain-barre-syndrome#symptoms3. Retrieved: 15 Sept. 2017.

  6. Muscular Dystrophy Canada.(n.d.). “Guillain-Barré Syndrome.” www.muscle.ca/about-muscular-dystrophy/types-of-neuromuscular-disorders/guillain-barre-syndrome/. Retrieved: 15/9/2017.

  7. National Health Service. (10/1/2017). “Guillain-Barré syndrome - Causes.” NHS Choices. www.nhs.uk/Conditions/Guillain-Barre-syndrome/Pages/Causes.aspx. Retrieved: 15/9/2017.

  8. University of Chicago. (16/4/2010). “Types of Peripheral Neuropathy - Inflammatory.” peripheralneuropathycenter.uchicago.edu/learnaboutpn/typesofpn/inflammatory/guillainbarre.shtml. Retrieved: (15/9/2017).

  9. National Institute of Neurological Disorders and Stroke. (n.d.). “Guillain-Barré Syndrome Fact Sheet.” U.S. Department of Health and Human Services. www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Guillain-Barr%C3%A9-Syndrome-Fact-Sheet. Retrieved: (15/9/2017).

Yasmeen Hmaidan

Yasmeen Hmaidan


Yasmeen Hmaidan is a computer science and neuropsychology student at the University of Toronto. At the IYNA, she hopes to share the fascinating nature of computational neuroscience and opportunities with like-minded students. Outside of the IYNA, she is a computational sciences director in the Women in Sciences and Computing Team at UofT. Her past time pleasures include podcasting, kayaking, and reading.