A Brief Synopsis of AFP's "Guillian-Barre Syndrome"

this is a brief synopsis of

Guillain-Barré Syndrome

ANNE D. WALLING, MD, ChB, and GRETCHEN DICKSON, MD, MBA, University of Kansas School of Medicine, Wichita, Kansas

Am Fam Physician. 2013 Feb 1;87(3):191-197.

     GBS is a very rare disease, and although most people recover completely,  up to 3% can die from it. The common clinical symptoms are symmetric ascending weakness, or absent reflexes. Complete areflexia has also been seen in GBS. Other less common, but very important symptoms are arrhythmia, orthostasis, blood pressure instability, cranial nerve involvement, urinary retention, or GI issues.
     Basically, GBS occurs about 3 weeks after a GI or respiratory illness. Common infections are from C. jejuni, M. pneumoniae, H. influenzae,  CMV, EBV, as well as triggering events like stress and surgeries. It occurs through cross-reactivity between the bacterial cell wall and gangliosides, which causes the antibodies to attack our nerves.
     The initial presentation is numbness, weakness, tingling, and pain in the limbs. It is symetrical. The symptoms peak within 2-4 weeks, followed by resolution, often spontaneously, with or withjout some residual diability.
     The CSF can be tested for increase protein levels with a normal WBC count. Electrodiagnostic studies can also be done to test for slowing of nerve conduction.
    Patients should be kept in the hospital during the disease process to monitor respiratory changes, which can precipitate the need for rapid intubation, tracheotomy and/or respiratory support if the ascending paralysis affects breathing. A swallowing eval should be ordered if patients present with cranial nerve dysfunction due to GBS. Other autonomic functions should be monitored as well, such as cardiac rhythm and blood pressure. Patients may need anticoagulation and compression stockings.  Pain is best controlled with gabapentin, or carbamazepine over opiods. PT and strength training has been helpful for patients to regain function and mobility.
     Plasma exchange has been shown to shorten the course of the disease, especially if given within 7 days. This is considered first line therapy. Patients may see benefit even  if treated up to 30 days after onset. IVIG has had similar success if given within 2 weeks, especially in non ambulatory patients. Giving patients both of these has not shown any benefit over monotherapy.