Lecture Notes: Guillain-Barré Syndrome (GBS)

Introduction

• Recent outbreak in India, particularly in Pune.
• One of the largest outbreaks as per WHO.
• Out of 140 affected patients, 18 on ventilators.

What is Guillain-Barré Syndrome?

• Also known as Acute Inflammatory Demyelinating Polyneuropathy.
• An autoimmune disease affecting the peripheral nervous system.
• Body's immune system attacks the myelin sheath of nerves.

Pathophysiology

• Myelin sheath damage leads to poor nerve impulse conduction.
• Affects several body functions:
  • Breathing Rhythm
  • Motor functions (movement of limbs)
• Visible symptoms:
  • Numbness in extremities (fingertips, toe tips)
  • Muscle Weakness
  • Tingling Sensations
  • Swallowing Difficulty
  • Shortness of Breath

Clinical Presentation

• Progressive onset of pain in a "stocking pattern".
• Paresthesia: Numbness and tingling in extremities.
• Loss of Reflexes (Areflexia): Fine-tuned reflexes are hampered.
• Autonomic Dysfunction:
  • Irregular heartbeat, blood pressure instability.
• Respiratory Involvement:
  • Phrenic nerve and intercostal muscle weakness.
  • Possible aspiration pneumonia due to bulbar dysfunction.

Risk Factors

• Bacterial Infections: Campylobacter jejuni.
• Viral Infections: Epstein-Barr virus, cytomegalovirus.
• Influenza Vaccine (rare cases).
• Molecular Mimicry: Antibodies mistakenly attack myelin due to bacterial antigen resemblance.

Subtypes of GBS

• AIDP (Acute Inflammatory Demyelinating Polyneuropathy): Most common in the US and Europe.
• Acute Motor Axonal Neuropathy: Often linked to Campylobacter jejuni infection.
• Acute Motor Sensory Axonal Neuropathy: Severe, affects both sensory and motor systems.
• Miller Fisher Syndrome: Characterized by ataxia and areflexia.

Diagnosis

• Electromyography Test: Checks nerve conduction velocity.
• CSF Examination:
  • Increased protein concentration (>55 mg/dL).
  • Little or no pleomorphic cells.

Treatment

• First-line Treatments: Plasmapheresis and IVIG.
• Corticosteroids: Generally not indicated.
• Monitoring:
  • Frequent respiratory function checks.
  • ICU admission may be required.
• Rehabilitation: Aggressive physical therapy.
• Recovery could take up to 1 year.

Summary

• GBS is an auto-immune condition with progressive paralysis and autonomic dysfunction.
• Clinical hallmark includes increased protein in CSF.
• For a detailed follow-up, monitoring and early treatment are crucial to manage the condition effectively.

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