Guillain–Barré syndrome (GBS) is a rare postinfectious, immune-mediated disorder affecting the nervous system.
Guillain–Barré syndrome is a one-time episode in more than 95% of cases .
The generally accepted criteria for the diagnosis of Guillain–Barré syndrome include: progressive, ascending weakness of more than two extremities, areflexia and numbness and tingling of fingers and toes   . Other associated symptoms include mild sensory loss and elevated cerebrospinal fluid (CSF) protein with normal cell count . Impairment of respiratory muscles happens in approximately 25% of patients and requires respiratory assist .
Symptoms of Guillain-Barré syndrome include :
Autonomic system involvement
The course of the disease is similar in most individuals with Guillain–Barré syndrome . In 75% of cases there is a history of a preceding viral or bacterial infection. This is followed, within several weeks, by mild sensory symptoms such as numbness or tingling of hands and muscle weakness. The disorder progresses rapidly from this point, with profound neuro-muscular impairment,  respiratory dysfunction, and autonomic nervous system involvement.
The length of the acute stage may vary widely from 2 weeks to 6 or more months. Studies have shown that 98% of patients reached the peak of the disease by 4 weeks. The acute stage is followed by a plateau stage that lasts 1 to 2 weeks .
After this plateau phase, recovery occurs gradually but is often incomplete. Many patients still have symptoms for years after the disease. Some 12% report persistent fatigue ; 52% still have difficulty walking one year after onset; and 62% report continuing changes in their daily living as a result .
The mortality rate continues to be approximately 5%, despite modern medical care and intensive care. Tracheostomy and respiratory support is necessary in 10-30% of the patients. In addition, 3-10% of individuals with Guillain–Barré syndrome have relapses, and up to 20% have permanent disability .
There is no specific test for Guillain–Barré syndrome. Diagnosis is based on clinical symptomology and supported by nerve biopsy. Analysis of the cerebrospinal fluid is the only recommended laboratory study. Cerebrospinal fluid shows an elevated protein level and fewer mononuclear cells .
Routine blood tests may be helpful with monitoring the disorders progress. They may show an elevated sedimentation rate, hyponatraemia due to release of antidiuretic hormone, and mildly abnormal liver function tests  .
Laboratory studies suggested in Guillain–Barré syndrome include :
Magnetic Resonance Imaging is a non-specific test that may show enlargement of the anterior root indicative of inflammation which strongly suggests Guillain-Barré syndrome .
There are currently only two therapies that have proven to be effective in treating Guillain–Barré syndrome: plasma exchange and intravenous immunoglobulin (IVIg) . Guillain-Barré syndrome does not respond to corticosteroids and other immunosuppressive medications  . Treatment with intravenous immunoglobulin and plasma exchange do not cure the disorder, but seem to reduce recovery time. Mortality rates and percentage of patients with residual disabled seem to be unchanged   . Both intravenous immunoglobulin and plasma exchange seem to be equally effective in treating Guillain–Barré syndrome .
Plasma exchange has been used in the treatment of Guillain–Barré syndrome since 1978 . Studies have shown that plasma exchange, if begun in the first two weeks after the onset of symptoms, reduced hospital stay and length of assisted ventilation. Recommended therapy is two exchanges in mild cases and four in severe cases .
Plasma exchange is not risk free and may be associated with morbidity and mortality. Another limitation to this therapy is that it can only be administered in tertiary facilities with experienced personnel . Complications of plasma exchange include the possibility of hypotension, abnormal clotting, and septicaemia .
Intravenous immunoglobulin is believed to suppress autoantibodies. It has been shown to be a safe form of treatment. When compared to plasma exchange it is equally effective, does not require a specialized medical environment for administration, is more convenient, and of comparable cost .
Studies have shown no significant difference between the effectiveness of plasma exchange and intravenous immunoglobulin, nor does there seem to be any advantage to using combined treatment   . As a result intravenous immunoglobulin treatment is the preferred therapy for Guillain–Barré syndrome .
Corticosteroid use in Guillain-Barré syndrome has not been shown to be effective . However, some recent studies suggest the use of intravenous methylprednisolone in combination with intravenous immunoglobulin may be more beneficial  .
Current treatments, though helpful in decreasing the length of the acute phase of Guillain–Barré syndrome, do not decrease mortality or morbidity rates. It is evident, therefore that new treatment methods are needed for the disorder, aimed at decreasing or preventing disability from the disease  . Current research is focused on doing this. Studies are looking at the use of nerve growth factors in the treatment of Guillain–Barré syndrome .
The prognosis and outcome of Guillain-Barré syndrome depend on multiple factors including: patient age, underlying disease, and availability of intensive medical care .
Between 3% and 12% of patients with Guillain–Barré syndrome die during the acute phase of the disease of complications usually from cardiac arrhythmias, pulmonary emboli, or respiratory failure  . The mortality rate is highest in older patients. Approximately 25% of deaths occur during the first week and 50% in the first four weeks . Ventilator assisted respiratory support is needed in 25% of patients with Guillain–Barré syndrome .
Recovery in cases of Guillain–Barré syndrome may take weeks to several months. Complete recovery may not occur for years or it may never be complete . Studies have shown that 65% of patients have almost complete resolution of symptoms at the end of one year. The 35% figure of permanent disability has not changed despite the increased use of plasma exchange and intravenous immunoglobulin .
Other studies have shown 18% of patients recovering from Guillain–Barré syndrome are still unable to run at one year, 9% unable to walk without help, and 4% are bed ridden or on a ventilator .
Recurrence is uncommon with Guillain–Barré syndrome, occurring in fewer than 5% of patients .
About 75% of patients with Guillain–Barré syndrome have a history of symptoms of infection a few days to weeks before being diagnosed with the disease . Associated organisms include Camyplobacter jejuni, cytomegalovirus, and Epstein-Barr virus. Evidence of Camyplobacter jejuni infection has been documented in about 30% of patients with Guillain -Barré syndrome . Triggers for the disorder may also include immunizations. The outbreak of Guillain–Barré syndrome in the 1970’s was associated with national swine flu vaccination. Rabies vaccines have also been implicated. The discovery of antiganglioside antibodies in at least one third of patients seems to confirm this hypothesis. These antibodies cross-react with the infecting antigens. This may be a mechanism for the disease .
Guillain-Barré syndrome is now thought to include, not one, but several distinct subtypes . All of the variants have the primary symptomatology of muscles weakness and nerve involvement, but have differences in clinical presentation.
A disorder with “ascending paralysis” was first reported in 1859 . The syndrome was first fully described in 1916 by French physicians, Guillain, Barré, and Strohl, during World War I. (4)(5) Two French soldiers presented with motor weakness, areflexia, and abnormalities in the cerebrospinal fluid. This clinical syndrome was named after Guillain and Barré .
The incidence of Guillain–Barré syndrome is 1 - 3:100,000  . In men it is 1.5 times higher than in women . Guillain–Barré syndrome can occur at any age,  though studies show the incidence increases with age, with a small peak in young adults . Approximately one-third of childhood cases occur before the age of 3 years .
Guillain–Barré syndrome includes multiple subtypes; the specific sub-type may vary by geographic location and/or population. The form of Guillain–Barré syndrome occurring in Europe and North America is the subtype that causes demyelination of the myelin sheath of peripheral neurons. An axonal form is common in China, Japan, India and Central America, but rarely seen in Europe and North America .
Guillain–Barré syndrome is assumed to be an immune-mediated disease where a preceding infection triggers an immune response. This response then cross reacts with the patient’s nerves causing demyelination of nerve fibers or involvement of the axions . The symptoms of Guillain–Barré syndrome are the result of diffuse inflammation of the myelin sheaths of the peripheral nerves and spinal roots  . Studies have linked Guillain–Barré syndrome to Campylobacter jejuni, cytomegalovirus, and Epstein Barr virus .
Guillain–Barré syndrome is actually a group of subtypes resulting in disorders with similar symptoms and courses. The two most common subtypes are: the demyelinating form of the disease accounting for about 75% of cases, and the subtype that attacks the axonal process and spares the myelin .
However, some features of the disorder are not characteristic of this type of pathology . The major reason for rejecting the immune-mediated hypothesis is the lack of a response to immunosuppressive medications in Guillain–Barré syndrome and the fact that it is a single occurrence, acute rather than chronic, illness . Thus the exact pathophysiology of Guillain–Barré syndrome is not fully understood.
There is no clear means of preventing Guillian-Brre syndrome since the exact cause is not known. Prevention of the prodromal infections may decrease the incidence of the disease, however.
Guillain-Barré syndrome (GBS) is an acute autoimmune disease affecting peripheral nerves, central nervous system and the autonomic nervous system . Guillain-Barré syndrome varies in severity and is thought to be triggered by a preceding infection . Symptoms are a result of inflammation of the nerves  . The disorder causes the rapid development of muscle weakness of the extremities, face, neck, and trunk. Muscles involved in swallowing and breathing are often affected . The term Guillain-Barré syndrome actually refers a group of several disorders with similar etiology and pathology  .
The cause of Guillain–Barré syndrome is still not fully understood. The most common theory is that it is an autoimmune response triggered by an earlier bacterial or viral infection. The attack on the nervous system results when antibodies or T-cells mistake neural cells for the infecting microbes .
Guillain–Barré syndrome is a progressive disease, lasting from a few weeks to months. The initial, acute stage reaches a plateau within several weeks. The recovery stage lasts several more weeks or months and is often incomplete .
As many as 12% of patients with Guillain–Barré syndrome die of complications during the acute stage .
What is Guillain– Barré syndrome?
Guillain-Barré syndrome is an auto-immune disorder that causes progressive muscle weakness, sensory-motor losses, and possible life threatening respiratory and cardiac symptoms. It is thought to be the result of a dysfunction of the immune response following a mild viral or bacterial infection.
What are the symptoms?
The complications of Guillain-Barré syndrome are the result of damage to peripheral or cranial nerves. Symptoms include: weakness of muscles of extremities, numbness and tingling of fingers, facial drooping and difficulty swallowing, difficulty walking, pain, and respiratory distress. These complications include respiratory failure, cardiac arrhythmias, permanent motor disability, and possible death.
What causes Guillain–Barré syndrome?
Guillain-Barré syndrome is caused by an abnormal immune response, where nerve cells are mistaken for foreign viruses or bacteria. As a result nerve fibers are attacked by the body’s immune system. Inflammation and damage to these nerves occurs causing the symptoms of the disease.
Who gets Guillain–Barré syndrome?
Anyone, at any age, is susceptible to Guillain- Barré syndrome. In 80% of cases the disorder is preceded by a mild bacterial or viral infection. This disease has also been associated with vaccination, swine flu and rabies in particular. The incidence of Guillain- Barré syndrome seems to increase with age.
How is it diagnosed?
There is no specific test for Guillain-Barré syndrome. Diagnosis is made by the clinical features of the disease: muscle weakness of extremities, facial palsy, pain, and numbness of fingers and toes.
How is Guillain–Barré syndrome treated?
There are two forms of treatment for Guillain- Barré syndrome: plasma exchange and intravenous immunoglobulin therapy. Plasma exchange involves the washing of harmful substances from the blood. immunoglobulin therapy is the infusion of human antibodies from donors into affected individuals. Both of these treatments have been proven to shorten the course of the disease but do not seem to decrease its complications.
What are the complications of Guillain–Barré syndrome?
Complications of Guillain- Barré syndrome include: