Although our immune system creates antibodies to fight the flu virus, sometimes these antibodies can also attack the protective sheath around nerves.
Guillain-Barré syndrome affects the nervous system of a patient and can turn fatal if chest muscles are affected. However, it is totally curable if diagnosed early, finds out Megha Reddy S. Imagine suffering from something as common as flu and being paralysed suddenly, without being able to walk, move your hands or legs or even swallow food.
Although our immune system creates antibodies to fight the flu virus, sometimes these antibodies can also attack the myelin or protective sheath around nerves. This condition is commonly known as the Guillain-Barré syndrome or GBS.
It is a rare condition in which a person’s immune system attacks the peripheral nerves. The syndrome can affect the nerves that control muscle movement as well as those that transmit pain, temperature and touch sensations. This can result in muscle weakness and loss of sensation in the upper and lower limbs.
“GBS is known as the ‘Ascending Paralysis’. It is a rare condition, and while it is more common in adults and in males, people of all ages can be affected,” said Dr Viraj Sanghi, paediatric neurologist at Narayana Health SRCC Children’s Hospital in Mumbai.
Dr Manohar KN, consultant, internal medicine at Manipal Hospitals in Bengaluru, said: “It is classically called demyelinating disease and can affect lower limbs and muscles of the trunk, cranial nerves, neck and speech, and can even cause death due to respiratory muscle involvement. Many cases can be missed due to the atypical presentation and lower degree of suspicion by the treating physicians.”
CAUSES GBS is usually seen as secondary to some kind of viral infection, fever, cough or loose motions. “The chikungunya and dengue virus can also trigger an immune response or damage the nerve,” said Dr Atul Prasad, director at the Centre for Neurosciences at Delhi’s BLK Super Specialty Hospital. “But the prominent virus is usually the flu virus or the virus causing gastrointestinal infection. Up to two-thirds of patients give a history of infections, mostly respiratory or gastrointestinal.”
Sanghi said that GBS may also be triggered by vaccine administration in some individuals. HIV infection is also a known cause of GBS, he said. Manohar opined that given its association with infectious viruses and bacteria, there could be a seasonal aspect to GBS.
SYMPTOMS GBS usually begins with burning, numbness and tingling sensations in the legs, and it can spread to the arms and face. The symptoms typically last a few weeks to months, with most individuals recovering without long-term, severe neurological complications.
“The ability to speak and swallow may become affected in severe cases. These cases are considered life-threatening and the individuals affected should be treated in intensive-care units,” said Sanghi.
DIAGNOSIS & TESTS According to Manohar, diagnosis mainly involves clinical observation and tests are done to exclude other causes. Electromyography (EMG), Nerve Conduction Study (NCS) and Lumbar Puncture (examination of fluid around the brain and spinal cord) are known to be effective. To exclude other problems, an MRI and CT scan are useful. Other routine tests such as blood biochemistry and specific serology are done to rule out possible infective causes.
THREAT TO LIFE In about a third of patients, GBS can lead to paralysis of the breathing or respiratory muscle. “When the respiratory muscle gets paralysed, the patient will have to be on a ventilator and this is when it can be fatal. This is a very dangerous form of the syndrome and this requires ICU care and ventilator care. Doctors are usually worried about respiratory failure,” said Prasad. Sanghi said in 20-30% cases, the chest muscles are affected, making it hard for the patient to breathe. Even in the best of settings, 3-5% of GBS patients die from complications, which can include paralysis of the muscles that control breathing, blood infection, lung clots or cardiac arrest, he said.
TREATMENT Two types of treatment are available for GBS, in addition to supportive care. Plasma exchange, in which the plasma in a patient’s blood is removed in an attempt to get rid of circulating factors causing the disease, and intravenous immunoglobulin injections which shorten the time a patient is paralysed and speed up the time of recovery. “Intravenous immunoglobulin treatment is less traumatic for the patient. The disease gets arrested and the patient starts improving very quickly,” said Prasad. Even with these treatments, many are left with weakness, severe pain and fatigue that impairs daily living.
RECOVERY GBS patients usually take two-three months to recover. “About 40% of patients require in-patient rehabilitation. Many patients can continue to have residual deficits following recovery. Involvement of physiotherapist, occupational therapist can be useful,” said Manohar. Prasad said: “GBS is totally treatable and totally curable if diagnosed early. But if we allow it to worsen, then it might turn fatal.”
GBS IN INDIA The first published GBS case in India was in 1973 and the disease has subsequently been reported from all over India. It is most commonly seen during the rainy season (June to August) and again following influenza outbreaks from January to March.
“Though GBS has been there for many years, we are seeing more number of cases due to rapid urbanisation and deteriorating sanitation,” said Prasad.
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