Guillain-Barre syndrome (GBS) can be difficult to diagnose in its earliest stages. The signs and symptoms are similar to those of other movement disorders, such as hypokinesia (absent or reduced ability to perform purposeful movement).
An individual presenting with signs and symptoms of GBS will generally be placed in a hospital setting for tests and evaluation. The length of stay depends upon the severity of the symptoms and the testing ordered by the doctor.
The individual's symptoms and a physical exam are usually sufficient to make a diagnosis of GBS. The rapid onset of weakness, frequently accompanied by abnormal sensations (such as tingling or numbness) that affect both sides of the body similarly, is commonly seen. Loss of reflexes, such as the knee jerk, is usually found. To confirm the diagnosis, a medical procedure called a lumbar puncture and an electrical test of nerve and muscle function may be performed.
Lumbar puncture: Lumbar puncture, or spinal tap, is a procedure that involves inserting a needle into the spinal canal, usually the low back area called the lumbar region. A doctor can determine the pressure of the cerebrospinal fluid and a sample of fluid can be removed for laboratory analysis. Lumbar puncture may include checking for evidence of bleeding, the number and types of white blood cells (indicating infection), the levels of glucose and protein, the types of proteins, and tests for bacteria and fungi. Generally, individuals undergoing a lumbar puncture are given an anesthetic, such as lidocaine (Xylocaine®), in the area where the needle will be inserted. Pain is common with a lumbar puncture.
Electromyogram: Electromyogram (EMG) is an effective diagnostic tool because it records muscle activity. An EMG can show the loss of reflexes due to the disease's characteristic slowing of nerve responses. In an EMG, a technician inserts electrodes in fine needles into the muscles being tested. Then, they place electrodes on the patient's skin that are over certain nerves.
Nerve conduction velocity: Nerve conduction velocity (NCV) is performed with EMG. Together, they are often referred to as EMG/NCV studies. NCV records the speed at which signals travel along the nerves.
signs and symptoms
The first symptoms of Guillain-Barre syndrome (GBS) include paresthesia (numbness or tingling) in the toes and fingers with progressive weakness in the arms and legs over the next few days. Some individuals experience paresthesia only in the toes and legs, while others only experience symptoms on one side of the body. GBS generally progresses quickly. Most individuals experience the most significant weakness in the legs, arms, chest, and other areas within three weeks of the start of this disorder. In some cases, the signs and symptoms of GBS may progress very rapidly with complete paralysis of legs, arms, and breathing muscles over the course of a few hours.
If an individual is at risk for developing GBS and symptoms appear, 911 should be called immediately and a doctor seen as soon as possible.
The symptoms may be mild, causing only slight difficulty in walking, requiring crutches or a walking stick. If GBS is mild, the signs and symptoms may not extend beyond a feeling of general weakness.
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.
The signs and symptoms of GBS may also include difficulty with eye movement, facial movement, and speaking, a slow heart rate, or low blood pressure. Difficulty with bladder control or intestinal functions may also occur.
GBS may improve without treatment within a few weeks and some individuals initially may think the signs and symptoms are simply due to the flu or a cold. The signs and symptoms of GBS may last days, weeks, or months before muscle sensation begins to return. Regaining strength and functioning is slow, sometimes requiring months or years. However, most individuals with GBS return to normal within months.
In chronic inflammatory demyelinating polyradicalneuropathy (CIDP), the illness lasts longer and respiratory failure is much less likely.
If a tingling sensation is experienced in the toes, feet, or legs followed by muscle weakness, prompt medical attention is recommended by healthcare providers. Failure to see a doctor promptly may lead to progression of the disorder and paralysis, which can leave the individual incapacitated and unable to get help.
risk factors and causes
The cause of Guillain-Barre syndrome (GBS) is not known. Many cases occur shortly after a microbial (viral or bacterial) infection such as the flu, the common cold, gastrointestinal viral infection, sore throat, or diarrhea. GBS can also occur due to campylobacteriosis (eating bacteria from undercooked poultry) and porphyria (a rare disease of red blood cells). The Epstein-Barr virus (herpesvirus type 4) or Hodgkin's disease (a type of lymphoma or cancer of the lymph nodes) also may occur before developing GBS.
GBS is not hereditary (transferred from parent to child) or contagious (transferred from one individual to another). Half of all cases the onset of the syndrome follow a viral or bacterial infection, such as in influenza (flu), common cold, gastrointestinal viral infection, infectious mononucleosis, and viral hepatitis (inflammation of the liver caused by a virus).
Autoimmune disorder: Some theories suggest that GBS is an autoimmune disease, in which the individual's defense system of antibodies and white blood cells begin to damage the myelin sheath, which is a fat layer that surrounds and covers peripheral nerves. The destruction of this myelin sheath may lead to weakness and abnormal sensations such as tingling and numbness. In diseases in which the peripheral nerves' myelin sheaths are injured or degraded, the nerves cannot transmit signals efficiently. The muscles begin to lose their ability to respond to the brain's commands that must be carried through the nerve network.
Virus: When a viral or bacterial infection occurs prior to GBS, it is possible that the virus has changed the nature of cells in the nervous system so that the immune system treats the cells as foreign cells. It is also possible that the virus makes the immune system itself less able to be detected, allowing some of the immune cells, such as certain kinds of lymphocytes and macrophages, to attack the myelin sheath surrounding the nerves. Cells of the immune system, called T lymphocytes and B lymphocytes, work together to produce antibodies against the cells in the myelin sheath. The antibodies will attack the cells and may contribute to the destruction of the myelin. This is an autoimmune disease.
Others: GBS may be triggered by medical procedures including surgery and, in rare cases, influenza immunizations. However, the connection between the flu vaccine and GBS is weak and the risk the vaccine poses to the individual's health is much less significant than the risk of developing flu-related illness.
Older adults with other medical problems, such as diabetes or heart conditions, are at the greatest risk of death from GBS.
The long-term outlook for most individuals with Guillain-Barre syndrome (GBS) is good. About 75-85% of those affected with GBS recover completely, generally with only minor, continued weakness or abnormal sensations such as numbness or tingling.
Individuals may experience more serious, permanent problems with sensation and coordination, including some cases of severe disability.
About one in ten of those affected is at risk of experiencing a relapse.
GBS may cause severe damage to the muscles and nervous system, weakening the heart and lungs. About one-third of individuals with GBS require assisted breathing using a machine called a ventilator while they are ill. Up to one in 12 individuals with GBS die of related complications such as respiratory (breathing) failure, pulmonary embolism, or a blockage of the pulmonary artery in the lungs by a blood clot and heart attack.
GBS can be a devastating disorder because of its sudden and unexpected onset. Most individuals reach the stage of greatest weakness within the first two weeks after symptoms appear. By the third week of the illness, 90% of all individuals are at their weakest. The recovery period may be as little as a few weeks or as long as a few years. About 30% of those with GBS still have a residual weakness after three years. About three percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack.