Guillain-Barré syndrome

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What is it about ?

Guillain-Barré syndrome is an inflammation of the nerves, more specifically a reaction (or attack) of the immune system against nerve roots of his own body. This attack causes characteristic symptoms, including muscular weakness is the standard bearer.

Cause

The cause of Guillain-Barré syndrome is unknown.

A large proportion of those affected (up to 70%) are victims of infection in the weeks before the onset of symptoms. However, this is not a sine qua non for the development of the affection. It is most often a question of a gastrointestinal infection caused by the bacteria Campylobacter, and sometimes from respiratory tract infection or a general infection such as mononucleosis, cytomegalovirus, or zika virus infection.

The condition can also occur after a vaccination or after a treatment that acts on the immune system.

Process

Up to 9 in 10 patients make a full recovery after 1 to 2 years. The affection usually takes place in three phases.

  • During the first phase, which lasts about 4 weeks, the symptoms become more and more severe.
  • During the second phase, symptoms remain stable for about 2 weeks.
  • Finally, during the six weeks that make up the last phase, the symptoms disappear.

In some people, it takes longer to heal. And a number of patients will have persistent symptoms. About 5-10% of people with the disease die from the disease.

What is its frequency?

Guillain-Barré syndrome is the leading cause of paralytic symptoms of fairly rapid onset. It can be seen all over the world and can affect anyone.

It is assumed that about 1 to 1.9 in 100,000 people get the condition each year. Across Belgium, for example, this represents around 100 to 200 people per year diagnosed with Guillain-Barré syndrome.

How to recognize it?

  • Symptoms usually start in both legs. It is often a question of tingling and numbness, then muscular weakness more and more serious. These symptoms are ascending: they start in the feet and work their way up to the legs, then to the hands and arms.
  • They are often accompanied by a deficit in the function of certain cranial nerves which is characterized, for example, by a paralysis of facial muscles or by swallowing disorders and speech. The function of the bladder is not affected.
  • People with Guillain-Barré syndrome also often have pain in the shoulders and chest. back.
  • In the most severe forms of the disease, breathing difficulties may appear, requiring hospital breathing assistance. These breathing problems can sometimes develop within a few hours.

How is the diagnosis made?

Your doctor will ask you a number of questions and examine you so that a quick assessment can be made. For example, he will test your tendon reflexes using a hammer and perform a neurological examination by asking you to perform certain movements on the face. It will also assess the degree of muscular weakness.

If Guillain-Barré syndrome is suspected, you will generally be referred to an emergency department. A number of examinations can be performed there:

  • a lumbar puncture, which involves taking a sample of the fluid around your spinal cord (cerebrospinal fluid) through a puncture in the back;
    • This fluid is then analyzed to determine the amount and type of protein in it, as well as the amount of white blood cells.
    • Guillain-Barré syndrome is usually associated with an increased amount of protein in the cerebrospinal fluid.
  • a MRI of the spinal canal ;
  • an electroneuromyogram (ENMG), which allows the doctor to check to what extent the electrical activity of your nerves is being disturbed.

What can you do ?

At present, there are no known preventive measures. If you have symptoms that could suggest Guillain-Barré syndrome, see your doctor right away.

What can your doctor do?

It is important that the doctor quickly recognizes Guillain-Barré syndrome to refer you to the hospital. It is indeed crucial, in the treatment of Guillain-Barré syndrome, that your body is under close observation and that it receives supportive measures. Sometimes themuscle weakness is such that it threatens respiratory function, for example. That is why you must be transferred to a hospital, where you can be put under respiratory support.

You will also be given an infusion in the hospital. You may be given immunoglobulins, which will help your body to recover faster. In very severe cases, another possible treatment is what is called a ‘plasmapheresis‘. The technique literally involves cleaning the blood. These treatments should be started as soon as possible.

Pain can be treated with painkillers, possibly supplemented by sessions of physiotherapy. The physiotherapist also plays an essential role in the treatment of muscular weakness. Lack or absence of movement causes muscles to weaken very quickly and can increase muscle stiffness. The physiotherapist will teach you the right exercises to avoid it.

People with Guillain-Barré syndrome often stay still for long periods of time. This results in an increased risk of thrombosis, which can be limited by means ofinjections daily.

Source

Foreign clinical practice guide ‘Guillain-Barré syndrome (polyradiculitis)’ (2000), updated on 01.09.2017 and adapted to the Belgian context on 19.05.2019 – ebpracticenet

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