GBS: Guillain-Barre Syndrome
What Is Guillain-Barre Syndrome (GBS)?
Guillain-Barre Syndrome is a rare, rapid onset neurological condition in which the body’s immune system attacks peripheral nerve cells, possibly leading to paralysis.
This autoimmune disorder affects the arms and legs, and early symptoms include pain, weakness, and numbness. It begins as a tingling sensation and then progresses to weakness that affects both sides of the body, worsening over time.
Patients may also experience weakness of the respiratory muscles. This can turn into a medical emergency that requires mechanical or assisted ventilation.
How Common Is GBS?
The prevalence of GBS in the U.S. is one to two cases per 100,000 individuals. The risk of hospitalization increases with age, with around nine cases for every 100,000 people over age 70. For pregnant women, there are roughly 2.8 cases per million. This includes patients that develop GBS up to 40 days after delivery.
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The exact cause of Guillain-Barre syndrome is unknown. Two-thirds of GBS patients report symptoms of an infection within six weeks before diagnosis. These infections can include respiratory, gastrointestinal, or Zika virus infections.
Possible GBS causes include the following:
- An Infection of Campylobacter jujeni, a bacteria that causes diarrheal illness. One of the risk factors for getting this infection is eating undercooked poultry.
- A viral illness caused by Hepatitis, HIV, influenza, cytomegalovirus, COVID-19, or Zika virus.
- Cancers such as Hodgkin lymphoma.
- Trauma or surgery.
How Is Guillain Barre Syndrome Diagnosed?
Common diagnostic tests include cerebrospinal fluid (CSF) testing, nerve tests, and nerve conduction studies. The doctor will start by obtaining the patient’s medical history and conducting a physical exam. Based on the findings, the doctor will then recommend one of the following diagnostic tests:
Cerebrospinal Fluid Testing
In a procedure called Lumbar Puncture (LP), a needle is inserted into the spine to collect cerebrospinal fluid.
The CSF is then analyzed for changes that commonly occur in people who have Guillain-Barre syndrome.
During an electromyography, thin-needle electrodes are inserted into the muscles. These electrodes measure nerve activity in the muscles.
Nerve Conduction Studies
Electrodes are taped to the skin above your nerves, and a small shock is passed through the nerve to measure the speed of nerve signals.
The symptoms of GBS vary depending on the subtype:
- Acute inflammatory demyelinating polyneuropathy (AIDP): This is the most common subtype in North America and Europe. The most common sign of AIDP is muscle weakness that starts in the lower part of your body and spreads upward.
- Acute motor axonal neuropathy (AMAN): This subtype is less common in the U.S., but more frequent in China, Japan, and Mexico.
The symptoms of these variants often overlap, so it is often difficult to identify the exact subtype. The treatment for these subtypes is the same, involving varying dosages of IVIG depending on the patient’s condition.
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GBS and Pregnancy
GBS in pregnancy can lead to respiratory and neurological problems. Patients often require respiratory support and monitoring, especially during labor.
Guillain-Barré syndrome during pregnancy is managed using intravenous immunoglobulin or plasma exchange. Other measures include venous thromboembolism prophylaxis, aggressive physical therapy, pressure ulcer prevention, enteral nutrition, and respiratory support.
IVIG Infusion for GBS
In Guillain-Barre syndrome, the immune system produces antibodies that attack the nerves. Intravenous immunoglobulin (IVIG) infusion is a potent therapy to help modulate the body’s immune system. In this therapy, antibodies are injected through the veins. These healthy antibodies help stop the harmful antibodies from damaging your nerves.
While several other mechanisms are also involved, IVIG mainly benefits the patient by soothing the damage and inflammation to the nerves. The body’s response to IVIG and its recovery from GBS is measured by the IgG levels in the blood.
IVIG Treatment Dosages
Intravenous infusion of immunoglobulins is the treatment of choice for patients diagnosed with GBS. It is injected at a rate of 2g per kg of body weight. This is done over the course of five days, with 0.4g per kg of body weight injected each day.
It is important to have the right IgG levels in the blood to optimize recovery. The IgG antibodies possibly work by neutralizing the action of autoantibodies that play a role in the autoimmune progression of the disease.
IVIG Side Effects
IVIG treatment for GBS can cause immediate or delayed side effects.
Immediate side effects may include fevers, headaches, skin reactions, hypertension, and arrhythmia. Delayed side effects include thrombotic and renal impairments.
Second Dose Administration
In some reported cases, patients do not show any improvement. In such instances, the patient might receive a second dose, often administered seven to nine days after the first dose.
However, there is inconsistent evidence to support the use of a second dose of IVIG for GBS. Therefore, the use of a second dose for IVIG is not commonly recommended. A second dose of IVIG should only be administered under expert guidance. The use of a second dose might also increase the risk of side effects that may outweigh the benefits of treatment.
What To Expect After IVIG Treatment
IVIG treatment can be given as ambulatory or non-ambulatory infusions. AmeriPharma offers both types of solutions. Each treatment course lasts for up to five days. The recovery time for GBS can vary. It is often a slow process that can take between 6 and 12 months. In some cases, improvement of GBS symptoms can take up to three years.
In addition, most of the symptoms tend to linger to some degree. Persistent symptoms can range from simple nerve damage to permanent limb weakness. However, some people make a full recovery.
Regardless of the severity of symptoms, if you or someone you know has GBS, contact AmeriPharma to speak with a specialist.
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How do you catch Guillain-Barre Syndrome?
The exact etiology is unknown, but researchers believe that GBS might be the result of infections caused by Campylobacter Jujeni or viruses such as HIV, COVID-19, influenza, and hepatitis.
Can Guillain-Barre syndrome be cured?
There is no cure, but patients recover from symptoms and severity over time. Most people with Guillain-Barre syndrome experience this general timeline:
- After the first signs and symptoms, the condition tends to progressively worsen for about 2 weeks.
- Symptoms reach a plateau within 4 weeks.
- Recovery begins, usually lasting 6 to 12 months, though for some people it could take as long as 3 years.
Among adults recovering from Guillain-Barre syndrome:
- About 80% can walk independently 6 months after diagnosis.
- About 60% fully recover motor strength a year after diagnosis.
- About 5% to 10% have very delayed and incomplete recovery.
Children, who rarely develop Guillain-Barre syndrome, generally recover more completely than adults.
How does Guillain-Barre syndrome affect the body?
GBS causes damage to peripheral nerves. The symptoms can include tingling, numbness, muscle weakness, and paralysis.
Can IVIG cure GBS?
IVIG can help improve GBS symptoms. However, the speed of recovery can vary greatly between individuals.
How many doses of IVIG are needed for GBS?
One dose over 5 days is recommended. However, a second dose might be needed in certain cases. If IVIG does not work, plasma exchange might be needed as an alternative.
Dr. Stephanie Shieh, PharmD was born in Kentucky and raised in Southern Los Angeles. She attended the Western University of Health Sciences and has been a practicing pharmacist for 7 years. The most rewarding part of her job is seeing her patients happy – whether it’s helping them understand their medication, catching a drug interaction, or being able to communicate with their doctor to improve their therapy. She is currently precepting students from Marshall B. Ketchum University. In her free time, she enjoys spending quality time with her husband and 2 daughters. They love playing outside, doing arts and crafts, and having family dinner.