Guillain-Barré Syndrome

Symptoms of Guillain-Barre syndrome may include:

• Weakness and tingling in legs that spreads to the upper body and arms
• In about 10% of people with the disorder, symptoms begin in the arms or face
• Prickling, pins and needles sensations in fingers, toes, ankles or wrists
• Unsteady walking or inability to walk or climb stairs
• Difficulty with facial movements, including speaking, chewing or swallowing
• Double vision or inability to move eyes
• Severe pain that may be worse at night
• Difficulty with bladder control or bowel function
• Rapid heart rate
• Low or high blood pressure
• Difficulty breathing

As Guillain-Barre syndrome progresses, muscle weakness can evolve into paralysis.  

There is a risk of blood clots and pressure sores due to immobility when patients are unable to walk.

People with Guillain-Barre syndrome usually experience their most significant weakness within two weeks after symptoms begin. In its most severe form Guillain-Barre syndrome is a medical emergency. 

Once thought to be a single disorder, Guillain-Barre syndrome is now known to occur in several forms. 

The main types are:

• Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) – damage to the nerves’ protective covering (myelin sheath) prevents nerves from transmitting signals to the brain, causing weakness, numbness or paralysis, most commonly starting in the lower part of the body and spreading upward.  More common in North America and Europe.
• Miller Fisher syndrome (MFS) – the muscles of the eyes are most affected. MFS is also associated with unsteady gait. More common in Asia.
• Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN) more frequently found in China, Japan and Mexico.

Consult a doctor if you have tingling in your toes or fingers. Seek emergency medical help if the tingly is spreading, or if you experience breathing or swallowing difficulties.

Guillain-Barre syndrome is a serious condition that requires immediate hospitalization because it can worsen rapidly. Rapid diagnosis and treatment are crucial.

The exact cause of Guillain-Barre syndrome is unknown. But in two-thirds of cases the disorder appears days or weeks after a respiratory or digestive tract infection.

In rare cases Guillain-Barre syndrome occurs following recent surgery or vaccination. There have been recent cases reported following Zika virus and COVID-19 infection.

Guillain-Barre syndrome can affect all ages, but the risk increases with age. It is also more common in males than females.

In the early stages, symptoms of Guillain-Barre syndrome vary and can be like those of other neurological disorders.

Diagnosis starts with a medical history and thorough physical examination.

Further tests may be required:

• Spinal tap – testing a small amount of fluid drawn from the spinal canal in the lower back
• Electromyography – thin-needle electrodes used to measure nerve activity in the muscles.
• Nerve conduction studies – to measure the speed of nerve signals.

There is no known cure for Guillain-Barre syndrome. Most people with the condition must be hospitalized to receive treatment. Although most people recover from Guillain-Barre syndrome, the mortality rate is 4% to 7%. 

Treatment which treatments can ease symptoms and reduce the severity of the illness include:

• Plasma exchange (plasmapheresis) – removing the liquid portion of part of blood (plasma) which may contain harmful antibodies but retaining the blood cells. The body produces more plasma to make up for the loss. 
• Immunoglobulin therapy – donated immunoglobulin containing healthy antibodies is transfused. High doses of immunoglobulin can block the damaging antibodies that may contribute to Guillain-Barre syndrome.

Medication may be given to relieve pain or reduce the risk of blood clots.

Physical therapy can help to improve muscle strength and flexibility. Adaptive devices, such as a wheelchair or braces, can help with mobility and independence. 

Recovery usually takes between 6 to 12 months, although for some people it could take as long as three years.

Children, who rarely develop Guillain-Barre syndrome, generally recover more completely than adults.

Diagnosis and treatment of Guillain-Barre syndrome can be physically and emotionally difficult. Support from family members or groups for those affected can be beneficial.