Guillain-Barré syndrome

Guillain-Barré syndrome, rare autoimmune condition of the peripheral nervous system. Guillain-Barré syndrome can range from mild to severe. Severe cases typically involve muscle paralysis and potentially life-threatening difficulties in breathing and swallowing. The condition affects individuals of all ages but tends to be slightly more common in adults and in males.

Historical developments

Guillain-Barré syndrome was first described in 1859, by French physician Jean Baptiste Octave Landry, who referred to it as a form of ascending paralysis, in which symptoms start in the legs and progress upward in the body. Owing to Landry’s reports, the condition became known as Landry paralysis. In 1916, French neurologists Georges Guillain, Jean-Alexandre Barré, and André Strohl found that patients with symptoms of a condition resembling Landry paralysis had elevated concentrations of protein in their cerebrospinal fluid. In 1919, Guillain and Barré acknowledged Landry paralysis in a report describing a fatal case of the syndrome they had observed. The condition subsequently took on the name Guillain-Barré syndrome; it is sometimes also referred to as Guillain-Barré-Strohl syndrome, though Guillain and Barré’s reports describing the condition did not include Strohl’s name.

Risk factors and symptoms

The underlying cause of Guillain-Barré syndrome is not fully known. In most instances, the condition develops following a bacterial or viral infection. It is especially likely to occur following infection with Campylobacter jejuni, a species of bacteria that causes diarrhea and vomiting. However, other infections, including those involving cytomegalovirus, Epstein-Barr virus, and influenza virus, can also increase risk of the condition.

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Symptoms of Guillain-Barré syndrome may emerge within several days or a few weeks of infection. Initial symptoms typically include tingling and weakness in the legs or in the arms or upper body; the sensations sometimes spread to the face. Affected individuals may have an unsteady gait or be unable to walk up stairs. They may also feel “pins and needles” sensations in their hands and feet; may experience severe pain, especially at night; or have problems with coordination, digestion, bladder control, or blood pressure. As the condition progresses over hours or days, paralysis of muscles in the legs, arms, or face may occur; paralysis in the latter can cause problems with chewing and swallowing. Roughly 20 to 30 percent of individuals experience paralysis of muscles in the chest, making it difficult to breathe and necessitating mechanical ventilation. These patients are at increased risk of potentially fatal complications, particularly cardiac arrest and the formation of blood clots in the lungs.

Pathophysiology

The pathophysiological mechanisms underlying Guillain-Barré syndrome are complex. The autoimmune attack on peripheral nerves is suspected of occurring when some part of an infectious bacterium or virus very closely resembles a constituent of peripheral nerve cells. The high degree of similarity confuses the immune system and thereby triggers an immune response against both the infectious agent and the peripheral nerve cells. The inadvertent immune attack on the body’s own nerve tissues results in nerve inflammation and demyelination, or the loss of myelin—the fatty insulating sheath on the axon of peripheral nerves that facilitates the conduction of electrical impulses. The loss of myelin leads to muscle weakness, numbness, and paralysis. In some cases, the axons themselves are destroyed.

Depending on pathophysiological and clinical features, Guillain-Barré syndrome may be classified as a specific subtype or variant. For example, it is often subdivided into demyelinating and axonal forms. Demyelinating forms include acute inflammatory demyelinating polyneuropathy (AIDP), which is the most commonly occurring version of Guillain-Barré syndrome. Axonal forms include acute motor axonal neuropathy (AMAN) and acute motor and sensory axonal neuropathy (AMSAN). Miller Fisher syndrome is a rare and often rapidly developing variant of the syndrome that has three defining characteristics: areflexia (loss of tendon reflexes), ataxia (loss of limb coordination), and ophthalmoplegia (muscle weakness in the eyes that results in double vision).

Treatment and recovery

There is no cure for Guillain-Barré syndrome. Treatment is typically with immunotherapy, such as plasmapheresis, in which blood is withdrawn from the body to remove antibodies and is then transfused back into the body, using a replacement plasma fluid. Another immunotherapy that may be used is intravenous immunoglobulin, which involves the injection into a vein of a concentrate of pooled antibodies. Immunotherapy can help reduce symptom severity and duration, especially when initiated 7 to 14 days after symptoms first emerge.

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Recovery from Guillain-Barré syndrome varies. For some individuals, the condition enters remission spontaneously, and damage to nerve cells is limited, facilitating healing and nerve regeneration. In other cases, however, patients require ongoing intensive rehabilitation and immune management. Even with such treatment programs, long-lasting nerve damage and persistent neurological deficits may occur.