Guillain-Barre Syndrome (GBS) - By: Tauqeer Hassan

Guillain-Barre syndrome or GBS is a severe inflammatory disorder of the peripheral nerves. Sensory information like pain and temperature is conveyed by the peripheral nerves from the body to the brain and motor.

Symptoms
The symptoms of Guillain-Barre syndrome are lack of feeling, weakness or itchiness in arms or legs, and possible loss of feeling and movement in the upper body, face, arms and legs. The symptoms can remain in this phase and can cause little difficulty in walking. However, in some cases the illness can progress resulting in entire paralysis of arms and legs.
Sometimes the paralysis infects the chest and the breathing muscles get freeze leaving the patient dependent to a ventilator. A feeding tube may be needed if the swallowing muscles also get affected.

Occurrences
The occurrences of Guillain-Barre syndrome are rare, it happens in about 1 to 2 cases out of every 100,000 people in the USA per year. Every person including young and old have a possibility of contracting this syndrome.

Causes of Guillain-Barre syndrome
The syndrome is infectious or inherited. It is still not known what causes this syndrome. Yet the onset of the syndrome follows a viral or bacterial infection in about half of all cases like the following;
- Flu or common cold
- Infectious mononucleosis
- Gastrointestinal viral infection
- HIV
- Viral hepatitis
- Porphyria - rare disease of red blood cells
- Campylobacteriosis - generally caused by eating undercooked poultry
There have occurrences of small number of cases after a medical procedure such as a minor surgery.

Diagnosing the syndrome
As the symptoms differ and the cause is not known, the syndrome is difficult is not easy to diagnose. However, if the symptoms occur consistently across the body and progress fast then it is easy to diagnose.
Observing the symptoms of the patient and an assessment of the medical history provide the basis for diagnosing the syndrome, in spite of this there is no single observation which is appropriate for diagnosing.

Tests
Three tests can be done to diagnose the Guillain-Barre syndrome.
Lumbar puncture (spinal tap):
A local anesthetic is given to the patient and a needle is inserted between two lower vertebrae. A sample of cerebrospinal fluid is taken. A rise in protein level without an increase in the number of white blood cells in the fluid is the trait of the syndrome.
Electromyogram (EMG):
It is a helpful tool in diagnosing as it records the activity of muscle and can show loss of separate nerve impulses because of the trait of the disease reducing the responses of the nerve.
Nerve conduction velocity (NCV):
This test is done with EMG and they are regularly referred as EMG/NCV studies. The NCV records the speed of the nerve signals. These signals are reduced in case of the syndrome which is the sign.

Treatment
This syndrome is known as a medical emergency and patients have to be admitted to the hospital after the disease is diagnosed. If the breathing of the patient is at risk then it is managed in the ICU or intensive care unit.
Recovery of the syndrome may be very slow and the illness can either get progressively better or worse. Many patients are treated with immunoglobulin or plasmapheresis.

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