2025-02-26 06:12:42  |    Med Health Pulse   Disease Treatment

What Is Guillain-Barré Syndrome (GBS)?

• Guillain-Barré Syndrome (GBS) is an acute paralytic polyneuropathy that affects the peripheral nervous system, and it causes an acute meaning quite quick onset of symmetrical affecting both sides equally ascending weakness.
• Its weakness is that, coming up from the feet upwards, it can also affect the sensory nerves, causing a sensory neuropathy. It's usually triggered by an infection and is particularly associated with gastroenteritis caused by Campylobacter jejuni or infection with cytomegalovirus or Epstein-Barr virus.

How Infections Can Identify Guillain-Barré Syndrome

• To describe it as a neurological condition, it's quite a serious neurological condition that can affect your nerves, leading to weakness predominantly, but also sensory changes like numbness or tingling. It can affect the arms and legs, but can sometimes also affect your ability to breathe or your ability to chew, swallow, and speak. The unique thing about GBS is that there are several other nerve conditions like this one, is that it usually occur quite rapidly, and a lot of times it's triggered by something, usually in an infection.
• So about 60 percent of the time after an infection like an upper respiratory tract infection or a gastrointestinal infection someone can react to it and develop this condition the reason behind it is perhaps something called molecular mimicry which means that the microbes the virus or the bacteria that one is exposed to looks similar to some components of the nerve, so the body thinks it's protecting itself but it actually will cause some damage to the nerves and lead to this condition.

What are the Symptoms to Look for When Diagnosing GBS?

• Some of the early symptoms that a specialist doctor should be aware of, as the symptoms develop, because many neurological conditions overlap, they cause weakness and numbness, and a lot of people feel that for many different reasons. But when something is relentlessly aggressive and develops rapidly over a period of a number of days or weeks, up to about six to eight weeks, and someone develops these symptoms of weakness, numbness.
• Sometimes in an ascending pattern, meaning it starts in the feet and rapidly moves up the arms or legs. Sometimes not sometimes it can affect the arms and legs in a different pattern, but when the key is when it happens very aggressive and relentless.

How Important is Early Diagnosis for Recovery From Guillain-Barré Syndrome?

Symptoms:

Some treatments can either halt or reduce the aggressiveness of the GBS, and the earlier they're instituted better. If someone gets to the hospital and is diagnosed and is treated with something like IVIG (intravenous immunoglobulin) or plasmapheresis, which is an exchange of the blood as early as within two weeks, that gives the patient the best chance of recovery, and if it can happen even sooner than that, then the better the chance of recovery. So that's why the sooner the better for sure, and if it can be done even sooner than that, within the first few days again the better chance of recovery. Again, usually that is done in hospitals when someone can identify that and be referred to a hospital to get tests in early treatment, which gives the patient the best chance of recovery.

Recovery

1. Recovery from GBS is different for everyone a lot of it depends on the aggressiveness of the gbs as it occurs a lot of it will also depend on how quickly the patient is identified and maybe receives one of those treatments like IVIG or plasmapheresis but after that acute period the usual or routine recovery phase is a fairly early phase of recovery that can occur more quickly and there can be an early phase followed by a longer plateaued but increased chance of recovery that are going to occur over a longer period of time.
2. Generally initial recovery we always hope for that early boost of recovery that can occur with the treatments over the first few days or weeks but the general recovery that follows that's a little more slow can occur usually over months and sometimes even into the second year after GBS, after this period of time recovery is thought to be perhaps very slow or a plateau may have reached now having said that i have heard patients still getting gains after many years after GBS but generally we're talking about the first year or two after gbs where most of the recovery will have occurred.

What Long-term Effects Can Patients with GBS Expect?

• So the way that GBS can affect people in the long term is because weakness, sensation, and balance are affected. These are the main things that can remain, and one would hope for additional improvement and stabilization, and recovery from these, but these are the types of things that one can feel after GBS. 
• So, residual weakness, residual balance difficulties performing daily activities, some of the things that are not talked about as much from these other obvious symptoms are pain, so a lot of patients with GBS can have pain.
• Imagine you know brick, carrying a set of bricks around, or wearing gloves while you are trying to maneuver and do things, so you hope that these things are lifted from you, but if you push through it can be painful, joints and ligaments can then be affected, and so there can be muscle soreness.
• Some other symptoms are fatigue, it is huge in GBS even though it's primarily the nerves and muscles because it takes so much effort to do regular activities fatigue is a big factor and then one final one is muscle cramps muscle cramps can often occur in many settings in the setting of many nerve diseases and GBS is one of them as well something to be aware of and maybe to ask about.

How to Diagnose Guillain-Barré Syndrome?

Guillain-Barré Syndrome, four important major types of GBS, and in each type, you have some sort of local variant we look into that also so the most commonly encountered type of GBS is:

AIDP (acute inflammatory demyelinating polyneuropathy)

Acute Inflammatory Demyelinating Polyneuropathy, a localized variant of ADP that is facial. We have bilateral fission of pulsy along with parasthesia, so this is known as facial diplegia and parasthesia.

Axonal Varieties of GBS:

You can have external varieties of GBS. Remember that axial varieties have a poor prognosis compared to demyelinating varieties. Actional varieties of GBS have a poor prognosis; they have a delayed recovery and usually an incomplete recovery.

AMAN (Acute Motor Axonal Neuropathy):

So we have a condition that is acute motor axonal neuropathy, and a localized variant of women is known as acute pharyngeal cervicobrachial neuropathy, so this is a localized type of amine in case you are also going.

AMSAN (Acute motor sensory axonal neuropathy):

It has sensory involvement in axial types, it is known as amsun that is acute motor sensory axonal neuropathy.

Miller Facial Syndrome:

It is characterized by a reflexia, so you will have a reflexive without weakness, and then you'll have ataxia. Remember, this ophthalmology is going to be complete, you're going to have both external as well as well as internal of thermoplastic, which means even your pupillary reaction is going to be involved. So Miller Fisher's syndrome is classically associated with antibodies to GQ1b, okay, that's why Miller Fisher syndrome and its variants come to come under a spectrum of disorders which is known as anti-GQ1b antibody syndromes, and they.

Comprises 5 of all GBS cases, so Miller-Fischer's syndrome, sometimes you might not have all three classical features so you can have incomplete forms where you have an acute ophthalmoparesis without ataxia, and you can also have an acute ataxic neuropathy without ophthalmoplegia, and a very important MCQ question the cns variant of anti-gq 1b antibodies spectrum of disorders is because of encephalitis.

So it's very simple, basically you have a patient with Miller Fisher syndrome also having altered sensory, presenting also with all types in sodium, so this is known as because of encephalitis, it's a CNS variant of MFS, and it's an important MCQ question.

Now coming to the different antibodies and different types of GBS, the most commonly encountered type is going to have anti-GM1 antibodies, okay, so all the antibodies are important MCQ questions, so make sure you remember them. And then for your axonal variety that is acute motor axon and neuropathy you're going to have anti-gd 1a antibodies and for miller fischer syndrome as we discussed earlier anti-gq 1b this is a very very important frequently asked mcq question and then we have a variety of women as we discussed earlier we have a localized variety of or variant of amon that is known as acute pharyngeal cervical brachial neuropathy here you're going to have anti-gt 1a antibodies so remember the four antibodies and where they're going to come next coming to the clinical.

What advice should patients suffering from GBS take?

1. A patient or family members that have been recently been diagnosed with GBS first and foremost is that you're not alone this is a rare disease so perhaps seek others around you then that's where cidpgbs foundation is key to kind of provide support and information and also seek resources about what is expected about some of the therapies and some of the rehabilitation that can occur and also to maintain hope there is always hope for ongoing recovery.
2. Especially the first year or two after the the illness uh might seem like dire straits at the beginning that something so traumatic and difficult has happened but with rehabilitation there can be recovery that will happen GBS is not expected to happen again or recur or be a chronic disease but it is a what we call a monophasic disease it hits you hard early but after that phase there can be improvement in recovery so always maintain hope i got a call the middle of the night while i was on call and heard the story about someone with rapid progression of weakness and GBS was on the very top of our minds and rushed to the hospital to try to confirm that that was the case and as i said intervene as soon as possible this person had gotten to the hospital very quickly which was encouraging so we're very hopeful that treating this would help halt the progression and this is something that was evolving hour to hour.
3. So you know in the morning he had had some arm weakness by the afternoon his legs were very weak and so we worked very hard with the icu team the intensive care unit the medical team to really try to get him the best treatment with IVIG as soon as possible it's not always easy to mobilize this can be a complex treatment to give but all the treatment.

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