Guillain-Barré Syndrome (GBS): Causes, Symptoms, Diagnosis, Treatment, and Recovery Explained

What is Guillain-Barré syndrome (GBS)?

Guillain-Barré syndrome (GBS) is a neurological condition where the immune system mistakenly attacks the peripheral nervous system, [1] which consists of nerves connecting the brain and spinal cord to the rest of the body. [2] GBS often follows a respiratory or gastrointestinal infection, commonly triggered by a bacteria named Campylobacter jejuni, though other organisms are also involved.[3]

Nerves have a central core called the axon, surrounded by a protective myelin sheath that speeds up nerve signals. In GBS, the immune system attacks and damages the myelin and sometimes the axons, causing rapid nerve damage. This disrupts communication between the brain and body over hours, days, or weeks, causing pain, numbness, and muscle weakness. [4]

GBS can affect anyone, but it is slightly more common in adults and men. However, depending on other risk factors, it can also occur in children. [5]

Types of GBS

GBS has several types, each with distinct features. The most common type, Acute Inflammatory Demyelinating Polyneuropathy, starts with sudden leg weakness that can spread to your arms and face. [6] It is more common in East Asia. [7] Other types can affect movement, sensation, or coordination.  [8] Some may target the muscles around your eyes, while others might cause weakness in your throat, neck, or upper arms. Each type varies in how it impacts your body. [9, 10, 11]

Causes and Risk Factors of GBS

The exact causes of Guillain-Barré syndrome are unclear, but it likely involves an autoimmune reaction triggered by various factors:

1. Bacterial or Viral Infection

Guillain-Barré Syndrome often follows respiratory illnesses or stomach infections. Common triggers include the flu, Epstein-Barr virus, or Campylobacter jejuni bacteria, which is found in undercooked poultry. [12] These infections can confuse your immune system, leading it to mistakenly attack your nerves. [13, 14]

2. Surgery and Trauma

Sometimes, surgery or trauma can trigger GBS, especially when it affects your nerves. This may happen because the body’s immune system becomes highly active during recovery and mistakenly targets nerve tissue. [15]

3. Vaccinations

In rare cases, certain vaccines, such as the flu vaccine, rabies, meningococcal disease, and COVID-19 vaccine, may be linked to Guillain-Barré Syndrome. While this connection is very uncommon, it’s thought that vaccines might trigger an overactive immune response in some individuals. [16, 17, 18]

Symptoms of GBS

Guillain-Barré syndrome (GBS) symptoms usually begin 1-3 weeks after an infection. They get worse over 2-4 weeks, then stay the same for a while before gradually improving. [19] Common symptoms include:

1. Weakness

You may experience sudden weakness that starts in your legs and moves up to your arms and face. In severe cases, this can lead to complete muscle paralysis. You might also feel tingling or a pins-and-needles sensation, usually starting in your toes and fingers and spreading upward. [20] You might find it hard to smile or shut your eyes tightly, especially if both sides of your face are affected.

2. Pain

You might feel pain in your lower back and legs, with burning, tingling, or shock-like sensations in your arms and legs. This pain often starts early, sometimes before muscle weakness, and can spread to your upper body as the condition worsens. Some people find the pain very distressing or even excruciating, and it may be severe enough to need strong painkillers like opioids. [21]

3. Difficulty Swallowing and Speaking

You may have trouble swallowing food and drinks, which can cause choking or a feeling that something is stuck in your throat. Your speech might be slurred or unclear, making it hard for others to understand you. [22]

4. Disrupted Muscle Coordination

GBS commonly causes coordination problems and a wobbly feeling. It can also affect automatic body functions, like blood pressure and heart rhythm, which can be serious. Some people may experience weak breathing muscles and might need a ventilator.

Diagnosis of GBS

Diagnosing GBS can be tricky because its symptoms are similar to other conditions.

1. Blood Tests

Blood work can rule out other conditions that mimic GBS, such as infections or metabolic disorders, but it doesn’t directly diagnose the syndrome.

2. Nerve Conduction Velocity Test (NCV)

It checks how well nerves send signals. In GBS, damaged nerves send signals more slowly because the myelin sheath is damaged. [23]

3. Lumbar Puncture

In this test, a small amount of fluid is taken from your spinal cord. The fluid is called cerebrospinal fluid. This fluid is then tested to see if the results are consistent with GBS. If you have GBS, the fluid usually shows higher protein levels without an increase in white blood cells. This is a key diagnostic clue. [24]

4. Immunological Test

Anti-ganglioside antibodies in GBS help identify specific antibodies that attack gangliosides. Gangliosides are molecules found in the nervous system, and their role is connected to the onset of GBS. [25]

5. Imaging

Sometimes, a nerve ultrasound or an MRI scan of the spinal cord or brain can help determine if something else is causing muscle weakness. [26]

Treatment of GBS

Currently, there is no cure for GBS, but treatments can lessen its severity and speed up recovery. There are two main treatments to stop nerve damage caused by the immune system:

1. Plasma Exchange

Plasma exchange is a useful treatment for GBS, especially for those with moderate to severe cases. This treatment involves removing plasma (the liquid part of your blood) and replacing it with a substitute like albumin or fresh frozen plasma. It helps by removing harmful antibodies attacking your nerves, reducing inflammation, and potentially speeding recovery. [27]

2. Intravenous Immunoglobulin Therapy (IVIg)

IVIG is a treatment where healthy antibodies are given through a vein to neutralize the harmful ones attacking your nerves. It is often as effective as plasma exchange and easier to administer.  [28]

Recovery from GBS

While most people with GBS recover well, some may have lasting effects. Studies show that many patients are symptom-free within a few years, but up to 20-40% may still experience weakness, pain, or fatigue. [29]  Although the risk of death is low, outcomes can be influenced by factors like age, early severe symptoms, and the need for a ventilator. Long-term quality of life might be affected, especially for those who need intensive care. Children usually recover with minor issues, but severe cases can impact their daily life and development. [30]

Aftercare in GBS

Close monitoring and support are essential in GBS, especially in the early stages. Breathing support is often a priority because GBS can weaken the muscles you use to breathe. In severe cases, a ventilator might temporarily help you breathe until your muscles regain strength. Heart rate and blood pressure may also need to be monitored closely, as GBS can affect your nervous system, leading to sudden changes. If swallowing becomes difficult, a feeding tube might be used to ensure you get the nutrition your body needs during recovery. [31]

As you stabilize, care focuses on helping you regain strength and independence. Physical therapy plays a big role in rebuilding your muscles and improving mobility. Eating and drinking are also important as you recover, and you might need to work with a speech therapist if swallowing remains a challenge. Emotional support is just as crucial. GBS can be overwhelming, and talking to a counselor or joining a support group can help you cope with the physical and emotional effects. [31]

Complications of GBS

GBS can lead to various complications in different parts of the body:

1. Respiratory Complications

Around 20-30% of patients may need a ventilator to help them breathe because their breathing muscles are weak. Trouble swallowing can also cause pneumonia from food or liquid entering the lungs. [32]

2. Cardiovascular Complications

Nervous system issues can change blood pressure and heart rhythm, which can be life-threatening. [33]

3. Neurological Complications

Some patients may have long-lasting muscle weakness that affects their ability to move. Sensory problems like tingling or pain can also continue and may need ongoing care. [32]

4. Long-Term Sequelae

Many patients may still have trouble walking independently after six months. Ongoing fatigue is common and can affect daily activities. The stress of long-term disability and pain can also cause depression and lower quality of life. [34]

Questions to ask your Doctor?

1. What lifestyle changes can I make to lower the risk of getting GBS?
2. Are there alternative ways to manage my GBS pain without using pain medications without risking addiction?
3. Can GBS trouble me again?
4. Will I need long-term care or follow-up appointments?
5. Are there support groups or communities where I can connect with others who have GBS?

References

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