Guillain-Barré syndrome: symptoms, causes and treatment
This neurological disease affects the nerves of the peripheral nervous system.
Guillain-Barré syndrome is a rare disease that destroys the myelin of the peripheral nerves of the body and causes muscular and sensory disturbances. of the organism and causes muscular and sensory alterations, generating in the person who suffers a great functional disability. It is a serious disorder that must be treated urgently, as it can lead to respiratory complications that can put the patient's life at risk.
In this article we explain what this neurological disease consists of, what its causes are, the signs and symptoms, how it is diagnosed and what its treatment is.
Guillain-Barré syndrome: what is it and how does it occur?
Guillain-Barré syndrome, or acute polyradiculoneuritis, is a rare neurological disease of autoimmune origin, characterized by rapid muscle weakening (distal onset and proximal progression), accompanied by alterations in sensation and sensation of the muscles. characterized by rapid muscle weakness (with distal onset and proximal progression), accompanied by alterations in sensation, such as pain or tingling sensations and tingling sensations.It is characterized by rapid muscle weakness (distal onset and proximal progression), accompanied by alterations in sensibility, such as pain or tingling sensations and loss of osteotendinous reflexes, and may also affect the respiratory bulbar musculature.
This disorder mainly affects the peripheral nervous system and is the most frequent cause of paralysis. is the most frequent cause of acute generalized paralysis.. The damage occurs in the myelin sheaths of the nerves (which increase the speed of transmission of nerve impulses), and is caused by the patient's own immune system.
Guillain-Barré syndrome affects all races, sexes and ages equally. Its incidence is 1 or 2 cases per 100,000 people. The course of the disease can be fulminant, with a rapid evolution that usually requires ventilatory assistance within a few days.
Possible causes
Although the causes are still unknown, the most plausible hypotheses point to an infectious origin of viral or bacterial type, which could be the cause of a demyelinating polyneuropathy.which could generate an autoimmune response that triggers a reaction against the basic proteins of the nerves, giving rise to the demyelinating process.
Diagnosis
Guillain-Barré syndrome cannot be diagnosed with the administration of a single test.. It is usually suspected when the patient presents the diagnostic criteria of Asbury and Cornblath: a progressive weakness in more than one limb and universal osteotendinous areflexia.
On the other hand, there are other clinical features that support the diagnosis; progression of weakness, relatively symmetrical involvement, mild sensory signs and symptoms, autonomic dysfunction (tachycardia, arterial hypertension or vasomotor signs), cranial nerve involvement (with facial weakness in half of the cases), and absence of fever.
Although the clinical picture may vary, Guillain-Barré syndrome is the most common current cause of cerebral nerve involvement (with facial weakness in half of the cases). syndrome is the most common current cause of symmetrical weakness that develops in just a few hours.. Progressive paralysis, respiratory failure and cardiovascular complications will also determine the diagnosis.
Other clinical manifestations may vary from patient to patient, such as: fever at onset; severe sensory loss with pain; cessation of disease progression with no recovery or significant permanent sequelae; sphincter involvement; and lesions in the central nervous system..
Differential diagnosis should take into account the following disorders: motor neuron diseases (such as acute viral poliomyelitis, amyotrophic lateral sclerosis, etc.); polyneuropathies (e.g. porphyria, other forms of Guillain-Barré syndrome, Lyme disease, etc.); disorders of neuromuscular transmission (such as autoimmune myasthenia gravis or botulism); and other muscular and metabolic disorders.
Clinical signs and symptoms
Initial symptoms in Guillain-Barré syndrome may involve abnormal sensations (paresthesias) that manifest in various forms, first in one limb and later in both, such as: tingling, numbness, numbness or a sensation of having something walking under the skin (formication)..
Muscle weakness is also present and usually starts in the lower limbs, later affecting other areas of the body. This weakness is sometimes progressive and affects arms, legs, respiratory muscles, etc., forming the typical clinical picture of Guillain-Barré syndrome. Cranial nerves are also affected in 25% of patients, with bilateral facial paresis being the most characteristic sign.
The disease follows a course that lasts between 3 and 6 months, evolving in several phasesThe progression phase, the stabilization phase and the recovery or regression phase.
1. Progression stage
In the progression stage the person experiences the first signs and symptoms such as tingling and paresthesia in the feet and hands, followed by muscle weakness that may lead to paralysis.followed by muscle weakness that may end in paralysis. It usually begins in the feet or legs and then gradually spreads to the rest of the body, leading to facial or respiratory paralysis.
This first phase may last from a few hours to three to four weeks and, depending on the severity of symptoms, may require urgent medical intervention due to possible airway blockage.
Stabilization phase
This second stage, known as the stabilization phase, comprises the end of disease progression and the beginning of clinical recovery.. In this phase, the signs and symptoms of Guillain-Barré syndrome usually stabilize; however, problems such as hypertension or hypotension, tachycardia and some complications such as pressure ulcers, Blood clots or urinary tract infections may occur.
The duration of the stabilization phase varies, ranging from a few days to several weeks or even months. However, it should be noted that this stage may be absent during the course of the disease.
3. Regression or recovery phase
This last stage is between the onset of recovery and the end of the disease. During this phase, the symptoms gradually diminish. After this last phase, if neurological damage persists in the patient, it can be considered as permanent sequelae..
This phase usually lasts approximately 4 weeks, although this time varies from one subject to another depending on the severity and extent of the neurological lesions, and can last for months.
Treatment
It is quite probable that the Guillain-Barré syndrome presents with a rapid deterioration.Therefore, all patients suspected of having the disease should be hospitalized, and their respiratory function should be monitored. Similarly, if the patient has swallowing difficulties, he/she should be fed through a stomach tube.
In case the person presents respiratory paralysis, assistance by means of breathing apparatus will be necessary.If the person has respiratory paralysis, mechanical ventilation will be necessary. The management of respiratory function includes the patency of the airways, the person's ability to cough and expectorate, the ability to swallow, and the appearance of symptoms of hypoxemia (decreased blood oxygen) or hypercapnia (increased blood carbon dioxide).
The treatment indicated for this disorder includes on the one hand, plasmapheresis, a procedure that consists of purifying the blood, that is, extracting a determined volume of blood plasma to eliminate particles and pathogens involved in the pathological immune response; and on the other hand, the intravenous administration of immunoglobulins, a treatment to replace a person's defenses when suffering from an infectious or autoimmune disease.
Bibliographic references:
- Hughes, R. A., & Cornblath, D. R. (2005). Guillain-barre syndrome. The Lancet, 366(9497), 1653 - 1666.
- Tellería-Díaz, A., & Calzada-Sierra, D. J. (2002). Guillain-Barré syndrome. Rev Neurol, 34(10), 966 - 976.
(Updated at Apr 14 / 2024)