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Guillain-Barre Syndrome

Comes on quickly

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Updated February 12, 2006

A typical case
Mr. S went to the emergency room because he was losing strength and feeling in both his legs. He told the doctor that five days earlier he had gotten sick with vomiting and diarrhea after eating at a fast-food restaurant. He seemed better after a few days, but then the diarrhea came back. Now he was having trouble walking. On examination, his temperature was 101 F and he didn't have the normal knee-jerk reflexes in his legs.

A diagnosis of Guillain-Barre (ghee-yahn bah-ray) syndrome was made. The doctor decided to admit Mr. S, since patients with Guillain-Barre need close monitoring as the disorder progresses.

By the time he was admitted to the hospital, Mr. S had lost the ability to move his arms as well. Over the next week he started having trouble breathing as the loss of muscle control (paralysis) spread to his chest muscles, and he had to be placed on a respirator. His food poisoning turned out to be an infection with Campylobacter jejuni, and he was treated with antibiotics. Plasmapheresis (plasma exchange) and high dose intravenous immune globulins helped relieve the symptoms of Guillain-Barre syndrome and shorten its course.

During the time that he was ill, Mr. S had to cope with suddenly being paralyzed and dependent on others for help. He was frightened by how quickly the symptoms came on, and it was scary to be awake and able to see and hear everything but not move. The times that he had to be on a respirator made things worse because he couldn't talk and had to depend on the machine for breathing. The intensive care nurses and a psychological counselor helped him adapt to his situation and kept him hopeful about the outcome.

Fortunately, Mr. S eventually made a full recovery, although it took four weeks in the hospital, and three more weeks in a rehabilitation center, for him to get the use of all his muscles back. The only reminder of his illness is that he gets tingling sensations in his feet sometimes.

Discussion
Although this case is fictional, it illustrates the typical course of the syndrome. Guillain-Barre, also called acute inflammatory demyelinating polyneuropathy, comes on quickly, and usually its symptoms (paralysis starting at the feet or legs and progressing upwards) and a physical examination point to the diagnosis. Recovery can take months, and some people are left with long-term disabilities. Less than 5 percent of people affected die.

It is not known exactly what causes Guillain-Barre syndrome, but there are some strong clues. Usually it occurs a few days or weeks after a person has had a respiratory or gastrointestinal infection with viruses such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), or Campylobacter jejuni (40% or more of cases). Therefore, Guillain-Barre is thought to be an autoimmune disorder, meaning that the antibodies created by the body to attack the virus also attack healthy nerve cells and cause damage. Researchers are working to discover which cells are responsible for this, so that ways can be found to prevent the disorder from occurring.

Last updated 2/11/06

Information for this article was taken from:
- Allen, A., & Antony, S. J. (1999.) Severe Guillain-Barre syndrome associated with Campylobacter jejuni infection with failure to respond to plasmapheresis and immunoglobulin. J Am Board Fam Pract, 12(3), 249-252.
- Guillain-Barre Syndrome Foundation International. What is Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)?.
- Jackson, M., Hickman, L. S., & Pugliese, G. (2000). Emerging infectious diseases. American Journal of Nursing, 100(10), 66-71.
- National Institute for Neurological Disorders and Stroke. Guillain-Barre Syndrome Fact Sheet.

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