Guillain-Barre

Guillain-Barre

  • Author: Dr. Jaime Espino
  • Date: April 15, 2022

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What is Guillain-Barré Syndrome?

Guillain-Barré Syndrome (GBS) is a serious health condition that occurs when the body's immune system mistakenly attacks part of the peripheral nervous system. This leads to nerve inflammation that causes muscle weakness or paralysis and other symptoms.



Symptoms of Guillain-Barré Syndrome:

Symptoms may include:

  • Areas of pain: Muscles.
  • Muscular: Muscle weakness, abnormal gait, weakness in arms and legs, or coordination problems.
  • Whole body: Fatigue or high blood pressure.
  • Heart: Rapid heart rate or irregular heartbeat.

Also common: facial muscle weakness, difficulty speaking, breathing or swallowing, tingling and burning sensations, slow reflexes, urinary retention, or difficulty lifting the foot.



Causes of Guillain-Barré Syndrome

  • Influenza.
  • Certain gastrointestinal infections.
  • Mycoplasma pneumonia.
  • HIV, the virus that causes AIDS (very rare).
  • Herpes simplex.
  • Mononucleosis.
  • COVID-19.

It can also occur with other conditions such as:

  • Systemic lupus erythematosus.
  • Hodgkin's disease.
  • After surgery.

GBS damages parts of the nerves. This nerve damage causes tingling, muscle weakness, loss of balance, and paralysis. The syndrome most often affects the nerve covering (myelin sheath). This damage is called demyelination, which slows nerve signal transmission. Damage to other parts of the nerve can cause it to stop working altogether.



Types of Guillain-Barré Syndrome

GBS is classified into four pathophysiological types:

  • Acute demyelinating sensory-motor polyneuropathy.
  • Acute motor axonal neuropathy (AMAN).
  • Acute sensory-motor axonal neuropathy (AMSAN).
  • Miller Fisher Syndrome.

Acute demyelinating sensory-motor polyneuropathy: This is the most common type in developed countries (90%). Histopathological studies show macrophage-mediated demyelination and T-cell infiltration.

Acute motor axonal neuropathy (AMAN): The lesion affects nerve terminals, presenting with macrophage-mediated axonal neuropathy, ion channel blockade in the axolemma, and little to no lymphocyte infiltration. AMAN is associated with C. jejuni infection.

Acute sensory-motor axonal neuropathy (AMSAN): Severe damage to sensory and motor axons is observed with minimal lymphocyte infiltration and no demyelination. Changes extend to the proximal portions of the nerve roots and are associated with sudden onset and sensory deficits.

Miller Fisher Syndrome: Triggered by C. jejuni strains, with IgG antibodies against ganglioside GQ1b present in 96% of cases. These antibodies recognize epitopes expressed in nodal regions of oculomotor nerves, dorsal root ganglion cells, and cerebellar neurons.



Diagnosis of Guillain-Barré Syndrome

It is recommended to perform cerebrospinal fluid (CSF) analysis in patients with clinical suspicion of Guillain-Barré Syndrome, after the first week of symptoms. Note that a normal result or a cell count above 50 cells/mm³ does not exclude the diagnosis.

Spinal tap (lumbar puncture). A small amount of fluid is drawn from the spinal canal in the lower back and analyzed for changes often seen in people with Guillain-Barré Syndrome.



Treatment for Guillain-Barré Syndrome

Treatment consists of transfusions. Special blood treatments (plasma exchange and immunoglobulin therapy) may help relieve symptoms. Physical therapy is also needed:

  • Medications: Blood transfusion.
  • Supportive care: Mechanical ventilation and intubation.
  • Therapies: Physical therapy.


Complications of Guillain-Barré Syndrome

In some cases, it can cause paralysis of the legs, arms, or facial muscles. In 20% to 30% of cases, the chest muscles are affected, making breathing difficult. In severe cases, speech and swallowing may be affected.



Prevention of Guillain-Barré Syndrome

There is no known way to prevent Guillain-Barré Syndrome, except by avoiding infection with viruses like HIV or hepatitis, or avoiding mosquito bites in countries where Zika is present. However, in the vast majority of cases, its appearance cannot be prevented due to numerous and sometimes unknown causes that are difficult to control.

Wash your hands with soap and water before and after eating. Eat well-cooked food. Cover your mouth and nose with your elbow or a disposable tissue, never with your hands. Get vaccinated against influenza (especially those over 60 years of age).



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