- What Is Guillain-Barré Syndrome?
- GBS Prevalence
- Causes and Risk Factors
- Types of GBS
- Guillain-Barré Syndrome Symptoms
- GBS Diagnosis
- GBS Complications
- Guillain-Barré Syndrome and the Zika Virus
- Guillain-Barré Syndrome Treatment
- Guillain-Barré Syndrome Prognosis
- Guillain Barré Syndrome – What is GBS?
- What is Guillain Barré Syndrome?
- Fast Facts and Considerations for Guillain Barré Syndrome
- Symptoms of Guillain Barré Syndrome Includes:
- Causes of Guillain Barré Syndrome
- Guillain Barré Syndrome Diagnosis
- How is Guillain Barré Syndrome Treated?
- Guillain Barré Syndrome Recovery and Rehabilitation
- Nursing Care of Guillain Barré Syndrome
- Key Outcomes:
- Guillain-Barré Syndrome
- What is Guillain-Barré syndrome?
- What causes Guillain-Barré syndrome?
- What are the symptoms of Guillain-Barré syndrome?
- How is Guillain-Barré syndrome diagnosed?
- How is Guillain-Barré syndrome treated?
- Key points about Guillain-Barré syndrome
- Next steps
- Guillain–Barré syndrome
- Treatment and care
- WHO Response
What Is Guillain-Barré Syndrome?
Guillain-Barré syndrome is a rare nerve disorder.
Guillain-Barré syndrome (GBS) is an illness that can result in muscle weakness or loss of muscle function in parts of the body.
In people with Guillain-Barré syndrome (pronounced GHEE-yan ba-RAY), the body’s own immune system attacks the peripheral nervous system.
The peripheral nervous system includes the nerves that connect the brain and spinal cord to the limbs. These nerves help control muscle movement.
Guillain-Barré syndrome is a rare disease.
The Centers for Disease Control and Prevention (CDC) estimates that about 1 or 2 out of every 100,000 people develop GBS each year in the United States.
Anyone can get GBS, but the condition is more common in adults than in children, and more men than women are diagnosed with GBS each year.
Causes and Risk Factors
Doctors don’t know what causes Guillain-Barré syndrome.
Many people with GBS report a bacterial or viral infection (such as the flu) days or weeks before GBS symptoms start.
Less common triggers for GBS may include:
Guillain-Barré syndrome is not contagious — it cannot spread from one person to another.
Types of GBS
There are several types of Guillain-Barré syndrome, which are characterized by what part of the nerve cell is damaged.
The most common type of GBS is called acute inflammatory demyelinating polyradiculoneuropathy (AIDP).
In AIDP, the immune system mistakenly attacks the protective nerve covering that helps transmit nerve signals from the brain to other parts of the body.
Guillain-Barré Syndrome Symptoms
The first symptoms of Guillain-Barré syndrome often include feelings of tingling or weakness in the feet and legs. These feelings may spread to the arms and face.
The chest muscles can also be affected. Up to a quarter of people with GBS experience problems breathing.
In very severe cases, people with GBS may lose all muscle function and movement, becoming temporarily paralyzed.
Signs and symptoms of Guillain-Barré syndrome may include:
- Pricking or tingling “pins and needles” sensations in the fingers, toes, ankles, or wrists
- Muscle weakness that starts in the legs and spreads to the upper body
- Unsteady walking
- Difficulty with eye or facial movements (blinking, chewing, speaking)
- Difficulty controlling the bowels or bladder
- Rapid heart rate
- Difficulty breathing
Before diagnosing Guillain-Barré syndrome, your doctor will perform a complete physical and neurological exam to rule out other illnesses that could be causing your symptoms.
Your doctor may then recommend additional tests that can help detect and measure changes in nerve function.
These tests may include:
Spinal tap: Your doctor will insert a needle into your lower back and remove a small amount of spinal fluid for testing.
Electromyography: Thin needles are inserted into certain muscles to measure nerve activity in the muscles.
Nerve conduction: You’ll receive small shocks from electrodes taped to your skin, allowing your doctor to measure nerve function.
In very severe cases of Guillain-Barré syndrome, muscle weakness may impair your ability to breathe. Some people with GBS need a breathing tube and machine to help them breathe.
Most people make a full recovery from GBS, but some people experience lingering problems, including:
- Minor weakness, numbness, or tingling
- Recurring nerve pain
- Sluggish bowels, or the inability to completely empty the bladder
- Blood pressure fluctuations
- Irregular heart rhythm
Guillain-Barré Syndrome and the Zika Virus
Several countries have reported a surge in Guillain-Barré syndrome cases in people who have also been infected with the Zika virus.
It’s not yet known whether the Zika virus can cause or trigger GBS.
Researchers from around the world are currently studying possible links between GBS and Zika.
Guillain-Barré Syndrome Treatment
There’s no cure for Guillain-Barré syndrome, but there are treatments that can reduce the severity of the illness and help speed up recovery.
People with GBS are typically treated in a hospital. Some people with GBS require breathing assistance, a heart monitor, or other medical devices to assist with basic bodily functions while their nerves recover.
Two main types of therapies are used to treat GBS:
Plasma exchange (plasmapheresis): In this procedure, blood is removed from the body and processed so that the blood cells are separated from the liquid portion of blood. The blood cells are then returned to the body.
Plasma exchange appears to reduce the severity and length of symptoms in some people with GBS.
High-dose immunoglobulin therapy: You’ll get injections of high doses of special proteins that help reduce the immune system’s attack on the body’s nerve cells.
Guillain-Barré Syndrome Prognosis
While most people make a full recovery from GBS, this can be a lengthy process. It may take as short as a few weeks — or as long as a few years — to recover.
About 3 to 5 percent of people with Guillain-Barré syndrome die from complications of the illness, according to the World Health Organization (WHO).
Guillain Barré Syndrome – What is GBS?
What is Guillain Barré Syndrome?
Let’s face it, you or someone you know is probably thinking ‘how do I say it?!’
Well, you can thank the Brain Foundation for giving the pronounciation of GBS as ‘ghee-yan bah-ray’ syndrome, named after three French neurologists, ‘who described the condition in two soldiers in 1916’ (2017).
Guillain Barré Syndrome (GBS) is an autoimmune disease in which the peripheral nerves and nerve roots are damaged by the immune system’s antibodies and lymphocytes (Brain Foundation 2017).
Often it will damage the myelin (the nerve insulation) and the axon (the inner covered part of the nerve) which then delays and changes signals to and from these nerves and the rest of the body (Better Health 2014; National Institute of Neurological Disorders and Stroke 2011; Vellozzi et al. 2014).
“As a result of the attack, the nerve insulation (myelin) and sometimes even the inner covered part of the nerve (axon) is damaged and signals are delayed or otherwise changed. The resultant antibodies attack the myelin sheath, and sometimes the axon, causing paralysis and muscular weakness as well as strange sensations, as the sensory nerves of the skin may be affected.”
(Better Health 2014)
Because of the damage caused by GBS, the patient will often present with progressive bilateral and symmetrical weakness and paralysis of the lower limbs as well as disturbed sensory sensations.
Described as ascending paraesthesia (NINDS 2011), the symptoms usually begin in the feet or legs, gradually progressing up the body during the following days and weeks. GBS has also been found to begin in the arms and progress downward but this is less common (Better Health 2014; NINDS 2011; Vellozzi et al. 2014).
The affected person may experience motor nerve related issues such as weakness or paralysis, and/or sensory nerve related issues such as tingling (Brain Foundation 2017).
GBS is not considered to be contagious (Better Health 2014). It can be diagnosed by: muscle strength testing; reflex tests; nerve conduction velocity testing; spinal tap; and physical examination of the signs and symptoms of GBS (Better Health 2014).
Fast Facts and Considerations for Guillain Barré Syndrome
- GBS is associated with having a bacterial or viral infection 1-3 weeks beforehand (e.g. respiratory infections, herpes zoster, glandular fever)
- Other triggers include pregnancy, surgery, dengue fever, Bell’s Palsy, and even insect bites!
- The exact cause is unknown and there is no known cure
- The most commonly identified trigger is gastrointestinal infection with Campylobacter jejuni (one of the most common causes of food poisoning)
- Some people may need to be placed on a ventilator to support breathing
- Males and females are equally as likely to get GBS
- As from the above information, GBS can have mild, moderate, severe, or life-threatening impacts
- It may be hard to diagnose, involving monitoring and ordered pathology tests
- NINDS 2011) report 1 in 100, 000 people get GBS
- As many as 2 to 8 people per 100,000 are affected by GBS; with most people being aged 30-50yrs
(NINDS 2011; Better Health 2014)
Symptoms of Guillain Barré Syndrome Includes:
- Muscle weakness and bilateral paralysis
- Jerky, uncoordinated movements
- Muscle aches, pains or cramps
- Disturbed sensations such as vibrations, buzzing or pins and needles
- Blurred vision
- Breathing difficulties
(Better Health 2014).
Individuals who are experiencing this range of symptoms will often be at an increased risk of other complications such as DVTs, PEs, pressure injuries and pneumonia (to name a few), further impacting on their recover (Better Health 2014).
Generally the symptoms will initially begin over a period of roughly 12 hours before reaching a plateau. The time in which an individual will reach this plateau varies but can be up to weeks following the initial onset of symptoms. From this plateau, the person will then begin to improve and start their recovery (Better Health 2014; NINDS 2011; Vellozzi et al. 2014).
Note that GBS is relatively rare with roughly 2-8 people being affected by this condition in every 100,000 people, is seen to be more common in the 30-59 year old age group and affects both sexes equally. Most patients do recover, however approximately 5% of patients will die (Better Health 2014; Vellozzi et al. 2014)
Causes of Guillain Barré Syndrome
The cause of GBS remains unknown. However, it is also important to note that in two-thirds of patients with GBS, the onset of symptoms is preceded by either an upper respiratory tract infection or a gastrointestinal infection occurring 1-3 weeks earlier (Better Health 2014; NINDS 2011; Vellozzi et al. 2014).
The specific infectious agent remains unknown in over half of GBS cases. However there have been several infectious agents that have been associated with the onset of GBS (Vellozzi et al. 2014).
Other events which have been found to potentially be related to the occurrence of GBS include pregnancy, dengue fever, surgical procedures, insect bites and Bell’s palsy (Better Health 2014).
This is why Guillain-Barré is called a syndrome, not a disease. In a disease, there is a clear specific disease causing agent that can be identified. A syndrome however, is classed as a collection of symptoms and signs or what the patient feels and what the doctor can observe – not defined by a clear causing agent. This is why diagnosis can be so difficult for syndromes in comparison to diseases (NINDS 2011).
Guillain Barré Syndrome Diagnosis
As with most conditions, it can range from being classed as mild to severe. In the most severe cases, the individual will often need life support as the nerves controlling their respiratory function and the autonomic nervous system are involved. Once the autonomic nervous system is affected, the individual can experience changes to their blood pressure, heart rate, vision, kidney function and regulation of body temperature (Better Health 2014; NINDS 2011).
This difficulty in diagnosing GBS is mainly due to the range of symptoms the individual presents with, that initially appear vague and unrelated to each other. Diagnosis will often rely on a physical examination including muscle strength and activity tests, reflex tests, nerve conduction tests and spinal taps to check for increased protein in the cerebral spinal fluid (Better Health 2014; NINDS 2011).
How is Guillain Barré Syndrome Treated?
Note: GBS is an emergency condition because it could lead to dangerous heart rates, blood pressures, and/or respirations (NINDS 2011). Kidney function and body temperature may also be affected (Better Health 2014).
Treatment for GBS always occurs in hospital. The person, no matter how insignificant their symptoms may initially appear, are always admitted into hospital for monitoring. This is so that if any complications occur that may affect vital functions, treatment can be initiated immediately (Better Health 2014; NINDS 2011).
There is no cure for GBS, however some treatment options include Gammaglobulin (IVIG) infusions over a period of 5 days. IVIG infusions help lessen the immune attack on the nervous system, however it is not know completely how or why this works. Plasmapheresis can also be undertaken in which the blood is taken from the person, the immune cells are then removed and the remaining red blood cells are returned to the body. Both are effective in reducing the severity of GBS and assisting in recovery, however IVIG infusions have been proven effective through trials and are often easier to administer so may be done more often than plasmapheresis (Better Health 2014; NINDS 2011).
Guillain Barré Syndrome Recovery and Rehabilitation
- Fortunately, many people with GBS recover well
- Recover could take between 6 months and 2 years
- Some people may be left with ongoing disabilities
Recovery from GBS varies. Most people spontaneously recover, however approximately 10-15% of people are also left with lengthy rehabilitation and permanent disabilities. Recovery times can vary between 6 months and two or more years. Most often the recovery time is better for the individual whose symptoms begin to ease earlier (Better Health 2014).
As with any neurological condition, and no exception being made to Guillain Barré Syndrome, assessment of the patient on entry to rehabilitation is essential. This assessment will include areas of the clinical history of the patient, initial presentation and any other medical conditions as well as other presenting symptoms such as paralysis, sensation disturbances, fatigue, spasticity and muscle tone (Mauk 2012).
Assessment is important in order to plan and implement a successful rehabilitation program for the patient. A program will often include extensive therapy from all members of the multidisciplinary team including a physiotherapist, occupational therapist, medical officers, speech pathologist, dietician and psychologist, to name a few, and lets not forget the important role that nurses play in the rehabilitation of someone with Guillain Barré Syndrome.
Nursing Care of Guillain Barré Syndrome
The role of a nurse during the rehabilitation of someone who has experienced Guillain Barré Syndrome is complimentary to the rest of the multidisciplinary team and involves providing critical education to the patient and family, as well as support and reassurance during recovery.
This education can encompass a variety of areas and will differ depending on the specific individual and their lifestyle. Often the education will be provided to help ensure adherence to the treatment recommendations made by the multidisciplinary team (Mauk 2012). Education may involve strategies to assist in the individual transferring safely or eating their food safely and decreasing their aspiration risk, or medication management for when they discharge home.
As mentioned, recovery from GBS varies, however 30% of patients will still have some residual weakness 3 years following the event, with 3% suffering further relapses of muscle weakness and tingling for many years after the initial illness.
Recovery can also be hampered by the emotional and psychological difficulties that often hinder the patient with GBS (NINDS 2011) – especially those with residual and permanent disabilities following the illness. Therefore, nursing care of the patient with GBS is varied but must look at the holistic view of the patient and take into account where they are at in their recovery from GBS.
Key Points to Nursing Care include:
- Watching for blood clots / DVT
- Monitor vital signs closely
- Keep patient safe from falls risks, considering that weakness or paralysis may occur
- Provide pain management appropriate to the individual – evidently, there will be a need to consider the types of analgesics used and their potential side effects on the person affected by GBS
- Remember, people at any age can be affected by GBS
- You may need to help the client to control their body temperature
- Complications of GBS can involve pneumonia and respiratory failure – you may need to complete regular, thorough observations and assessments (including respiratory assessments) of the client
- Referral to other health professionals in the multidisciplinary team e.g. physiotherapists to improve mobility and prevent deformity
- Education to patient and family members or carers
- Increase your awareness of this uncommon condition
- Remember the key points to nursing care of a patient with Guillain Barré Syndrome
- Understand the seriousness of this condition and what associated risks can develop
- Remember, empathy and genuine care for the client and their unique experience can go a long way to contributing to the success of a person’s recovery
What is Guillain-Barré syndrome?
Guillain-Barré syndrome (GBS) is also called acute inflammatory demyelinating polyradiculoneuropathy (AIDP). It is a neurological disorder in which the body’s immune system attacks the peripheral nervous system, the part of the nervous system outside the brain and spinal cord. The onset of GBS can be quite sudden and unexpected and requires immediate hospitalization. It can develop over a few days, or it may take up to several weeks with the greatest weakness occurring within the first couple of weeks after symptoms appear.
GBS is rare, affecting about 3,000 people in the U.S. It can affect people at any age and both men and women equally. GBS often develops after a respiratory or gastrointestinal viral infection.
What causes Guillain-Barré syndrome?
It’s not clear why some people get GBS. What is known is that the body’s immune system begins to attack the body itself.
Normally, the cells of the immune system attack only foreign material and invading organisms, but in GBS, the immune system starts to destroy the myelin sheath that surrounds the axons of many nerve cells, and, sometimes, the axons themselves.
When this occurs, the nerves can’t send signals efficiently, the muscles lose their ability to respond to the commands of the brain, and the brain receives fewer sensory signals from the rest of the body. The result is an inability to feel heat, pain, and other sensations.
GBS can occur after a viral infection, surgery, injury, or a reaction to an immunization.
What are the symptoms of Guillain-Barré syndrome?
These are the most common symptoms of GBS. But each person may have slightly different symptoms.
The first symptom includes weakness or tingling sensations in the legs. This sometimes spreads to the arms and upper body. A neurological exam usually reveals a loss of all deep tendon reflexes. The symptoms may get worse. In some cases, you may not be able to use your muscles at all. You become paralyzed, and breathing is hard. Your blood pressure and heart function are affected. GBS is a medical emergency and needs to be treated promptly.
Although symptoms can become life-threatening, partial recovery is possible from even the most severe cases of GBS. But you may always have some degree of weakness.
The symptoms of GBS may look like other health conditions. Always talk with your healthcare provider for a diagnosis.
How is Guillain-Barré syndrome diagnosed?
The signs and symptoms of GBS vary. It can be difficult to diagnose in its earliest stages.
These signs and symptoms are unique to GBS:
- Symptoms on both sides of the body
- Symptoms appear quickly–days or weeks instead of months
- Loss of reflexes
- High protein level in cerebral spinal fluid. This is the fluid that surrounds the spinal cord and brain.
To diagnose GBS, you may have the following tests:
- Spinal tap (lumbar puncture). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to find out if there is an infection or other problems.
- Electrodiagnostic tests, such as electromyography (EMG) and nerve conduction velocity (NCV). These studies are done to evaluate and diagnose disorders of the muscles and motor neurons. Electrodes are inserted into the muscle, or placed on the skin overlying a muscle or muscle group, and electrical activity and muscle response are recorded.
How is Guillain-Barré syndrome treated?
There is no known cure for GBS. The goal of treatment is to prevent breathing problems and relieve symptoms. You will need to stay in the hospital for treatment. Medicines are used to control pain and other conditions that may be present. In addition, you may get treatments, such as plasmapheresis or immunoglobulin, to suppress the immune system and reduce inflammation caused by the immune system’s response to the disease.
- Plasmapheresis is a procedure that removes the plasma (liquid part of the blood) and replaces it with other fluids. Antibodies are also removed with the plasma, which is thought to help reduce the symptoms of the disease.
- Immunoglobulin is a blood product that helps to decrease the immune system’s attack on the nervous system.
Other therapies include hormonal therapy and physical therapy (to increase muscle flexibility and strength).
Through research, new treatments for GBS are continually being identified.
Key points about Guillain-Barré syndrome
- Guillain-Barré syndrome (GBS) is a neurological disorder in which the body’s immune system attacks part of the peripheral nervous system.
- The onset can be quite sudden and unexpected and requires immediate hospitalization.
- The first symptoms include varying degrees of weakness or tingling sensations in the legs, which, sometimes, spreads to the arms and upper body.
- The goal of treatment is to prevent breathing problems and relieve symptoms.
- Recovery can be lengthy and residual muscle weakness or paralysis can occur.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
In Guillain-Barré syndrome, the body’s immune system attacks part of the peripheral nervous system. The syndrome can affect the nerves that control muscle movement as well as those that transmit pain, temperature and touch sensations. This can result in muscle weakness and loss of sensation in the legs and/or arms.
It is a rare condition, and while it is more common in adults and in males, people of all ages can be affected.
Symptoms typically last a few weeks, with most individuals recovering without long-term, severe neurological complications.
- The first symptoms of Guillain-Barré syndrome include weakness or tingling sensations. They usually start in the legs, and can spread to the arms and face.
- For some people, these symptoms can lead to paralysis of the legs, arms, or muscles in the face. In 20%–30 % of people, the chest muscles are affected, making it hard to breathe.
- The ability to speak and swallow may become affected in severe cases of Guillain-Barré syndrome. These cases are considered life-threatening, and affected individuals should be treated in intensive-care units.
- Most people recover fully from even the most severe cases of Guillain-Barré syndrome, although some continue to experience weakness.
- Even in the best of settings, 3%–5% of Guillain-Barré syndrome patients die from complications, which can include paralysis of the muscles that control breathing, blood infection, lung clots, or cardiac arrest.
Guillain-Barré syndrome is often preceded by an infection. This could be a bacterial or viral infection. Guillain-Barré syndrome may also be triggered by vaccine administration or surgery.
In the context of Zika virus infection, unexpected increase in cases of Guillain-Barré syndrome has been described in affected countries. The most likely explanation of available evidence from outbreaks of Zika virus infection and Guillain-Barré syndrome is that Zika virus infection is a trigger of Guillain-Barré syndrome.
Diagnosis is based on symptoms and findings on neurological examination including diminished or loss of deep-tendon reflexes. A lumbar puncture may be done for supportive information, though should not delay treatment. Other tests, such as blood tests, to identify the underlying trigger are not required to make the diagnosis of GBS and should not delay treatment.
Treatment and care
The following are recommendations for treatment and care of people with Guillain-Barré syndrome:
- Guillain-Barré syndrome is potentially life-threatening. GBS patients should be hospitalized so that they can be monitored closely.
- Supportive care includes monitoring of breathing, heartbeat and blood pressure. In cases where a patient’s ability to breathe is impaired, he or she is usually put on a ventilator. All GBS patients should be monitored for complications, which can include abnormal heart beat, infections, blood clots, and high or low blood pressure.
- There is no known cure for GBS. But treatments can help improve symptoms of GBS and shorten its duration.
- Given the autoimmune nature of the disease, its acute phase is typically treated with immunotherapy, such as plasma exchange to remove antibodies from the blood or intravenous immunoglobulin. It is most often beneficial when initiated 7 to 14 days after symptoms appear.
- In cases where muscle weakness persists after the acute phase of the illness, patients may require rehabilitation services to strengthen their muscles and restore movement.
WHO is supporting countries to manage GBS in context of Zika virus infection by:
- Enhancing surveillance of GBS in Zika affected countries.
- Providing guidelines for the assessment and management of GBS.
- Supporting countries to implement guidelines and strengthen health systems to improve the management of GBS cases.
- Defining the research agenda for GBS.