Guillain Barre Syndrome

Guillain Barre syndrome or GBS (also known as infectious polyneuritis) is a rare disease that affects the peripheral nervous system. This condition arises when the body's immune system attacks the peripheral nerves after an infection or an immunization. Guillain-Barre syndrome affects the myelin sheath that covers nerve cells. The loss of myelin is called as demyelination. It causes progressive muscle weakness usually starting in the lower extremities and often ascending to the muscles involved in respiration and usually reversible paralysis which develops over days or up to four weeks and lasts several weeks to several months.

Guillain-Barre syndrome can be life-threatening. Typically GBS follows an infection such as sore throat, Hodgkin's disease or other bacterial diseases. Sometimes surgery can trigger GBS. A severe attack of Guillain-Barre syndrome can leave a patient totally paralyzed. The patient has difficulty in breathing and sharp fluctuations in blood pressure and pulse rate.

Symptoms may start with muscle weakness in the legs first, then it progresses to the arms and face. Paresthesia (abnormal skin sensation like tingling) often occurs at the same time. Again the disorder doesn't restrict its action to one side alone. This affects both sides of the body and may involve paralysis of the muscles that control breathing.

Symptoms of Guillain-Barre syndrome include severe numbness and weakness in the limbs. It can result in loss of feeling and movement and temporary paralysis. There may be bouts of headache and vomiting. Symptoms such as tingling in the limbs and muscle weakness are characteristic of GBS.When Myelin (sheath that wraps around nerves), which is responsible for speed and efficiency of impulses traveling through those nerves, suffers damage, nerve communication is disrupted. The most common preceding infections are cytomegalovirus, herpes, Epstein-Barr virus and viral hepatitis. A gastrointestinal infection with the bacteria Campylobacter jejuni is also common. Patients with infections that impair body defense system like lymphoma, systemic lupus erythematosus or AIDS, have a higher than normal risk of GBS.

Diagnosis Early diagnosis is vital to the treatment of Guillain-Barre syndrome. Diagnosis of GBS is primarily to look for a particular cluster of symptoms which start with progressively worse muscle weakness and then paralysis. A spinal tap is another diagnostic mechanism that helps to determine the pressure of the cerebrospinal fluid (CSF) that bathes the brain and spinal canal. This fluid is obtained by a lumbar puncture, which upon examination will reveal a greater than normal quantity of protein but with normal numbers of white blood cells and a normal amount of sugar. A nerve conduction velocity (NCV) test can aid the doctor in diagnosis of Guillain-Barre syndrome. Electromyography helps in identifying the extent of damage to the neurological system. Electrodiagnostic studies may show slowing or a block of conduction in nerve endings in parts of the body other than the brain.

Treatment If diagnosed within the early weeks, patients suffering from Guillain-Barre syndrome can recover in good time. Although there is no direct treatment for Guillain-Barre syndrome, palliative care, and symptom management is usually attempted. Careful attention must also be paid to the amount of fluid intake. Blood pressure, heart rate and heart rhythm also must be monitored. Plasmapheresis and high-dose immunoglobulin therapy are used to treat Guillain-Barre syndrome. Plasmapheresis consists of withdrawing the patient’s blood, passing it through an instrument that separates the different types of blood cells and returning all the cellular components along with either donor plasma or a manufactured replacement solution. This process is resorted to rid the blood of the substances that are attacking the myelin. Severe cases of GBS need hospitalization. Critical body functions need to be monitored during the recovery of the nervous system.

Prognosis Usually about 85 % of cases of GBS recover with little complications. But some 30 % adult cases and a larger percentage of children never regain their functions completely. Elderly patients and patients who had their worst symptoms within the first 7 days have a higher risk of dying due to complications.

Electromyography

Electromyography or EMG is a diagnostic test that understands the physiological of muscles thereby assessing their health. Electromyography involves inserting a needle electrode through the skin into the muscle. This electorde detects electrical activity in the muscles and nerves controlling the muscles. A patient is asked to flex or contract the muscles so that the response of the muscle to the nerve stimuli is observed. An electromyograph is used to detect and measure electric potential that is generated by the contracting muscles. Other indicators to the proper functioning of the muscles and their corresponding nerves are the size, duration and frequency of electric signals received from them. EMG is often conducted along with a nerve conduction velocity test.

The EMG test is used to diagnose any possible weakness or impaired muscle strength due to neurological problems. Some discorders that can lead to abnormal readings on EMG test are cervical spondylosis, myasthenia gravis, carpal tunnel syndrome, myopathy, Brachial plexopathy, Guillain Barre syndrome, sciatic nerve dysfunction and mononueritis multiplex. EMG test aids in differentiating between a muscle and nerve disorder. The muscle may feel tender after the EMG test with localised bruising.