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Guillain Barre Syndrome

Overview

Guillain Barre syndrome is a prevalent cause of acute neuromuscular paralysis.

Guillain Barre syndrome is an acquired neuropathy caused due to the formation of autoantibodies, which are generated in response to infections caused by Campylobacter jejuni, Cytomegalovirus (CMV), Epstein–Barr Virus, Haemophilus influenzae, and Mycoplasma pneumoniae. Common antibodies associated are ganglioside antibodies (GM1) in acute inflammatory demyelinating neuropathy (AIDP), GQ1b antibody (Miller Fisher variant), and GD1a antibody in acute motor axonal neuropathy (AMAN).

  • Bacterial or viral infection
  • Surgery
  • Age over 50 years
  • Vaccinations in rare cases

  • Gradually worsening ascending muscle weakness, sometimes accompanied by paraesthesia, with symptoms typically peaking within four weeks
  • Progressive loss of tendon reflexes
  • Back pain and radicular discomfort
  • Weakness in respiratory muscles
  • Cranial nerve dysfunction, affecting facial and bulbar muscles
  • Autonomic system involvement
  • Occasional bladder and bowel dysfunction
  • Regional variants:
    • Miller Fisher syndrome (ophthalmoplegia, areflexia, and ataxia)
    • Acute pandysautonomia
    • Acute oropharyngeal palsy (similar to diphtheria)
    • Pharyngo-cervico-brachial pattern
    • Flaccid paraparesis variant
    • Pure sensory variant

Neurologist

  • Blood tests to rule out conditions mimicking GBS like hypokalaemia, porphyria.
  • CSF examination for albuminocytological dissociation
  • Antibody measurements
  • NCV may show prolonged F waves, demyelination with/ without conduction blocks (AIDP) or axonal degeneration as in AMAN or AMSAN variants
  • MRI to determine enhancement of nerve roots

  • Intravenous immunoglobulin (IV Ig) is treatment of choice.
  • Plasma exchange (PE)
  • Disease-modifying therapy
  • General supportive management
  • Monitoring of swallowing dysfunction
  • Management of respiratory insufficiency
  • Autonomic dysfunction management- arrhythmia/ blood pressure fluctuations
  • Thromboembolic complication prevention
  • Neuropathic pain treatment with gabapentin, carbamazepine, or tramadol
  • Physiotherapy
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