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Guillain-Barré Syndrome

Guillain-Barré Syndrome

Guillain-Barrésyndrome (GBS) is a rare medical condition that affects the nerves outside the brain and spinal cord.

Although it can be frightening because it often causes people to have some type of paralysis, Guillain-Barré (GHEE-yan bah-RAY) syndrome is very rare: It only affects 1 or 2 people in every 100,000. Most of the people who do get Guillain-Barré syndrome recover and return to their normal lives and activities.

What Is Guillain-Barré Syndrome?

Experts believe that GBS is an autoimmune disorder. These disorders happen when the immune system, which usually protects us by attacking invading organisms that can harm the body, mistakes the body's own cells for foreign material and begins to attack them. Guillain-Barré can affect people of any age, but it becomes more common with increasing age.

The nerves outside the brain and spinal cord are called the peripheral nerves. They transmit signals from our brain to our muscles, telling them to move. They also send sensory signals (such as touch, pressure, temperature, and pain) to the brain. When GBS causes these nerves to be temporarily damaged, the signals are interrupted. As a result, someone with GBS may have weakness or problems moving, or may feel numbness and tingling in the arms or legs.

GBS is rare, but can get serious: If the muscles in the chest are affected, for example, it may interfere with breathing and require the person to use a ventilator for a while. The good news is that the paralysis that goes with GBS is usually temporary.

What Causes It?

No one knows yet what causes GBS or why it affects some people and not others. GBS is called a syndrome because, like irritable bowel syndrome and other syndromes, doctors diagnose it based on a collection of symptoms.

Although no one knows what causes GBS, scientists do have some theories about the syndrome and why it surfaces in the body. For example, doctors report that more than half of all GBS cases seem to happen after a viral or bacterial infection, such as those that cause sore throats or diarrhea. Occasionally, minor surgery or something else might trigger GBS symptoms.

There's no reason to worry that a typical sore throat or a minor surgery is going to trigger an autoimmune response and lead to GBS, though. Colds, sore throats, and the occasional bout of diarrhea are fairly normal parts of everyone's lives; getting GBS, thankfully, is not.

Signs and Symptoms

When GBS does strike, it can progress quickly, with the most severe symptoms taking place as soon as 2 weeks after the first signs appear. The first symptoms, such as weakness or tingling in the legs, can show up within a day. These sensations can then spread to the arms and upper body, and the person may feel increasingly tired. Sometimes, someone with GBS also begins to lose his or her reflexes (for example, the person may not have the knee-jerk reaction that happens when a doctor tests reflexes).

In the most severe cases of Guillain-Barré syndrome, the symptoms continue to get worse until certain muscles become completely paralyzed. At this stage, the paralysis can interfere with breathing or swallowing, so a person usually has to go to the hospital. It can be frightening, but even at this stage doctors expect most people to recover completely.

How Is GBS Diagnosed?

Doctors rely on a person's medical history and a physical exam to diagnose GBS. If a doctor suspects GBS, he or she will ask some detailed questions, such as whether the symptoms affect both sides of the body (which is typical with GBS), whether the symptoms happened quickly and got progressively worse, and whether the symptoms started in the feet and legs and spread to the upper body and arms.

Doctors also may do a few tests to confirm that a patient has GBS, including a lumbar puncture (spinal tap). Two other tests — an electromyogram (EMG) and a nerve conduction velocity (NCV) test — can show how well nerves are sending signals down to the arms and legs.

How Is It Treated?

People with GBS are usually hospitalized so doctors and nurses can monitor their body functions. Because the progression of GBS can be unpredictable, some patients are cared for in an intensive care unit (ICU). This lets doctors and nurses keep an eye on vital signs, such as blood pressure or heart rate, and to step in and keep the body functioning until the nervous system can take over again.

In the hospital, somebody with GBS might also receive treatment to help speed recovery. One treatment for GBS is plasmapheresis (plaz-muh-fuh-REE-sus), where blood is drawn from the body and then processed so that the red and white blood cells are separated from the plasma, the liquid portion of the blood. Then these cells are returned to the body without the plasma. Scientists think that this helps remove some of the harmful antibodies and seems to reduce the severity and length of GBS symptoms.

Another treatment for GBS is immunoglobulin therapy, which involves using healthy antibodies (immunoglobulins) from blood donors to help block the harmful antibodies in the body of the person with GBS.

How long someone with GBS has to stay in the hospital depends on how serious the condition is. Some patients are in the hospital for only a few days; others are hospitalized for several weeks.

Recovering From GBS

Even after coming home from the hospital, it may take a while before a person feels as good as new. Some people with GBS might need to be in a wheelchair or use a walker until they regain their strength. Many will need physical therapy to get their bodies moving well again.

Recovering from GBS takes patience: People may feel some weakness as long as 3 years after having the condition. But the good news is most people do eventually recover from even the most severe cases of GBS.

Because GBS strikes so suddenly and without warning, it can be difficult to deal with and to adjust to the recovery period. Doctors may recommend that a person see a counselor or therapist or join a support group as a way to talk through the many confusing feelings that can go with having the syndrome. People recovering from GBS usually have tons of questions, such as "Why me?" and "Will it come back?"

GBS can really affect a person's lifestyle, and it might be a while before people can participate fully in their favorite sports or activities. This can feel particularly hard for someone who is usually very active.

For people who go through the ordeal of a slow recovery, it's natural to worry that GBS might come back. Often, this is because some people notice symptoms during recovery that are similar to those they had during the GBS episode, such as tingling in the hands or feet. In most cases, though, these symptoms are not a sign that they have GBS again. More likely, these are due to lingering nerve trouble after the initial bout of GBS. Luckily, only a very small number of people who've had GBS get it again.

As with any medical condition, if you've had GBS and you notice some of the same symptoms coming back, talk to your doctor.

It may take a while before a person who has had GBS is ready to get back to sports and other physical activity, but there's a lot that medical experts can do to help make the road to recovery smoother and faster.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: March 2013