Overview

Guillain-Barré syndrome (GBS) is an inflammatory disorder of the peripheral nerves. The peripheral nerves convey sensory information (e.g., pain, temperature) from the body to the brain and motor (i.e., movement) signals from the brain to the body. GBS is characterized by weakness and numbness or tingling in the legs and arms, and possible loss of movement and feeling in the legs, arms, upper body, and face.

Chronic inflammatory demyelinating polyradicalneuropathy (CIDP), is considered to be a related form of Guillain-Barre syndrome. It is much less common than GBS, and evolves much more slowly and usually is longer lasting. Some CIDP patients experience periods of worsening and improvement, and individual relapses are often confused with GBS.

Incidence

Causes

* flu, common cold
* gastrointestinal viral infection
* infectious mononucleosis
* viral hepatitis
* campylobacteriosis (usually from eating undercooked poultry)
* porphyria (rare disease of red blood cells)

A small number of cases have been known to occur after a medical procedure, such as minor surgery.

Guillain-Barré syndrome may be an autoimmune disorder in which the body produces antibodies that damage the myelin sheath that surrounds peripheral nerves. The myelin sheath is a fatty substance that surrounds axons. It increases the speed at which signals travel along the nerves.

Signs and Symptoms

The first symptoms of GBS are usually numbness or tingling (paresthesia) in the toes and fingers, with progressive weakness in the arms and legs over the next few days. Some patients experience paresthesia only in their toes and legs; others only experience symptoms on one side of the body.

The symptoms may stay in this phase, causing only mild difficulty in walking, requiring crutches or a walking stick. However, sometimes the illness progresses, leading to complete paralysis of the arms and legs. About one quarter of the time, the paralysis continues up the chest and freezes the breathing muscles, leaving the patient dependant on a ventilator. If the swallowing muscles are also affected, a feeding tube may be needed.

In CIDP, the course of illness is longer and respiratory failure is much more unlikely.

Diagnosis

Because its symptoms vary and its cause is unknown, GBS can be difficult to diagnose. If the symptoms occur uniformly across the body and progress rapidly, the diagnosis is easier.

Observation of the patient's symptoms and an evaluation of the medical history provide the basis for diagnosis of Guillain-Barré syndrome, although no single observation is suitable to make the diagnosis.

Tests

Three tests can confirm a diagnosis of Guillain-Barré syndrome.

Lumbar puncture (spinal tap) The patient is given local anesthetic. Once the anesthetic has taken effect, a needle is inserted between two lower (lumbar) vertebrae and a sample of cerebrospinal fluid is drawn. An elevated level of protein in the fluid is characteristic of GBS

Electromyogram (EMG) This is an effective diagnostic tool because it records muscle activity and can show the loss of reflexes due to the disease's characteristic slowing of nerve responses