Guillain Barre Syndrome: When Your Legs (and More) Feel Like Rubber

Guillain Barre Syndrome: When Your Legs (and More) Feel Like Rubber

It might be upsetting to watch a wave of weakness rise up your body from your ankles. Guillain Barre syndrome, which is more properly known as acute inflammatory demyelinating polyradiculoneuropathy, is when this happens. Guillain Barre syndrome affects only one or two people out of every 100,000 people each year. It is very rare, but it can suddenly disable people and catch them off guard.

The name "acute inflammatory demyelinating polyradiculoneuropathy" is quite long and hard to say, yet it does a good job of describing the disease's main symptoms. Starting from the back end and working forward, "-pathy" means illness; "neuro" says that the peripheral nerves are involved; "radiculo" means that the spinal nerves emanating from the spinal cord are also affected; "poly" means it's a widespread process; "demyelinating" means that the nerve-fibers are stripped of their sheath-like myelin coverings; "inflammatory" means a local tissue reaction to biochemical or physical irritation; and "acute" means that the disease develops rapidly over a matter of days. Even though the entire name teaches you about medical terms, it's easy to see why people typically call the ailment AIDP or Guillain Barre Syndrome (GBS) for short.

Georges Guillain and Jean-Alexandre Barre wrote about cases of this disease in French soldiers during World War I. It is interesting that the condition is called a "syndrome" instead of a "disease." This is because it is possible that more than one disease process can induce the same pattern of clinical sickness (syndrome).

To diagnose GBS, doctors look for the normal pattern of symptoms getting worse over time, with weakness moving up the legs and sometimes even into the arms and breathing muscles. The symptoms get worse quickly, often in only a few days or even hours. The weakness usually reaches its peak 2 to 3 weeks after the symptoms start. The peripheral and spinal nerves that are injured also send messages about how the body feels, but sensory loss is usually a small part of GBS. Weakness, on the other hand, is the main problem because it happens when nerves that send messages to muscles stop working.

The physical exam confirms the weakness in the muscles and, if there is any, the numbness that goes along with it. Another common sign that doctors look for is a loss of tendon reflexes that feel like a rubber hammer. Nerve conduction studies and cerebrospinal fluid analysis are other procedures that can help confirm the diagnosis or, depending on the results, indicate in a different path. Nerve conduction investigations look at how well the electrical signals travel along the peripheral nerves. People with GBS often have nerve impulses that are slowed down or stopped when they move from one portion of the nerve to another. Cerebrospinal fluid is the watery fluid that surrounds the brain, spinal cord, and spinal nerves. A lumbar puncture, also called a spinal tap, is how it is gotten for testing. In GBS, the fluid has more protein but not more red or white blood cells.

We don't know what causes GBS, although it commonly happens after an infection or other immune system challenge and involves inflammation. This makes it likely that GBS is caused by an overactive immune system. In this situation, GBS is one of numerous so-called autoimmune disorders in which the body's own immune system targets a part of the body, in this case the myelin coverings of particular nerve fibers. Rheumatoid arthritis and psoriasis are two other autoimmune diseases. In rheumatoid arthritis, the immune system targets the joints, and in psoriasis, the immune system assaults the skin.

A case series is a group of cases that happen one after the other and have the same agreed-upon characteristics. A case series will help you understand how different the condition might be and which symptoms are more stable.

Researchers from the Aga Khan University Hospital in Karachi, Pakistan, gathered a case series of 34 patients with GBS from 1995 to 2003. The patients were between the ages of 3 and 70, and 62% of them were men. In 35% of the instances, there was a gastrointestinal illness before the current one, and in 26% of the cases, there was a respiratory infection before the current one. In 56% of the instances, breathing stopped, so mechanical ventilation was needed. One person died.

Even though GBS is often very bad, most patients get better, though it takes time. Researchers from the Centre for Rehabilitation Research in Orebro, Sweden, followed the progress of 42 people with this illness in a separate case series. Only 21% of their cases needed mechanical ventilation. After 2 weeks, 1 year, and 2 years of having symptoms, 0%, 38%, and 45% of patients had normal strength. At the same times, 38%, 90%, and 93% could walk 30 feet without help.

Patients with GBS can get treatment. When patients can't breathe on their own, utilizing a mechanical ventilator to help them breathe is a type of treatment that usually saves their lives. Randomized, controlled trials, which are the best way to test a treatment, have demonstrated that two other medicines speed up recovery in GBS.

One is plasmapheresis, or plasma exchange, which separates the liquid part of the blood (plasma) from the blood cells. The blood cells are then put back into the patient's body, and the body makes new plasma on its own to make up for the plasma that was taken out. We don't know why plasmapheresis works, but it probably takes harmful antibodies out of the blood.

The second treatment that has been shown to work is giving the patient immunoglobulin through an IV. The immunoglobulin preparation has antibodies from a lot of healthy donors mixed together. These healthy antibodies probably fight the harmful antibodies that the GBS patient makes.

You may imagine that getting both plasmapheresis and immunoglobulin infusion at the same time or one after the other would be better than just one, but that's not the case. A study found that using both treatments together didn't speed up recovery any more than using just one.

(C) 2006 by Gary Cordingley

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