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Guillain-Barre Syndrome

  • Definition

    The guillain-barre syndrome is an illness that usually occurs one to two weeks after a mild viral infection such as a sore throat, bronchitis, or flu, or after vaccination or surgical procedure.

    Symmetric weakness of the limbs develops over a few days, begins in the legs, and sometimes progresses to complete paralysis.


    The face muscles may be paralyzed as well, making it impossible to swallow normally. In severe cases, paralysis of respiratory muscles requires artificial ventilation on a respirator. With intensive medical treatment and support, the majority of patients recover, but about 10 to 20 percent are left with some residual weakness.

    The illness results from inflammation and destruction of myelin (the fatty material, composed of lipid and protein that forms a protective sheath around some types of nerve fiber) similar to that seen in multiple sclerosis. The main difference, however, is that multiple sclerosis attacks the central nervous system, whereas in the Guillain-Barre syndrome, it is the peripheral nerves that are affected. The nerve damage is thought to be the result of an abnormal immune reaction directed against the myelin of the peripheral nervous system. Another difference is that Guillain-Barre syndrome does not recur except in rare instances.


    The exact cause of Guillain-Barre syndrome is unknown, as are the factors that make certain individuals susceptible to it.


    Muscle weakness usually affects both sides of the body equally. Facial nerves often become involved, causing slurred speech and blurred vision. There may be sensory symptoms such as numbness or tingling in the feet and hands.

    More severe cases may involve the muscles of breathing and swallowing. Symptoms usually progress rapidly, getting dramatically worse within hours or a day. Then, within two to four weeks, progression usually stops, and two to four weeks later, recovery begins.


    There is no specific test for Guillain-Barre syndrome. Diagnosis is made by the clinical features, characteristic changes in the spinal fluid (from a lumbar puncture [spinal tap]), and electrical studies of the peripheral nerves and muscles, a procedure known as electromyography. The diagnosis reflects an elimination of other possibilities.


    While there is no specific therapy for Guillain-Barre syndrome, physicians have shown that certain treatments, administered early, can temper the progression of symptoms, shorten hospitalization and speed the start of recovery.

    One treatment is plasmapheresis, filtering the blood to remove plasma, which is replaced by an albumin solution or artificial substitute this is believed to remove many of the antibodies that attack nerves. A newer remedy involves the intravenous injection of gamma globulin, which is thought to block the receptors where the antibodies attach to do their damage.

    It takes injured nerves a long time to repair themselves. Most patients recover most of their lost function within a year. In about 3 percent of cases, the syndrome recurs or becomes chronic.

    Even when recovery is uneventful, months of intensive physical therapy are needed.


    How severe is the condition?

    What is a spinal tap? What are the risks involved?

    What are electrophysiological studies? What do they determine?

    Are there any other treatments besides plasmapheresis and intravenous injection of gamma globulin?

    What are the risks and/or side effects of these treatments?