Guillian Barre Syndrome: Symptoms, Causes, Treatment and Management

What is GBS (Guillian Barre Syndrome)?

Guillian Barre Syndrome (GBS) is also called as ‘acute inflammatory demyelinating poly – radiculo – neuropathy’.

GBS is defined as an acute, predominantly motor neuropathy, which progresses to its peak in less than 4wks.

Causes of Guillian Barre Syndrome

Usually affects 20 – 50yrs of age.
Usually male predominate.
In about 70% of patients, GBS precedes an upper respiratory illness or gastrointestinal illness. Infectious agents commonly identified as a precipitation feature are cytomegalovirus and campylobacter jejuni.
Probably a cell mediated immune response to preceding infection is the pathogenesis of GBS.

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Symptoms of Guillian Barre Syndrome

Prodromal stage – presents with headache, vomiting, slight fever, pain in back and limbs.
Latent period – few days to several days.
- Stage of paralysis – some patients may directly present with this stage, initial symptoms being absent.
  
  Alarming clinical picture with motor weakness progressing to paralysis and various sensory disturbances is characteristic.
- Motor symptoms – onset of paralysis is sudden or may be gradual. All four limbs may be paralyzed simultaneously or 1^st lower then upper proximal and distal segment muscles are equally affected. Involvement of muscles of neck and trunk is seen. Loss of superficial and deep reflexes is seen.
- Sensory symptoms – patients complain of radicular pain most commonly in the proximal portion of limbs with numbness and tingling. All forms of sensations may be impaired at periphery and may be associated with muscle tenderness.
- Cranial nerve paralysis – facial and bulbar paralysis is common.
- Reflexes are usually depressed or absent.
- Symptoms of toxemia – include fever, rash, albuminuria and leucocytosis.

Diagnosis of Guillian Barre Syndrome (GBS)

Cerebrospinal fluid (CSF) – shows typical elevation of protein with normal cell count.

Nerve conduction studies – typical early findings are prolonged distal motor latencies in either upper or lower limbs.

Asbury’s Diagnostic Criteria
- Features required for diagnosis
  - Progressive motor weakness of more than one limb.
  - Areflexia.

Features strongly supporting diagnosis
- Clinical features
  - Progression of symptom over days up to 4wks.
  - Relative symmetry of symptom.
  - Mild sensory symptom.
  - Cranial nerve involvement.
  - Recovery beginning 2 – 4wks after progression stops.
  - Autonomic dysfunction.
CSF picture
- Elevated CSF protein after 1wk of symptom.
- Cell count of CSF increased.
- Electro – diagnostic studies.

Development of Guillian Barre Syndrome

Within period of 3wks GBS progresses to maximum disability, often with complete quadriparesis (paralysis of four limbs).
Recovery without significant disability occurs in about 80% of patients.

Management and treatment options for Guillian Barre Syndrome

No specific therapy is known.
Analgesics and hot packs are used as general measures.
Corticosteroids for patients with bulbar symptoms or generalized weakness.
Supportive therapy – intravenous (IV) or intra – gastric feeding may be necessary.
Physiotherapy – early active and passive movements. Splints to prevent foot and wrist drop.
Plasma exchange.
IV immunoglobulin as an alternative to plasma exchange.
Liquorpheresis (CSF filtration) done in few cases. It is a technique to purify CSF from pathological factors (probably responsible to GBS).

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