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$Unique_ID{BRK03793}
$Pretitle{}
$Title{Guillain-Barre Syndrome}
$Subject{Guillain-Barre Syndrome Acute Idiopathic Polyneuritis Acute
Immune-Mediation Polyneuritis AIMP Ascending Paralysis Post-Infective
Polyneuritis Kussmaul-Landry Paralysis also known as Landry Paralysis GBS
Landry Ascending Paralysis Miller-Fischer Syndrome also known as Fischer's
Syndrome and Acute Disseminated Encephalomyeloradiculopathy Chronic
Guillain-Barre Syndrome also known as Chronic Idiopathic Polyneuritis or CIP,
Relapsing Guillain-Barre Syndrome, Chronic Inflammatory Demyelinating
Polyradiculoneuropathy, Chronic Relapsing Polyneuropathy, Polyneuropathy and
Polyradiculoneuropathy Neuropathy, Peripheral Fischer Syndrome Chronic
Idiopathic Polyneuritis}
$Volume{}
$Log{}
Copyright (C) 1985, 1987, 1988, 1990, 1992 National Organization for Rare
Disorders, Inc.
40:
Guillain-Barre Syndrome
** IMPORTANT **
It is possible that the main title of the article (Guillain-Barre
Syndrome) is not the name you expected. Please check the SYNONYMS listing to
find the alternate name and disorder subdivisions covered by this article.
Synonyms
Acute Idiopathic Polyneuritis
Acute Immune-Mediation Polyneuritis
AIMP
Ascending Paralysis
Post-Infective Polyneuritis
Kussmaul-Landry Paralysis also known as Landry Paralysis
GBS
Landry Ascending Paralysis
Disorder Subdivisions:
Miller-Fischer Syndrome also known as Fischer's Syndrome and Acute
Disseminated Encephalomyeloradiculopathy
Chronic Guillain-Barre Syndrome also known as Chronic Idiopathic
Polyneuritis or CIP, Relapsing Guillain-Barre Syndrome, Chronic Inflammatory
Demyelinating Polyradiculoneuropathy, Chronic Relapsing Polyneuropathy,
Polyneuropathy and Polyradiculoneuropathy
Information on the following diseases can be found in the Related
Disorders section of this report:
Neuropathy, Peripheral
Fischer Syndrome
Chronic Idiopathic Polyneuritis
General Discussion
** REMINDER **
The Information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Guillain-Barre Syndrome (acute idiopathic polyneuritis) is a very rare,
rapidly progressive disorder causing inflammation of the nerves
(polyneuritis) and paralysis. Although the precise cause of Guillain-Barre
Syndrome is unknown, a viral or respiratory infection precedes the onset of
the syndrome in about half of the cases. This has led to the theory that
Guillain-Barre Syndrome may be an autoimmune disease (caused by the body's
own immune system). Damage to the covering of nerve cells (myelin) and nerve
axons (the extension of the nerve cell that conducts impulses away from the
nerve cell body) results in delayed nerve signal transmission. There is a
corresponding weakness in the muscles that are supplied with nerve impulses
(innervated) by the affected nerves.
The following subdivisions are recognized: Miller-Fischer syndrome
(Fischer syndrome, acute disseminated encephalomyeloradiculopathy); chronic
Guillain-Barre Syndrome (chronic idiopathic polyneuritis); relapsing
Guillain-Barre Syndrome; chronic inflammatory demyelinating
polyradiculoneuropathy; chronic relapsing polyneuropathy; polyneuropathy; and
polyradiculoneuropathy.
Symptoms
Guillain-Barre Syndrome is a very rare, rapidly progressive disorder that
affects the nervous system. This disorder is characterized by ascending
polyneuritis (inflammation of nerves) causing paralysis that usually begins
in the feet and progresses upwards to the trunk and arms. Numbness, tingling
and/or "pins and needles" (paresthesias) begin in the feet. This is
generally followed by weakness and paralysis of the legs. Eventually the
torso, upper limbs, and face are affected. The symptoms of Guillain-Barre
Syndrome progress over hours to weeks. Deep tendon reflexes may be lost;
most notably the ankle jerk reflex. Other symptoms may include fever,
paralysis of the lips, tongue, mouth and voice box (bulbar palsy), and an
increase in cerebrospinal fluid protein levels.
The neurological symptoms of Guillain-Barre Syndrome affect both sides of
the body (bilateral) and directly reflect the portion of the nervous system
that is involved in an inflammatory process. Sensory nerve damage produces
numbness and tingling in the feet, hands, gums and face. The face may appear
pouchy and lopsided. In the acute stage Guillain-Barre Syndrome may cause
difficulty breathing or swallowing food. Involvement of the autonomic
nervous system (part of the nervous system that regulates vital functions)
may cause an abnormally rapid heart beat (sinus tachycardia) or abnormally
low heart rate (bradycardia), high blood pressure (hypertension) and/or a
sudden drop in blood pressure upon arising from a bed or chair (postural
hypotension). Other symptoms may include changes in body temperature,
vision, bladder function and blood chemistries.
The symptoms experienced by every person with Guillain-Barre Syndrome
vary widely. Paralysis generally peaks in less than 10 days, although in
rare cases it may continue to progress for months. Recovery begins after the
condition has stabilized and this may take 6 months to 2 years. A favorable
prognosis for Guillain-Barre Syndrome generally correlates with speedy
recovery.
Causes
Guillain-Barre Syndrome is a very rare, rapidly progressive disorder that
affects the nervous system. This disorder is thought to be caused by an
autoimmune mechanism following a viral infection. Autoimmune disorders are
caused when the body's natural defenses against invading organisms
(antibodies, lymphocytes, etc.) mistakenly attack healthy tissue.
Many viral infections have been identified as preceding the onset of
Guillain-Barre Syndrome. These can include the common cold, viral hepatitis
or mononucleosis. Guillain-Barre Syndrome has also been observed following
surgery, porphyria (a group of inherited metabolic disorders), an insect
sting, Lyme Disease and swine flu inoculations.
Affected Population
Guillain-Barre Syndrome affects approximately 1 or 2 adults in 100,000 in the
United States. Men and women are affected in equal numbers.
Related Disorders
Symptoms of the following disorders can be similar to those of Guillain-Barre
Syndrome. Comparisons may be useful for a differential diagnosis:
Peripheral Neuropathy is a disorder of the nervous system characterized
by sensory, motor, reflex and vasomotor (nerve and muscles that control the
blood vessels) symptoms. Degenerative changes in the nerve fibers occur.
The symptoms may involve a single nerve (mononeuropathy) or many nerves
(symmetric polyneuropathy, polyneuritis, multiple peripheral neuritis).
Symptoms may include muscle weakness and muscular pain. Generally there is a
tingling feeling, numbness or a burning sensation in the affected area
(paresthesias). The symptoms of Peripheral Polyneuropathy are frequently
confused with the early symptoms of Guillain-Barre Syndrome. Peripheral
Polyneuropathy usually affects both sides of the body equally and has a wide
range of symptoms. It may be caused by malnutrition, poisoning or other
underlying diseases such as diabetes or other metabolic disorders. (For more
information on this disorder, choose "Peripheral Neuropathy" as your search
term in the Rare Disease Database).
Fischer Syndrome is a rare subtype of Guillain-Barre Syndrome that
commonly follows an upper respiratory tract infection. Men are predominantly
affected. A generalized weakness occurs and is particularly severe in the
muscles of the eyes (ocular). This may cause impaired vision. Involvement
of the muscles of the face and neck may lead to impaired speech and a sagging
look to the face. Deep tendon reflexes may be lost and an awkward, unsteady
gait (ataxia) is common. (For more information on this disorder, choose
"Fisher" as your search term in the Rare Disease Database.)
Chronic Idiopathic Polyneuritis produces symptoms that are
indistinguishable from those of Guillain-Barre Syndrome with the exception
that the eyes and face are involved in only 15 percent of cases. The course
of Chronic Idiopathic Polyneuritis is unpredictable. Symptoms tend to
progress over 6 to 12 months and then subside for a period of time before
recurring. (For more information on this disorder, choose "Chronic Idiopathic
Polyneuritis" as your search term in the Rare Disease Database.)
Therapies: Standard
The debilitating effects of Guillain-Barre Syndrome vary greatly and usually
reach a plateau from which recovery begins. Relapses of this disorder rarely
occur.
Muscular strength is first regained in the upper body. Recovery from
Guillain-Barre Syndrome can take from 6 months to over 2 years. More rapid
recovery patterns are associated with a diminished chance of long-term
disabilities.
Various forms of treatment have proven effective for some people with
Guillain-Barre Syndrome. Physical therapy may help restore muscle strength
as recovery begins. Therapy must be customized for each patient.
Respiratory assistance may be needed by hospitalized patients during the
acute stage of this disorder.
Corticosteroid drugs (for chronic Guillain-Barre Syndrome) and
plasmapheresis may be prescribed. Plasmapheresis is a method for removing
unwanted substances (toxins, metabolic substances and plasma parts) from the
blood. Blood is removed from the patient and blood cells are separated from
plasma. The patient's plasma is then replaced with other human plasma and
the blood is transfused back into the patient.
Plasmapheresis is recommended only for Guillain-Barre patients with
severe weakness at the time of the first plasma exchange (e.g., those unable
to walk). The benefits of plasmapheresis are clearest when treatment is
started within two weeks after symptoms begin. This procedure can reduce
motor weakness and reduce time spent on a respirator, sometimes enabling
patients to leave the hospital sooner. It is unclear whether patients able to
walk without support will benefit from plasmapheresis. Researchers have found
that patients who respond best to plasmapheresis are the younger patients who
also have a larger number of muscle fibers that contract in response to an
electric nerve stimulus. Age and electrical stimulation of the median nerve
at the wrist and the peroneal nerve at the ankle may predict the success of
treatment with plasmapheresis.
Over fifty percent of people with Guillain-Barre Syndrome typically
resume full and active lives. Approximately 5 to 15 percent of affected
people experience significant long-term disabilities, and 35 to 45 percent
experience mild long-term difficulties such as tingling and muscle aches.
Only 1 to 5 percent die of complications of Guillain-Barre Syndrome.
Fischer Syndrome and Chronic Idiopathic Polyneuritis are similarly
treated with corticosteroid drugs and/or plasmapheresis.
Therapies: Investigational
Research is ongoing to investigate possible treatments for Guillain-Barre
Syndrome. Several studies suggest that high-dose intravenous immunoglobulin
may be beneficial for some people with severe cases of Guillain-Barre
Syndrome.
For information on plasmapheresis as a treatment for Guillain-Barre
Syndrome, your physician can contact:
The Johns Hopkins University Hospital
Plasmapheresis Center
601 North Broadway
Baltimore, Maryland 20205
This disease entry is based upon medical information available through
October 1992. Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate. Please check with the agencies listed in the Resources section for
the most current information about this disorder.
Resources
For more information on Guillain-Barre Syndrome, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
Guillain-Barre Syndrome Support Group International
P.O. Box 262
Lynnewood, PA 19096
(215) 667-0131
NIH/National Institute of Neurological Disorders & Stroke (NINDS)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-5751
(800) 352-9424
References
THE MERCK MANUAL 15th ed. R. Berkow, et al: eds; Merck, Sharp & Dohme
Research Laboratories, 1987. P. 1446.
CECIL TEXTBOOK OF MEDICINE, 19th Ed.: James B. Wyngaarden, and Lloyd H.
Smith, Jr., Editors; W.B. Saunders Co., 1990. Pp. 471, 1855, 2181.
PRINCIPLES OF NEUROLOGY, 4th Ed.; Raymond D. Adams, M.D. and Maurice
Victor, M.D., Editors; McGraw-Hill Information Services Company, 1989. Pp.
1035-1039.
AUTOIMMUNE DISEASE AND THE NERVOUS SYSTEM. BIOCHEMICAL, MOLECULAR, AND
CLINICAL UPDATE, J.E. Graves et al.; West J Med (Jun 1992; 156(6)): Pp. 639-
646.