Guillain-Barré Syndrome

Question 1

What is Guillain-Barré syndrome?

Answer 1

Guillain–Barré syndrome is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system.

Typically, both sides of the body are involved, and the initial symptoms are changes in sensation or pain often in the back along with muscle weakness, beginning in the feet and hands, often spreading to the arms and upper body

Question 2

What is the pathophysiology of Guillain-Barré syndrome?

Answer 2

Paralysis follows 1–3 weeks after an infection that is often trivial and seldom identified

Infecting organisms induce antibody responses against peripheral nerves
Molecular mimicry, i.e. sharing of homologous epitopes between microorganism liposaccharides and nerve gangliosides (e.g. GM1), is the possible mechanism

Question 3

What organisms can cause Guillain-Barré syndrome?

Answer 3

Campylobacter jejuni and cytomegalovirus infections are well-recognized causes of severe GBS

Question 4

What is the clinical presentation of Guillain-Barré syndrome?

Answer 4

Numbness, pins and needles, muscle weakness, pain, problems with balance and co-ordination. Areflexia

The patient complains of weakness of distal limb muscles and/or distal numbness. Low back pain is a frequent early feature.

The weakness and sensory loss progresses proximally, over several days to 6 weeks.

Question 5

How would you diagnose Guillain-Barré syndrome?

Answer 5

This is established on clinical grounds and confirmed by nerve conduction studies; these show slowing of conduction in the common demyelinating form, prolonged distal motor latency and/or conduction block

CSF protein is often raised to 1–3 g/L; cell count and glucose level remain normal.

Question 6

How would you manage Guillain-Barré syndrome?

Answer 6

Paralysis may progress rapidly (hours/days) to require ventilatory support

Immunoglobulin (IVIg) given intravenously within the first 2 weeks reduces duration and severity of paralysis.

Question 7

What is the prognosis for Guillain-Barré syndrome?

Answer 7

Improvement towards independent mobility is gradual over many months or even years but may be incomplete. 5–8% either die and 30% are left disabled

Question 8

What is the most common subtype of Guillain Barre?

Answer 8

Acute Inflammatory Demyelinating Polyradiculoneuropathy

AIDP