Guillain-Barré Syndrome

• Guillain-Barré syndrome is an acute paralytic polyneuropathy that affects the peripheral nervous system.
• Guillain-Barré causes acute, symmetrical, ascending weakness and can also cause sensory symptoms.
• Guillain-Barré is usually triggered by an infection and is particularly associated with Campylobacter jejuni, cytomegalovirus (CMV) and Epstein-Barr virus (EBV).
• Guillain-Barré is thought to occur due to a process called molecular mimicry.
• In Guillain-Barré, the B cells of the immune system create antibodies against the antigens on the triggering pathogen.
• These antibodies also match proteins on the peripheral neurones.
• They may target proteins on the myelin sheath or the nerve axon itself.
• Symptoms of Guillain-Barré usually start within four weeks of the triggering infection.
• Symptoms of Guillain-Barré begin in the feet and progress upward.
• Symptoms of Guillain-Barré peak within 2-4 weeks.
• There is a recovery period that can last months to years after the symptoms of Guillain-Barré.
• Recovery from Guillain-Barré syndrome can take months to years, and patients can continue regaining function five years after the acute illness.
• Autonomic dysfunction in Guillain-Barré syndrome can lead to urinary retention, ileus or heart arrhythmias.
• The characteristic features of Guillain-Barré syndrome are symmetrical ascending weakness, reduced reflexes, and there may be peripheral loss of sensation or neuropathic pain.
• Severe cases with respiratory failure may require intubation, ventilation and admission to the intensive care unit.
• Mortality from Guillain-Barré syndrome is around 5%, mainly due to respiratory or cardiovascular complications.
• Guillain-Barré syndrome may progress to the cranial nerves and cause facial weakness.
• Management of Guillain-Barré syndrome involves supportive care, VTE prophylaxis, IV immunoglobulins (IVIG) first-line, and plasmapheresis is an alternative to IVIG.
• The diagnosis of Guillain-Barré syndrome is made clinically, using the Brighton criteria, and is supported by investigations such as nerve conduction studies and lumbar puncture for cerebrospinal fluid.
• Most patients with Guillain-Barré syndrome eventually make either a full recovery or are left with minor symptoms, while some are left with significant disability.