Guillain–Barre Syndrome (GBS)

Guillain–Barre Syndrome is an inflammatory disease of the peripheral nervous system and is the most common cause of acute flaccid paralysis. Guillain–Barre syndrome occurs more frequently in males than in females and the incidence increases with age, although all age groups can be affected1. Patients with GBS typically present with weakness and sensory signs in the legs that progress to the arms and cranial muscles, although the clinical presentation of the disease is heterogeneous and several distinct clinical variants exist. Diagnosis of Guillain–Barre syndrome is based on the patient history and neurological, electrophysiological and cerebrospinal fluid (CSF) examinations. Other diseases that have a similar clinical picture to Guillain–Barre syndrome must be ruled out. Electrophysiological studies provide evidence of PNS dysfunction and can distinguish between the subtypes of Guillain–Barre syndrome: acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN). Disease progression can be rapid, and most patients with Guillain–Barre syndrome reach their maximum disability within 2 weeks. About 20% of patients with Guillain–Barre syndrome develop respiratory failure and require mechanical ventilation. Cardiac arrhythmias and blood pressure instability can occur owing to involvement of the autonomic nervous system. This involvement of the autonomic nervous system contributes to mortality, which is estimated at 3–10% for patients with GBS even with the best medical care available. After the initial progressive phase, patients with Guillain–Barre syndrome reach a plateau phase that can last from days to weeks or months, after which they start to recover, and 60–80% of patients with GBS are able to walk independently 6 months after disease onset, with or without treatment. GBS is a monophasic illness, although some patients can deteriorate after first stabilizing or improving on therapy — a phenomenon that is referred to as a treatment-related fluctuation. Relapses of GBS can occur in 2–5% of patients. This discussion of GBS includes etiology, pathophysiology, symptoms and clinical features, diagnosis and treatment.

Reference:
Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019;15(11):671-683. doi:10.1038/s41582-019-0250-9
Nguyen TP, Taylor RS. Guillain Barre Syndrome. [Updated 2019 Dec 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532254/
Cunningham, M.W. (2009). Molecular Mimicry. In e LS , (Ed.). doi:10.1002/9780470015902.a0000958.pub2
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Alkan, Ozlem & Yildirim, Tulin & Tokmak, Naime & Tan, Uner. (2009). Spinal MRI Findings of Guillain-Barré Syndrome. Journal of radiology case reports. 3. 25-8. 10.3941/jrcr.v3i3.153.

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