Guillain Barré - Part I

What is it?

The Guillain-Barré Syndrome (GBS) is a bacterial or viral infection disease, which will cause humoral and cellular immune dysfunctions. It is classified as an autoimmune disorder, where the immune system attacks components of the nervous system. [1] It primarily affects the peripheral nervous system (nerves), but it can also affect the central nervous system (brain) [2], and occasionally the cranial nerves. [3]

The rehabilitation of a patient with GBS is comprehensive, involving not only clinical management and the use of drugs, but also the management of the functional, social and psychological aspects of disability. There should be a coordinated approach by the whole rehabilitation team, working together towards the independence of the patient, playing the physical therapy a very important role. [3] Most people recover, but the length and degree of recovery varies.

Who is affected

GBS affects all people through all age groups, but it affects mostly adolescents and older adults. Most patients with GBS have had an infection within the three weeks prior to onset of weakness, most commonly consisting of diarrhea or an upper respiratory infection. [4] In about half the cases, there is a recent history of viral or other infection but, rarely, it can appear after vaccination, surgery or trauma. [1]

Symptoms

Patients may experience sensory disturbances (tingling or dull feelings in the hands and feet) a few days before the onset of weakness. Weakness most frequently starts in the distal legs, but may also first appear in the upper legs or in the arms [4]

The weakness may increase until muscles cannot be used at all and may result in paralysis. Muscles of the neck and trunk can be affected, and there may be facial paralysis. [1] The maximal level of weakness is reached within four weeks [4].

The muscular weakness requires admission to the intensive care unit (ICU), due to the weakness of the respiratory muscles. [2]

[1] New Jersey Department of Health and Senior Services (2006). Guillain-Barre Syndrome 

[2] Orsini, M., et al (2010). Guideline for Neuromuscular Rehabilitation in Guillain-Barré Syndrome: What can we do? Rev Neurocienc; 18(4): 572-580  

[3] Doraisamy, P. (1983). Rehabilitation of the Guillain-Barre Syndrome at the Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore. Singapore Medical Journal; 5(24): 289-293

[4] van Doorn, P., A. (2004). Guillain-Barré syndrome. Orphanet Encyclopedia.