GBS – Guillain-Barré Syndrome: Symptoms & Treatment
GBS (Guillain-Barré syndrome) is a rare autoimmune disorder in which the immune system attacks the peripheral nerves, leading to muscle weakness and, in severe cases, paralysis.
Things worth knowing about "GBS"
GBS (Guillain-Barré syndrome) is a rare autoimmune disorder in which the immune system attacks the peripheral nerves, leading to muscle weakness and, in severe cases, paralysis.
What is Guillain-Barré Syndrome (GBS)?
Guillain-Barré syndrome (GBS) is a rare but serious autoimmune disorder affecting the peripheral nervous system. The body's immune system mistakenly attacks its own nerves, damaging the myelin sheath – the protective covering around nerve fibers – or the nerve axons themselves. This disrupts the transmission of signals between the brain and the rest of the body.
GBS affects approximately 1 to 2 people per 100,000 each year worldwide. It can occur at any age but is slightly more common in males and shows peak incidence in young adults and older individuals.
Causes
The exact cause of GBS is not fully understood. In most cases, the condition develops days to weeks after an infection that triggers an abnormal immune response. Common triggers include:
- Bacterial infections: most often Campylobacter jejuni (the leading trigger), as well as Mycoplasma pneumoniae
- Viral infections: including influenza, Epstein-Barr virus (EBV), cytomegalovirus (CMV), SARS-CoV-2, and Zika virus
- Vaccinations: a very rare association with certain vaccines has been reported in some cases
- Surgery or trauma: may occasionally trigger GBS in rare circumstances
Symptoms
GBS typically begins with tingling and numbness in the feet or legs, which gradually spreads upward. Other symptoms include:
- Progressive muscle weakness, usually starting in the legs and ascending
- Loss of deep tendon reflexes
- Pain, often in the back and limbs
- Difficulty walking, potentially progressing to complete paralysis
- In severe cases: weakness of the breathing muscles, requiring mechanical ventilation
- Autonomic dysfunction: irregular heartbeat, blood pressure fluctuations
- Difficulty swallowing or speaking
Symptoms typically reach their peak within 2 to 4 weeks, followed by a gradual recovery phase.
Diagnosis
Diagnosis of GBS is based on clinical findings and supported by the following tests:
- Lumbar puncture (spinal tap): typically reveals elevated protein with normal cell count (albuminocytologic dissociation)
- Nerve conduction studies (NCS): assess the speed and strength of electrical signals in the nerves
- Blood tests: to rule out other conditions and detect anti-ganglioside antibodies
- Clinical assessment: weakness pattern, reflex status, and disease progression
Treatment
GBS is a medical emergency requiring hospitalization, often in a neurological intensive care unit. The main treatment approaches are:
Specific Immunotherapy
- Intravenous immunoglobulin (IVIG): high-dose immunoglobulins help neutralize harmful antibodies and modulate the immune response
- Plasma exchange (plasmapheresis): removes harmful antibodies from the blood
Supportive Care
- Monitoring of respiratory function; mechanical ventilation if needed
- Pain management and treatment of autonomic complications
- Prevention of blood clots (deep vein thrombosis prophylaxis)
Rehabilitation
After the acute phase, intensive physiotherapy and occupational therapy are essential for restoring muscle strength and function. Recovery can take months to years. Most patients recover fully or largely, though a small proportion may have lasting deficits.
Prognosis
The prognosis of GBS varies by individual. Approximately 80% of patients are able to walk independently within 6 months. Around 3 to 5% die from acute complications such as respiratory failure. A small percentage may develop a chronic form known as CIDP (chronic inflammatory demyelinating polyneuropathy).
References
- van den Berg B et al. - Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nature Reviews Neurology, 2014.
- Willison HJ, Jacobs BC, van Doorn PA - Guillain-Barré syndrome. The Lancet, 2016; 388(10045): 717–727.
- World Health Organization (WHO) - Guillain-Barré syndrome. Fact Sheet, 2023. Available at: www.who.int
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