Guillain-Barré Syndrome

What is Guillain-Barré syndrome?

Guillain-Barré syndrome (GBS) is a condition affecting the nerves that control our senses and movements (peripheral nerves) including the facial nerve. They leave the brain and spinal cord and carry impulses to and from the rest of the body. This includes our limbs and internal organs.

What causes Guillain-Barré syndrome?

The cause is unclear but in most people symptoms develop following a recent illness such as a throat infection. Normally when we develop an infection the body’s natural defence system produces “antibodies” which attack and kill viruses and bacteria. GBS causes this natural defence system to go out of control, and antibodies start to attack the body itself. The antibodies usually attack the protective covering of the nerves. This covering is called the myelin sheath. If the myelin sheath is damaged then the nerve can no longer send signals to your muscles or organs to enable them to perform the jobs they normally carry out.

What are the symptoms?

• Usually GBS develops quickly, over a few days.
• Occasionally it develops over a period of up to four weeks.
• Once the symptoms are at their worst point, they usually remain at this level for a few days before recovery starts.
• Symptoms tend to appear one to three weeks after a minor infection, such as a cold or sore throat.

Early symptoms can occur in the legs and or arms and include:

• Tingling
• Numbness
• Unsteadiness
• Muscle weakness

Later symptoms may develop in some people and include:

• Temporary paralysis of the legs, arms and face.
• Facial weakness or paralysis can affect one or both sides of the face.
• Weakness or paralysis of the facial muscles will cause difficulty with eye movements, speech, chewing and swallowing.
• In more severe cases the respiratory muscles may also be affected making breathing difficult.
• In some cases people experience pain in their arms, legs and or spine.

It is important to remember that the severity of muscle weakness and paralysis will vary considerably from person to person. Occasionally Guillain-Barré syndrome is life threatening if weakness or paralysis develops in the muscles used for breathing. In these cases hospital admission is required so that you can be put on a machine that helps you breathe (a ventilator). If you start to feel tingling in your toes, feet or legs, followed by muscle weakness, visit your GP immediately.

What is the treatment for Guillain-Barré syndrome?

Treatment will depend on the severity of your symptoms but you will need to go into hospital. The two main treatments to reduce the severity of the symptoms and help you recover more quickly are:

• Intravenous immunoglobulin (IVIg): Immunoglobulin is another name for antibodies produced by your immune system. Antibodies are proteins in your blood produced by your immune system. Healthy immunoglobulin is taken from blood donors and given to you intravenously (directly into the vein). The healthy antibodies block and destroy harmful antibodies that are attacking your nerves.
• Plasma exchange (plasmapheresis): Plasma is the yellow fluid that is found in the blood which contains proteins including your antibodies. A plasma exchange means that blood is taken from your body and pumped through a machine. The machine takes away the plasma from your blood but puts the red blood cells back into your body. These red blood cells will then produce healthy plasma. The healthy plasma will replace the harmful plasma which contained the antibodies attacking your body.

How quickly will I recover?

• 80% of people with GBS will make a complete recovery.
• It takes a few weeks or months for recovery to take place.
• Some people will need to stay in hospital for several weeks or months.
• It may take up to a year to fully recover.

What happens when the facial nerve is attacked?

The facial nerve is responsible for all the movements of your face. It controls eye closure and blinking, it controls speech, eating, drinking and swallowing. The muscles in your face also control facial expression. Without a healthy facial nerve some of these functions may be temporarily lost or impaired.

Guillain-Barré syndrome can occur on one side of your face or both sides. If only one side is affected then you may temporarily lose the functions described above just on that side of your face (facial palsy). The health of your eye is of primary importance as an eye which cannot close or blink will be vulnerable to damage.

If both sides of your face are affected then this is more serious and the hospital doctors and nurses will be able to help with any problems you encounter. The most important issues in the early stages will again be the health of your eyes and also eating and drinking sufficient amounts to remain healthy.

Note that usually the facial recovery is more prolonged in this disease, particularly if bilateral, and specialist help should be sought wherever possible as those affected are prone to atypical movement patterns and upper lip retraction.