What is Guillain-Barré Syndrome?
Guillain-Barré Syndrome (GBS) is a rare illness which affects the peripheral nervous system. The peripheral nervous system contains the nerves that are outside of the brain and spinal cord. In Guillain-Barré Syndrome, the covering layer of the nerve, called the myelin sheath is damaged, and signals cannot be properly received or sent to and from the brain. As a result of this, the nerves cannot transmit signals efficiently.
GBS is an autoimmune disorder. Autoimmune disorders happen when the defence system of the body (immune system), mistakes the person’s own cells/tissues as foreign, and begins to attack them. In GBS, the immune system attacks the peripheral nervous system and starts to destroy the myelin sheath that surrounds the nerves.
Image found at mayoclinic.com
GBS normally affects the muscles of the legs and arms but can affect all parts of the body. It can cause symptoms such as numbness, tingling, vibration and pain. The symptoms typically start in the feet or legs and progress up the body (ascending paralysis), but can sometimes start in the arms and progress downwards (descending paralysis). In some people, the whole body can become paralysed, including the muscles used for breathing and the muscles of the face. Symptoms can take a few days or weeks to progress. Recovery may take six months to two years or more. GBS can occur at any age, but mostly occurs in young adult and the elderly. The incidence of GBS is approximately 1-2 in 100000 people each year.
What causes Guillain-Barré Syndrome?
The exact cause is unknown. However, the autoimmune reaction that causes the nerve damage is usually triggered by an infection, such as a cold, sore throat or a stomach virus. It may also be related to having an immunisation, childbirth, or surgery. GBS is not contagious.
Signs and symptoms
- Varying degree of muscle weakness and paralysis affecting both sides of the body
- Jerky, uncoordinated movements
- Muscle aches, muscle spasm, pains or cramps
- Abnormal sensations such as tingling, vibrations
- Blurred vision
- Difficulty breathing
What tests are done to diagnose Guillain-Barré Syndrome?
As well as the patient having a medical history taken and medical examination, there are a few other tests which may be done to diagnose GBS:
A needle is inserted in between the bones of the lower back into the fluid around the spinal cord. A small amount of spinal fluid is taken and the protein level is tested. In GBS, the protein level is usually increased.
Electromyogram (EMG or Electromyography)
A thin-needle electrode is inserted into the muscle to be tested and electrodes are placed on the skin over peripheral nerves. This test helps to determine if the peripheral nerves are not communicating between the brain and muscles in the body.
Nerve Conduction Study (NCS)
Two electrodes are taped to the skin in the affected area of the patient's body. A small shock is then passed through to measure the electrical impulses from one electrode to the other. This test records how long it takes for the electrical impulse to travel from one electrode to another. If the impulse is slow, it suggests nerve damage.
How is Guillain-Barré Syndrome treated?
There is no cure for GBS, but a number of treatments can shorten the duration of the illness and relieve symptoms.
Plasmapheresis (Plasma Exchange)
In this treatment, blood is "cleansed" of the damaging antibodies that are present in GBS. Antibodies are a substance used by the immune system to identify and destroy or neutralise foreign objects in the body, such as bacteria and viruses. A plastic catheter (called a vas cath) is inserted into the neck or groin of a patient (see insertion of central line). Blood is withdrawn and sent via plastic tubing and passes through a series of filters that separate the different types of blood cells. The red and white blood cells are separated from the plasma (the liquid part of the blood). The blood cells are then combined with replacement fluids and returned to the patient. Plasmapheresis is thought to remove the substances that damage myelin, because the plasma component of the blood contains important elements of the immune system. In some cases it can shorten the course of GBS, alleviate symptoms, and prevent paralysis.
Intravenous Immunoglobulin (IVIg)
Immunoglobulin (IVIg) contains healthy antibodies from blood donors. High doses of immunoglobulin are injected into the patient through an intravenous line to block the damaging antibodies in the blood that may contribute to GBS.
What happens in the Intensive Care Unit?
- Monitoring of the heart rate, blood pressure, oxygen saturation and temperature. This will be seen on a bedside monitor.
- An arterial line may be inserted to monitor blood pressure and to take blood samples.
- Medication and intravenous fluids may be given via a central venous catheter including sedatives (to assist in sleep), analgesics (pain killers) and antibiotics (for infections). These medications will be given via infusion pumps.
- Oxygen may be delivered via a face mask, and mechanical ventilation via an endotracheal tube or tracheostomy may be required to assist with breathing. The ventilated patient will require suctioning to remove secretions from the lungs and airways.
- If the patient is unable to eat, nutrition may be given via a nasogastric tube. This is a tube that is placed in the nose and goes down the throat into the stomach. Fluid can also be removed from the stomach via the nasogastric tube.
- Insertion of an indwelling catheter to drain and measure urine output.
- Chest x rays and other tests such as blood tests.
- Sequential compression devices may be put on the legs to prevent the formation of blood clots.
- An air mattress may be used to prevent pressure areas developing.
- Care of the eyes is very important, as sometimes even blinking the eyes may be affected.
How long will the patient remain in ICU?
A patient may need to remain in ICU for weeks to many months, depending on the severity of GBS. Please ask the ICU nurse or doctor if you have any questions.
Guillain-Barré Association on New South Wales
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
Guillain-Barré Syndrome Version 1
Author Kathleen Ryan CNC ICCMU
First published August 2008