Can you imagine that a small numbness that starts in the tips of your toes can gradually spread throughout your body, causing numbness in your limbs and even paralysis? It's a scary story. But this is the reality of a rare neurological disorder called
Guillain-Barré Syndrome (GBS). It often develops after you've recovered from a common stomach bug (like jaundice) or respiratory infection (like
a cold ).
Simply put, what is Guillain-Barré syndrome (GBS)?
In simple terms, GBS is when our body's defense system,
the immune system , suddenly starts attacking our own nerves. It's like our own army accidentally attacking our own people. Think of it like our nerves are like electrical wires. There's a plastic sheath around these wires as insulation, right? Similarly, our nerves are also surrounded by a protective sheath called
myelin . When GBS develops, our immune system attacks that myelin sheath. When this sheath is damaged, messages from the brain don't get to the muscles properly. The result is muscle weakness, numbness, and sometimes complete paralysis.
This is not a contagious or hereditary disease. However, it is a condition that requires emergency medical attention . Therefore, it is very important to seek medical advice as soon as the first symptoms appear.
What are the main types of GBS?
There are several main types of GBS, but the first type is the most common in Sri Lanka.
| Disease type | Specialty |
|---|
| Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) | This is the most common type. In this type, muscle weakness begins in the legs and spreads upward throughout the body. |
| Miller Fisher syndrome (MFS) | This is common in Asian countries. It first starts with difficulty moving the eyes. Loss of balance when walking is also a symptom. |
| AMAN and AMSAN types | These are more common in countries like China and Japan. Symptoms can be more severe than other types. |
Causes and risk factors for developing GBS
The exact cause of GBS is not yet known. However, doctors believe that certain infections change the nature of our nerve cells, causing the immune system to mistake them for enemies. About two-thirds of people who develop GBS have a stomach illness like diarrhea or a respiratory infection like a cold a few days or weeks before the onset of neurological symptoms.
Some of the main factors that can contribute to GBS include:- Campylobacter bacteria: This bacteria, which is transmitted through undercooked chicken, is considered the main cause of GBS .
- Influenza virus
- COVID -19 virus
- Cytomegalovirus
- Epstein-Barr Virus
- Zika virus
- Hepatitis A , B, C and E
- HIV virus
- Some surgeries or accidents
- In rare cases, some vaccines (e.g. Johnson & Johnson and AstraZeneca COVID-19 vaccines)
Not everyone who has this infection will develop GBS. Only one in a million people is at risk.
What symptoms should you look out for?
Symptoms of GBS can appear very quickly, sometimes becoming severe within a few hours or days.
| Symptom | Description |
|---|
| Numbness | A tingling sensation like ants crawling on your toes, ankles, fingers, and wrists. |
| Muscle weakness | A lifeless feeling that starts in the legs and gradually spreads to the upper parts of the body. |
| Difficulty walking | I lose my balance when walking and have difficulty climbing stairs. |
| Facial changes | It becomes difficult to speak, chew food, and swallow. You may see one or two things in both eyes (double vision). |
| Severe pain | A stabbing, stabbing pain in the muscles of the body. This pain can be especially severe at night. |
| Other features | Increased heart rate, high and low blood pressure, inability to control urine and stool, difficulty breathing. |
Extremely important: If you suddenly feel unwell and it gets worse over the course of a few hours, or if you have difficulty breathing or swallowing, go to a hospital's Emergency Department (ETU) immediately. This is not something to delay.
How does the doctor diagnose this disease?
Because the symptoms of GBS are similar to other neurological diseases, the doctor will run several tests to make sure there are no other diseases.
- Questioning you: Asking things like how and when your symptoms started, and if you've had any recent illnesses.
- Nervous system test: This tests your muscle strength, gait, balance, and reflexes.
- Spinal tap / Lumbar puncture: This involves inserting a very thin needle into your lower back and taking a small amount of the fluid around your spinal cord (cerebrospinal fluid) and sending it to a lab for testing. If the protein levels in this fluid are elevated, it is a sign of GBS.
- Neurological function tests:
- Electromyography (EMG): This involves inserting fine needle-like electrodes into the muscles to measure nerve activity.
- Nerve conduction study: This measures the speed at which nerve impulses travel by placing electrodes on the skin and sending a small electrical current. This speed is slowed in GBS.
- MRI scan: You may also have an MRI scan of your brain or spine.
What are the treatments?
If you are diagnosed with GBS, you need to start treatment right away. You will often be treated in the intensive care unit (ICU) of a hospital. There are two main treatments: 1.
Plasma exchange / Plasmapheresis: Your blood is put into a special machine, and the liquid part of your blood (plasma) is separated. This plasma contains antibodies that damage nerves. The machine removes these bad antibodies and puts good blood cells back into your body. 2.
Immunoglobulin therapy: A large amount of good antibodies taken from healthy people are given to you through a saline solution. These good antibodies reduce the activity of the bad antibodies in your body. In addition to these main treatments, you will be given painkillers, blood thinners, and if necessary, you will be fed through a tube because you cannot swallow food.
If breathing difficulties become severe, you may need to be temporarily connected to a ventilator. During your recovery, you will need to do strength training with the help of physical therapy and occupational therapy.
What will recovery and the future be like?
The disease reaches its peak 2-3 weeks after the onset of symptoms. After that, recovery begins gradually.
- About 80% of patients are able to walk without any assistance within 6 months.
- About 60% of patients regain full muscle strength within a year.
- Recovery can take between 6-12 months, and for some it can take up to 3 years.
Children with GBS recover more quickly than adults. Once you have fully recovered from GBS, you can live a normal life.
Take-Home Message
- If you have numbness or a feeling of weakness that starts in your legs and spreads up your body, don't ignore it.
- If these symptoms are accompanied by difficulty breathing or swallowing, it is a medical emergency . Go to a hospital's Emergency Department (ETU) immediately.
- GBS is a rare but potentially serious disease. However, if treatment is started early, most people can make a full recovery.
- Don't panic. If you have these symptoms, see your doctor immediately for advice.
Guillain-Barré Syndrome, GBS, neuropathy, leg numbness, numbness, immune system, myelin
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