Guillain-barre syndrome – symptoms, diagnosis and treatment electricity and magnetism connect to form

##

Normally, the cells of the immune system attack only foreign material and invading organisms, but in Guillain-Barre syndrome, the immune system starts to destroy the myelin sheath that surrounds the axons of many nerve cells, and sometimes the axons themselves.

The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances. When they are injured or degraded, nerves cannot send signals efficiently, and muscles begin to lose their ability to respond to the brain’s commands. And, the brain also receives fewer sensory signals from the rest of the body, resulting in an inability to feel textures, heat, pain, and other sensations.

If Guillain-Barre is preceded by a viral infection, it is possible that the virus changes the nature of cells in the nervous system causing the immune system to interpret them as foreign cells. It is also possible that the virus makes the immune system itself less discriminating about what cells it attacks. Incidence; Causes and Development

The cause of GBS is not known. Perhaps 50% of cases occur shortly after a microbial (viral or bacterial) infection such as a sore throat or diarrhea. Many cases developed in people who received the 1976 swine flu vaccine. Some theories suggest an autoimmune mechanism, in which the patient’s defense system of antibodies and white blood cells are triggered into damaging the nerve covering or insulation, leading to weakness and abnormal sensation. Signs and Symptoms

The disorder can develop over the course of hours or days, or it may take up to three to four weeks. GBS is characterized by the rapid onset of weakness and often paralysis of the legs, arms, breathing muscles and face. Abnormal sensations often accompany the weakness.

The symptoms of GBS vary a great deal from patient to patient, and so each has a unique case history. Pain appears to be a common feature and the symptoms usually appear soon after an infection. They increase in intensity over a period of time, varying from a few hours in serious cases, to around 4 weeks in most patients. The symptoms vary, also with regard to the pattern in which they appear. Their distribution is usually symmetrical and double-sided. This means that the symptoms appear on both the left and right side of the body, but they may also appear randomly, especially in the beginning. They may appear for a short while, disappear for some days, and reappear shortly.

GBS symptoms vary, depending on whether the syndrome has affected the sensory nerve fibers (that transmit signals from a body area to the brain and spine), or the motor nerve fibers (that transmit signals from the brain and spine to a body area). When both motor and sensory nerves are affected, the patient experiences a mixture of symptoms. The patient may also experience disruption in the working of the autonomous nervous system.

The few patients who experience a mild attack of GBS feel weak, may think they have a viral infection and perhaps experience a brief sensory reduction. They are not ill enough to seek a doctor, and as the illness disappears completely after a few days or weeks, they may be completely ignorant of the fact that they’ve just had GBS.

In moderate cases, the patient may partially or completely lose the ability to walk and carry out daily chores. This frightens the patient, who then seeks medical help after a while. The course of the syndrome is unpredictable, and the patient is generally hospitalized immediately for diagnosis, observation and treatment.

In very serious cases, the entire body can be paralyzed, even including the eye muscles. GBS can – very rarely – present with coma and absent brainstem reflexes. Such patients are NOT brain dead; their brains and sense of hearing and smell work perfectly well, and the patient is alert and conscious of what is going on around him or her. But he or she can literally not move a muscle in response.

In some cases, the face may be affected when damage occurs to the cranial nerves. These connect the brain to the muscles of the jaw, face and tongue, and also control the muscles that move the patient’s head, neck and shoulders. As the paralysis progresses, all these areas may be paralyzed. The eyelids or one side of the face may droop, the face loses it’s ability to express feelings.

The autonomous nerves control the inner organs, whose function is normally carried out automatically, such as secretion of hormones, vision, urination, breathing, heart beat, etc. These functions may be disrupted, resulting in arrhythmia, unstable blood pressure, blurred or double vision, dizziness, fainting spells, inability to regulate the body temperature, difficulty breathing, reduced ability to control the function of the stomach, digestive system and bladder, loss of weight, vomiting after meals, reduced function of various glands, incontinence, impotency, etc. It may be difficult to urinate, and the bladder may feel as it is not being emptied. Diagnosis and Tests

Guillain-Barre is called a syndrome rather than a disease because it is not clear that a specific disease-causing agent is involved. The signs and symptoms of the syndrome can be quite varied, so doctors may, on rare occasions, find it difficult to diagnose Guillain-Barre in its earliest stages.

In addition, other disorders have symptoms similar to those found in Guillain-Barre, so doctors evaluate carefully before making a diagnosis. Signs and symptoms that may differentiate Guillain-Barre from other disorders include the following. With Guillain-Barre:

Quite often, the patient’s symptoms and physical exam are sufficient to indicate the diagnosis. To confirm the diagnosis, a lumbar puncture to find elevated fluid protein and electrical test of nerve and muscle function may be performed. Treatment and Prevention

Care involves use of general supportive measures for the paralyzed patient, and also methods specifically designed to speed recovery, especially for those patients with major problems, such as inability to walk. Plasma exchange (a blood "cleansing" procedure) and high dose intravenous immune globulins are often helpful to shorten the course of GBS.