The Guillain-Barré syndrome (GBS) is an autoimmune process, in which the body produces antibodies that attack the components of peripheral nerves (Pena et al., 2014). It is one of the most frequent acquired polyneuropathies (KopyKo & Kowalski, 2014).
Guillain Barré Syndrome: Symptoms
Different studies show that this is the first cause of extensive acute paralysis in the cases developed since the eradication of poliomyelitis (Ritzenthaler et al., 2014).
It appears that this pathology is the result of a process mediated by the immune system which, in many cases, appears after an episode of virus infectious type, and which essentially affects the motoneurons (January et al., 2010).
This type of syndrome is characterized by ascending flaccid paralysis or weakness that begins in the lower limbs and is symmetrical and harmonious, and may also be associated with sensory symptoms and autonomic alterations (Vazquez Lopez et al., 2012).
Because it is an evolutionary or progressive condition that can have squeal, a thorough and repeated examination is essential to confirm the diagnosis and to control the possible complications resulting from the development of acute respiratory insufficiencies (Ritzenthaler et al.).
Prevalence of Guillain-Barré syndrome
Guillain-Barré disease (GBS) is considered a rare or rare disease. In spite of intensive treatments, GBS mortality ranges from 4% to 15% Kopek & Kowalski, 2014).
In Western countries, the incidence is estimated at approximately 0.81 to 1.89 cases per 100,000 inhabitants per year (Ritzenthaler et al., 2014).
Statistical data show that this disease can occur at any stage in life and affects men and women in a proportional way (Kopek & Kowalski, 20014).
However, there is evidence about the greater proportion of the disease in men, being 1, 5 times more likely to suffer from it (Pena et al., 2014). In addition, it appears that the risk of GBS disease increases with age, increasing its incidence after age 50 to 1.7-3.3 cases per 100,000 inhabitants per year (Pena et al., 2014).
On the other hand, in the case of children, its incidence has been estimated at 0.6-2.4 per 100,000 cases. Of these, between 70% -80% of those affected had undergone infectious processes before the onset of the syndrome (January et al., 2010).
Definition and symptoms of Guillain-Barré syndrome
It is a progressive disease that affects the peripheral nervous system that usually presents three phases or stages: an extension phase, a plateau phase and a recovery phase (Ritzenthaler et al., 2014)
The first symptoms or signs of this pathology are manifested by the presence of different degrees of weakness or paralysis, or by tingling sensations in the lower extremities that are progressively expanding towards the arms and torso (National Institute of Neurological Disorders And Stroke, 2014).
Symptoms are likely to increase in severity until limbs and muscles are not functional and severe paralysis occurs. This paralysis can cause significant problems in maintaining respiration, blood pressure and heart rate, requiring assisted breathing (National Institute of Neurological Disorders and Stroke, 2014).
Usually, in the first two weeks of the appearance of the first symptoms, a significant weakness is usually already reached. In the third week approximately 90% of the patients are in the phase of greater weakness (National Institute of Neurological Disorders and Stroke, 2014).
Thus, in 80% of cases, par aesthesia and painful or reef-like processes are present. In 80% of cases, the presence of a dysplasia is general, with the loss of gait in 75% of patients. In addition, 30% of cases progress to cardiac failure (Ritzenthaler et al., 2014)
This increase in symptoms is usually followed by a phase of remission lasting from 6 to 14 months (Kopek & Kowalski, 20014).
In the case of motor reacquisition, most individuals do not recover from the paralysis processes until about 6 months later. In addition, approximately 10% may present residual symptoms up to 3 years after resolution of the episode (Ritzenthaler et al., 2014)
On the other hand, relapses do not usually occur frequently, appearing in 2-5% of cases. Although fluctuations may occur after initiation of treatment (Ritzenthaler et al., 2014).
Most patients recover, including the more severe cases of Guillain-Barré syndrome, although some continue to have some degree of weakness (National Institute of Neurological Disorders and Stroke, 2014).
Causes and path physiology
The exact causes of the factors that trigger GBS are unknown. However, several lines of research suggest that different infectious or viral agents may trigger an abnormal immune response (January et al., 2010).
In many cases a post infectious syndrome is considered. A history of digestive, respiratory or grille syndromes is usually described in the patient’s medical history. The major deoxygenating agents are bacterial (Campylobacter jejuna, Mycoplasma pneumonia, Homophiles influenza), viral (cytomegalovirus, Epstein-Barr virus) or human immunodeficiency virus (Ritzenthaler et al., 2014)
However, from the path physiological mechanisms it is known that the body’s immune system begins to destroy the axonal myelin sheaths of the peripheral nerves.
The involvement of the nerves will prevent the signal transmission so that the muscles begin to lose their responsiveness and in addition, less sensory signals will be received, diffusing in many cases the perception of textures, heat, pain, etc. (National Institute of Neurological Disorders and Stroke, 2014).
The signs and symptoms of the syndrome can be quite varied, so doctors may find it difficult to diagnose Guillain-Barré syndrome in its early stages (National Institute of Neurological Disorders and Stroke, 2014).
For example, doctors will look at whether symptoms appear on both sides of the body (most common in Guillain-Barré syndrome) and the rate at which symptoms appear (in other disorders, muscle weakness may progress through months Instead of days or weeks) National Institute of Neurological Disorders and Stroke, 2014).
Therefore, the diagnosis is mainly clinical and the complementary tests are performed for differential diagnosis (Ritzenthaler et al., 2014). The following tests are usually used:
- Electromyograms : used for the study of nerve conduction velocity since demyelization slows down these signals.
- Lumbar puncture: used to analyze the cerebrospinal fluid since in patients with GBS contains more proteins than normal.
Consequences and possible complications
The majority of complications are due to the presence of musculoskeletal paralysis and nerve conduction deficiency. They may appear (Ritzenthaler et al., 2014):
- Acute respiratory failure : one of the main causes of mortality. Its appearance requires the use of mechanical ventilation. Usually the first signs that appear are of the type orthopnea, tachypnea, and polypnea, sensation of chest pressure or difficulty to speak. The control respiratory function is vital to patient survival.
- Bulbar affectation: the main complications that are presented are the type of borokaspiration, risk of neuropathy, respiratory failure and aleclectasia.
- Dysautomy : involvement of the autonomic nervous system will lead to disorders of the heart rhythm, tensile lability, urinary retention, etc.
- Dolores: present in most patients and are usually derived from paraesthesia and distention in the extremities. Generally, pain is often correlated with the degree of motor involvement.
- Venous thromboembolic disease: Paralysis of the patient’s prolonged immobilization will increase the risk of venous thrombosis or pulmonary embolism.
In addition to these eminently medical complications, we will have to consider the possible neuropsychological squeal.
It is a progressive disease that fundamentally affects the mobility of the individual. Therefore, suffering from a progressive paralysis process will have important repercussions on the patient’s quality of life.
Limitation of walking, movements and even dependence on assisted breathing will drastically limit the patient’s daily, labor, and even personal activities. Usually, there is also a decrease in social interactions due to functional limitations.
The impact of all symptoms can also interfere with normal cognitive functioning, resulting in difficulties of concentration, attention, decision making or slight alterations of memory processes.
The National Institute of Neurological Disorders and Stroke (2014) notes that a specific cure for Guillain-Barré syndrome has not yet been identified. However, there are different therapeutic interventions aimed at reducing the severity of the symptoms presented and promoting the speed of recovery of these patients.
The specific treatment of GBS is based on plasmapheresis or polyvalent immunoglobulin’s. However, treatment should be based primarily on the prevention and symptomatic treatment of complications (Ritzenthaler et al., 2014)
Therefore, there are different approaches in the treatment of the different complications derived from the GBS condition (National Institute of Neurological Disorders and Stroke, 2014):
- Plasmapheresis: this is a method in which all the blood reserves of the organism is extracted and processed by separating the red and white blood cells from the blood plasma. Once plasma (which may contain elements of the immune system that damage myelin) has been suppressed, the blood cells are reintroduced into the patient. Although the exact mechanisms are not known, these types of techniques reduce the severity and duration of the Guillain-Barré syndrome episode.
- Immunoglobulin therapy: In this type of therapy, specialists administer intravenous immunoglobulin injections (in small doses the body uses this protein to attack invading organisms). It has been proven that the administration of high doses can reduce the destruction caused by immune system.
- Steroid Hormones: The use of these hormones has also been proven to reduce the severity of the episodes; however detrimental effects on the disease have been identified.
- Assisted breathing: in many cases the presence of respiratory insufficiency may require the use of a respirator, heart rate monitors and other elements for the control and monitoring of bodily functions.
- Physical intervention: even before recovery begins, caregivers are instructed to manually move the limbs of patients to help keep the muscles flexible and strong.
- Early rehabilitation: early and intensive rehabilitation seems to be effective for motor recovery and residual fatigue. Respiratory physiotherapy , with secretion removal techniques, is of special interest in preventing the accumulation of bronchial secretions and pulmonary super infections (Ritzenthaler et al., 2014)
- Physiotherapeutic intervention: as the patient begins to regain control of limbs, physical therapy begins with specialists with the aim of recovering motor functions and alleviating the symptoms derived from par aesthesia and paralysis.
Guillain-Barré syndrome is a rare disease that usually has a good prognosis with intensive treatment, with mortality estimated at 10%.
On the other hand, the prognosis of motor recovery is also favorable. However, within 5 years, patients can maintain different squeal such as pain, barbaric symptoms or enfinterian disorders.
Due to the risk of suffering from heart failure, it is a medical emergency that must be carefully controlled to reach the recovery phase in the shortest time possible.