Diseases

Guillain-Barre Syndrome

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The Guillain-Barre Syndrome (GBS, idiopathic polyradiculoneuritis) is an inflammatory disease of the nerves. The typical symptom is a paralysis and sensory disturbance beginning on the hands or feet, which gradually spreads to the body trunk. The GBS is based on a misguided immune system response. Read all important information about Guillain-Barré syndrome here.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. G61ArtikelübersichtGuillain-Barre Syndrome
  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Guillain-Barré syndrome: description

In 1916, the three French doctors Guillain, Barré and Strohl first described Guillain-Barré syndrome (GBS). "Syndrome" means that it is a disease characterized by a certain combination of symptoms.

Guillain-Barré syndrome is characterized by ascending paralysis and sensory disturbances, most of which begin in the hands or feet. These failures occur because autoaggressive immune cells attack the insulating sheath of the nerve tracts (demyelination) and also damage the nerve tracts (axons) themselves. In particular, the peripheral nerves and nerve outlets from the spinal cord (spinal nerves) are affected.

The causes of Guillain-Barré syndrome are still largely unclear. However, the disease usually occurs after infection.

The Guillain-Barré syndrome can be divided into seven different subtypes, which differ by the severity of the symptoms and certain laboratory findings. In Europe, the so-called Acute Inflammatory Demyelinating Polyneuropathy (AIDP) the most common subtype. It is characterized by a degradation of the protective sheath, which isolated the nerve tracts (myelin sheath).

Guillain-Barré syndrome: frequency

About one in every hundred thousand people in Germany suffer from Guillain-Barré syndrome every year. The GBS can occur at any age, but it is more common in older age. Men are more likely to be affected by Guillain-Barré syndrome than women.

In about 70 percent of cases, the symptoms return completely within weeks or months. However, about eight percent of those infected die from complications of GBS, such as respiratory paralysis or pulmonary embolism. Guillain-Barré syndrome is more common in spring and autumn, possibly because infections are much more common during these seasons.

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Guillain-Barré syndrome: symptoms

Guillain-Barré syndrome usually causes typical signs. However, the first indications of the onset of GBS are nonspecific and are similar to a mild infection. For example, back and body aches occur. In contrast to other diseases such as meningitis, Guillain-Barré syndrome usually causes no fever in the early stages.

In the further course, the actual Guillain-Barré syndrome develops with discomfort, pain and paralysis of the hands and feet. In most cases, these failures are approximately equally pronounced on both sides (symmetrical). Particularly typical are the paralyzes, which can develop within hours to days. These symptoms, which usually begin far from the body, progressively get closer to the body trunk and gradually increase in intensity. The back pain sometimes misleads to the misdiagnosis herniated disc. The pain in Guillain-Barré syndrome is probably caused by the inflammation of spinal cord nerves (spinal nerves).

In the second to third week of illness, the Guillain-Barre syndrome reaches its peak. Thereafter, the symptoms initially remain stable (plateau phase), before slowly regressing within eight to twelve weeks.

It is also possible that the Guillain-Barré syndrome lasts longer and the symptoms do not completely disappear. If the symptoms of GBS persist for more than two months, this chronic form of the disease is also called Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP) designated.

In many patients, so-called cranial nerves are affected by Guillain-Barré syndrome. These nerve pathways emerge directly from the brain and above all control sensory and motor functions in the head and face area. Cranial nerve involvement in Guillain-Barré syndrome is characterized by bilateral paralysis of the seventh cerebral nerve (facial nerve) leading to facial nerve paralysis (facial palsy).

In addition, Guillain-Barré syndrome may affect the autonomic nervous system. This can lead to dysregulation in the function of the circulation and glands (sweat, saliva, lacrimal glands). The normal functioning of the bladder and rectum may also be compromised, leading to incontinence.

Guillain-Barré syndrome: complications

The symptoms of Guillain-Barré syndrome often increase as the disease progresses. They can lead to almost complete paralysis of all muscles. For this reason, Guillain-Barré syndrome can cause serious complications. In the worst case, breathing and the cardiovascular system are severely disturbed. Breathing is impaired in up to 20 percent of the cases ("Landry paralysis") and may require mechanical ventilation of the patient.

Since sufferers can move increasingly worse, the risk of blood clot formation in the vessels (thrombosis) increases. The clots can break loose, enter the lungs via the heart and block the vessels (pulmonary embolism).

If the signs of paralysis of the muscles last longer, muscle atrophy (muscular atrophy) can occur.

Guillain-Barré syndrome: special forms

The so-called Miller Fisher Syndrome is a special form of GBS disease that particularly affects the cranial nerves. The three main symptoms of this special form are paralysis of the eye muscles, reflex loss and gait disturbances. In contrast to the classic Guillain-Barré syndrome, Miller-Fisher syndrome causes paralysis of the extremities to be less pronounced.

In some cases of Guillain-Barré syndrome, only the autonomic nervous system be affected (acute pandy autonomy). This may result in the disturbances of circulatory function, sweat and saliva secretion as well as bladder and rectal function described above.

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Guillain-Barré syndrome: causes and risk factors

So far, it is not clear what causes Guillain-Barré syndrome. Particularly striking, however, is that GBS disease usually occurs after infection. Three-quarters of all patients report having had respiratory or gastrointestinal infection before the onset of Guillain-Barré syndrome. In most cases, GBS begins seven to ten days after infection.

It is assumed that autoaggressive immune cells attack the insulating sheaths of the nerve tracts (myelin sheaths) and thus provoke inflammation of the nerves (polyneuritis). In addition, inflammation-related swelling (edema) of the nerves. In Guillain-Barré syndrome, peripheral nerves (peripheral nervous system) and spinal nerves (spinal nerves) emerge from the spinal cord. The so-called central nervous system, which includes the brain and spinal cord, is less frequently affected.

Guillain-Barré syndrome after infections

It has been proven that Guillain-Barré syndrome is particularly common in infections with certain pathogens. These include infections such as herpes zoster, mumps or even Lyme disease. Campylobacter jejuni, a bacterial agent of gastrointestinal infection, is believed to be the most common trigger of GBS:

During an infection, the body forms antibodies against surface structures of a pathogen. Campylobacter jejuni has structures on its surface that are similar to those of the nerve sheath. It is therefore assumed that the antibodies against the pathogen circulate after surviving the infection in the body and now attack the nerves due to the similar surface structures ("molecular mimicry"). However, only about 30 out of 100,000 people who are infected with this bacterium develop Guillain-Barré syndrome. This assumption of "molecular mimicry" applies equally to other bacteria and viruses.

Guillain-Barré syndrome after vaccinations

In the safety information of vaccinations, Guillain-Barré syndrome is mentioned as a potential side effect within six weeks of vaccination. A GBS as a result of vaccination, however, according to the current state of knowledge is extremely. The benefit of vaccination in any case exceeds the negligible risk of developing Guillain-Barré syndrome.

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Guillain-Barré syndrome: examinations and diagnosis

Suspected Guillain-Barré syndrome should immediately a neurological clinic with intensive care be visited. The doctor can already receive important information (history) by describing your symptoms and possible pre-existing conditions. Typical questions the doctor might face if Guillain-Barré syndrome is suspected are:

  • Have you been ill for the past four weeks (cold or gastrointestinal infection)?
  • Have you been vaccinated in the last few weeks?
  • Do you notice signs of paralysis or discomfort on hands, feet, or any other part of the body?
  • Do you have back pain?
  • Do you take any medicine?

Often, the above-mentioned association is with a gastrointestinal or respiratory disease about two weeks in advance. If muscle weakness or sensitivity disorders appear after such an infection, medical advice should be sought immediately. In a clinic then has to be checked whether in fact the Guillain-Barré syndrome behind it or the symptoms have another cause such as muscle diseases or spinal cord injuries.

Physical examination:

After the medical history follows the physical examination. The doctor tests the sensitivity and muscle strength at various parts of the body. Also, a review of the twelve cranial nerves and the reflexes is part of the physical examination.

Experts have defined criteria that can help diagnose Guillain-Barré syndrome. The three required main criteria are:

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