Guillain-Barre syndrome

This disease occurs when the immune system attacks the nervous system, affecting the nerves within the limbs and the rest of the body. It develops after an infection and can affect anyone although young adults and the elderly are at particular risk.

Causes of Guillain-Barre syndrome

This disease develops 3 weeks after an infection -usually caused by any of the following viruses or bacteria:

• Epstein-Barr virus: responsible for glandular fever
• HIV
• Hepatitis B
• Cytomegalovirus

But the strain of bacteria which is more likely to cause Guillain-Barre syndrome is campylobacter jejuni. This is responsible for campylobacter food poisoning – the most common type of infection which occurs as a result of eating contaminated food or water.

So how does this disease develop?

Guillain-Barre syndrome is classed as an ‘autoimmune’disease. This means that the body’s immune system produces proteins known as ‘antibodies’which for some reason, attack various parts of the body.

What appears to be the case is that a prior infection such as campylobacter food poisoning causes antibodies to be released which then destroy the bacteria responsible for this infection.

This is a normal process but, something goes wrong which results in these antibodies attaching themselves to and damaging healthy nerves within the body which then leads to Guillain-Barre syndrome.

Experts believe that the structure of our nerves and that of the bacteria are almost identical which confuses the antibodies into mistaking healthy nerves for hostile bacteria and so attack them.

This damage also affects those muscles which are supplied by these nerves.

Guillain-Barre syndrome differs from other autoimmune diseases in that it has a set time limit. Other autoimmune diseases persist for several years as long term, chronic conditions such as rheumatoid arthritis.

But this disease is different in that the immune system reacts to an infection by producing antibodies which may damage the nerves before settling down. The result of this is that most people completely recover from Guillain-Barre syndrome.

Symptoms of Guillain-Barre syndrome

These appear 3 weeks after an infection. They worsen over a period of time and reach a peak 2 to 4 weeks after the initial onset. These symptoms vary in their severity when they reach this peak, which differs between individuals.

They include:

• Tingling or numbness in the arms and legs
• Weakness: this starts in the lower half of the body and gradually moves up towards the middle. If it spreads to the chest, neck and head then it can affect eye movements, breathing and the ability to swallow.
• Muscle pain or nerve pain: this tends to be worse during the night or when movement occurs.
• Affects the autonomic nervous system: this causes problems with blood pressure, heart rate, body temperature, pulse and eyesight.

The risk with this is if the chest muscles become affected which will lead to breathing problems. If this occurs then the person affected will need to be put onto a ventilator to aid with their breathing. A tube called a ‘naso-gastric’ tube will be inserted to help with swallowing and the digestion of food.

In some cases only the muscles of the legs are affected which will cause a problem with walking although this will ease over time.

The symptoms of Guillain-Barre syndrome reach a peak where they remain in a level state (plateau) for some time before easing. This only occurs once the damaged nerves start to heal.

Diagnosing Guillain-Barre syndrome

This involves a physical examination followed by tests designed to assess electrical activity in the nerves of the body. If this electrical activity follows a set pattern then it may indicate this syndrome.

Another procedure is where a sample of cerebrospinal fluid is removed via the insertion of a needle into the base of the spine. This fluid collects around the spinal cord and brain and acts as a form of protection to both of these. If this fluid contains a high level of antibodies then it is a sign of Guillain-Barre syndrome.

Blood and lung function tests may also be performed.

If the results of these tests confirm that you have Guillain-Barre syndrome then you will be admitted to hospital.

Treatment for Guillain-Barre syndrome

This is necessary due to the fact that these symptoms can spread throughout your body, affecting your heart rate and breathing. So, if for example you develop breathing difficulties, you will receive emergency treatment quickly and efficiently.

If you are exhibiting problems with swallowing or breathing then you will be given help with these and carefully monitored until your condition has improved.

Treatment will include:

• Plasma exchange
• Immunoglobulin injections
• Heparin injections
• Painkillers

Plasma exchange

This exchange involves removing a sample of your blood which is then separated into plasma and blood cells.

Plasma is the villain here as it contains harmful antibodies which are responsible for this disease.

This plasma is removed and replaced with a substitute. This substitute plus the blood cells are then replaced in the body. The earlier this is done the more effective it is.

However, plasma exchange is not undertaken that often due to the fact that injections of immunoglobulin have proved to be as equally as effective and with fewer side effects.

Immunoglobulin injections

Immunoglobulin is a type of protein (antibody) which is produced by the immune system. This injectable version is a combination of immunoglobulins from various blood donors which have been screened for diseases before use.

They work by removing any harmful antibodies and changing the behaviour of the immune system. Immunoglobulin is injected into a vein and slowly, passes into the body.

If you undergo this treatment then your pulse, temperature and blood pressure will be constantly monitored to assess your response. This is important in case you develop any side effects.

Heparin injections

Heparin is an anticoagulant which is used to help thin the blood. You may be given injections of heparin and asked to wear special compression stockings to reduce the risk of thrombosis.

Thrombosis is the medical name for a blood clot which can form as a result of inactivity. You are at increased risk of this due to the fact that you are likely to be immobile in bed for some period of time.

Painkillers

This refers to medication prescribed for nerve related pain.

Most people with Guillain-Barre syndrome recover after 6 months to a year. They will do so without any long term effects.

However, a small percentage of people will suffer some permanent damage such as muscle weakness or problems with walking.