Guillain-Barre Syndrome Overview and Practice Questions Illustration

Guillain-Barré Syndrome: Overview and Practice Questions

by | Updated: Nov 24, 2023

Guillain-Barré Syndrome (GBS) is a rare but serious autoimmune disorder where the body’s immune system mistakenly attacks peripheral nerves, leading to rapid-onset muscle weakness and, sometimes, paralysis.

This article provides an overview of Guillain-Barré Syndrome, exploring its causes, symptoms, diagnosis, treatment, and the ongoing research dedicated to understanding this complex condition better.

 

 

What is Guillain-Barre Syndrome?

Guillain-Barré Syndrome (GBS) is a rare neurological disorder in which the body’s immune system mistakenly attacks the peripheral nerves, which connect the brain and spinal cord to the rest of the body. It often occurs after an infection, surgery, or vaccination, although the exact cause is not fully understood. The condition can be life-threatening and requires immediate medical attention.

Guillain-Barre Syndrome Vector Illustration

Symptoms

The symptoms of Guillain-Barré Syndrome can vary, but they usually start with weakness and tingling in the legs. The weakness can rapidly progress, affecting the muscles responsible for breathing and other bodily functions.

Some common symptoms include:

  • Muscle weakness or paralysis, usually starting in the legs and potentially spreading to the arms and face
  • Tingling or prickling sensations in the skin
  • Pain, which can be severe, especially at night
  • Difficulty swallowing or chewing
  • Unstable blood pressure and heart rate
  • Difficulty breathing due to weakness of the respiratory muscles

Treatment

There is no cure for Guillain-Barré Syndrome, but there are treatments that can reduce the severity of the symptoms and accelerate recovery:

  • Plasmapheresis (plasma exchange): This process involves removing and replacing the liquid part of the blood (plasma) to remove antibodies causing inflammation.
  • Intravenous immunoglobulin (IVIG): This treatment involves administering high doses of proteins that, in small amounts, function as antibodies, which can help block the damaging antibodies that are attacking the nerves.

Recovery

Recovery from Guillain-Barré Syndrome can vary significantly from person to person. Some may experience a full recovery, while others may have lasting neurological damage.

The recovery period can range from a few weeks to several years, depending on the severity of the condition and other individual factors.

Rehabilitation therapies, including physical, occupational, and speech therapy, can be crucial in helping individuals regain function and independence.

Risk Factors

While the exact cause of GBS is unknown, it is often preceded by an infectious illness such as a respiratory infection or gastroenteritis.

Certain infections, like Campylobacter jejuni, Cytomegalovirus (CMV), and Epstein-Barr virus, have been associated with GBS.

Additionally, the syndrome may occur following surgery or vaccination, although it is extremely rare in these cases.

Prognosis

Most people with Guillain-Barré Syndrome experience a good recovery, but the extent and speed of recovery can be highly variable.

Some may continue to experience varying degrees of weakness, numbness, or other neurological symptoms.

In severe cases, GBS can lead to long-term disability or even be fatal, especially if there are complications such as respiratory failure, blood clots, or severe infections.

However, with prompt diagnosis and treatment, many individuals can recover and lead normal, healthy lives.

Guillain-Barré Syndrome Practice Questions

1. What is the definition of Guillain-Barre Syndrome?
It’s an acute, rapidly progressing polyneuritis that causes ascending symmetrical paralysis. In other words, it’s a rare autoimmune disorder of the peripheral nervous system (PNS) in which the flaccid paralysis of the skeletal muscle and loss of reflexes develop, usually in a person who was previously healthy.

2. What does Guillain-Barre Syndroms affect?
It affects the cranial nerves and the peripheral nervous system.

3. Why are reflexes useful for patients with Guillain-Barre Syndrome?
It can give an indication of what is going on with the innervation of the muscles.

4. What are the clinical manifestations of Guillain-Barre Syndrome?
Weakness, paresthesia, paralysis, hypotonia, areflexia, ANS dysfunction, pain, SIADH (syndrome of inappropriate antidiuretic hormone secretion), and respiratory failure.

5. What investigation is done to diagnose Guillain-Barre Syndrome?
History, physical exam, CSF analysis, EMG, nerve conduction tests, and brain MRI.

6. What care should be done for patients with Guillain-Barre Syndrome?
Mechanical ventilation, plasmapheresis, IV immunoglobulins, vasopressors, and proper nutrition.

7. What can occur in severe cases of Guillain-Barre Syndrome?
Paralysis of the diaphragm and ventilatory failure.

8. What can develop from Guillain-Barre Syndrome?
Mucus accumulation, airway obstruction, and atelectasis.

9. What happens to the myelin sheath due to Guillain-Barre Syndrome?
Demyelination and inflammation

10. How does Guillain-Barre Syndrome cause paralysis?
It prevents the ability of the neurons to transmit impulses to the muscles.

11. How does Guillain-Barre Syndrome affect the body?
From the ground to the brain; It’s an ascending disorder that starts at the extremities and works towards the head.

12. What is the precise cause of Guillain-Barre Syndrome?
The precise cause is unknown.

13. What antigen causes the infections in Guillain-Barre Syndrome?
Campylobacter jejuni causes 60% of the infections in this condition.

14. What elevated levels are present in Guillain-Barre Syndrome?
Antiganglioside antibodies and protein levels.

15. What factors are more susceptible to Guillain-Barre Syndrome?
Being caucasian (50 to 60% more likely) and being >45 years of age.

16. What is the clinical presentation of Guillain-Barre Syndrome?
Symmetric muscle weakness with tingling, burning, shock-like sensations; throbbing pain; numbness to extremities, face, and trunk can occur; drooling and difficulty swallowing; and, respiratory muscle paralysis.

17. What percent of people with Guillain-Barre make a full recovery?
90%; 10% have long-term neurological deficits.

18. How long is the recovery time for Guillain-Barre Syndrome?
6 months to two years, but not much recovery after 2 years, and may be as long as 3 years.

19. What history do patients with Guillain-Barre typically have?
Sudden onset of weakness, abnormal sensations that affect both sides of the body, and loss of reflexes, such as knee-jerk.

20. What are the clinical Indicators of ventilatory failure?
FVC: <20 ml/kg; MIP: < -30 cmH2O; NIF: < -20; MEP: <40 mmHg; Ph: < 7.35; and, CO2: > 45 mmHg.

21. What types of bronchopulmonary hygiene are used to manage Guillain-Barre Syndrome?
CPT, flutter value, acapella, and IS therapy.

22. What was found not to be effective in treating Guillain-Barre Syndrome?
Corticosteroids

23. What breath sounds do patients of Guillain-Barre Syndrome typically have?
Diminished

24. What are the typical vital signs for Guillain-Barre patients?
Heart rate increased, respiratory rate increased, and oxygen saturation decreased.

25. What will the chest x-ray for Guillain-Barre patient look like?
It will appear normal or show a slight decrease in expansion.

26. What will chest percussion reveal for a Guillain-Barre patient?
It will typically be normal.

27. What will the ABG results of a Guillain-Barre patient typically show?
Uncompensated acute respiratory acidosis

28. What are the diagnostic tests for Guillain-Barre Syndrome?
Spinal tap, electromyography, and nerve conduction studies.

29. What type of airway disease is Guillain-Barre Syndrome?
Restrictive

30. What type of disease is Guillain-Barre?
Acute

31. What is another name for Guillain-Barre Syndrome?
Acute inflammatory demyelinating polyradiculoneuropathy

32. What type of disorder is Guillain-Barre Syndrome?
Immune-mediated disorder

33. What are the other causes of Guillain-Barre Syndrome?
Viral, bacterial infection, surgery, or vaccinations.

34. What will develop in around 75% of patients within 2 months of contracting Guillain-Barre Syndrome?
An acute infection

35. What conditions will 90% of Guillain-Barre Syndrome patients have within one month of the disease?
GI or URI

36. How do lesions with Guillain-Barre Syndrome happen?
Throughout the whole PNS

37. From where do lesions occur?
Spinal roots to distal termination of motor and sensory fibers.

38. What is the primary target of Guillain-Barre Syndrome?
Schwann cells

39. How does demyelination occur with Guillain-Barre Syndrome?
There is a generalized inflammatory response, and myelin is stripped from the nerves.

40. When does classic acute Guillain-Barre Syndrome peak?
At 4 weeks

41. How do motor deficits, sensory deficits, and weakness present with the classic acute form?
Rapidly ascending symmetrically distally.

42. What kind of recovery do patients with Guillain-Barre Syndrome typically have?
Often complete or near complete.

43. Why does Guillain-Barre Syndrome have flaccid paralysis?
It is LMN.

44. How long does recovery take for Guillain-Barre Syndrome?
Months to years.

45. What is very important to do for patients with Guillain-Barre Syndrome?
Positioning, bed mobility, ROM, and plasmapheresis.

46. What parts of the body are affected last with motor weakness in patients with Guillain-Barre?
Trunk, intercostal, cranial nerves, face, and respiratory system.

47. What type of autonomic dysfunctions occur with Guillain-Barre?
Fluctuating BP, decreased cardiac output, and bradycardia.

48. What are the signs and symptoms of Guillain-Barre Syndrome?
Tingling of UE and LEs, paralysis, symmetrical weakness upwards, bulbar involvement, areflexia, pain, orthostatic hypotension, facial droop, bilateral paresthesia, difficulty with eye or facial movement, including speaking, chewing, and swallowing, and difficulty with bladder control. Other symptoms are sensory impairments, motor weakness, pain and muscle aches, hyporeflexia, and autonomic dysfunction.

49. What are the risk factors for Guillain-Barre Syndrome?
Epstein Barr virus, HIV, and mycoplasma pneumonia.

50. What is the pathophysiology of Guillain-Barre Syndrome?
Damage to myelin, muscle paralysis, sensory disturbance, and autonomic dysfunction. Acute inflammatory demyelinating polyradiculoneuropathy characterized by areflexia. Flaccid paralysis affects limb movement, facial muscles, dysphagia, dysarthria, and respiration. Neurologic dysfunction includes a humeral immune reaction that blocks the conduction of nerve impulses to muscle leading to paralysis and a cell-mediated immune reaction where macrophages attack myelin surrounding nerve fibers.

51. What are the types of Guillain-Barre Syndrome?
Acute inflammatory demyelinating polyradiculoneuropathy in the USA; Miller Fisher syndrome eyes in Asia; and, acute motor axonal neuropathy in China. AIDP: Acute inflammatory demyelinating polyradiculopathy; AMAN: acute motor axonal neuropathy; AMSAN: acute motor sensory axonal neuropathy; APN: acute panautonomic neuropathy; and, PSN: Pure sensory neuropathy.

52. What is the prognosis of Guillain-Barre Syndrome?
The distal compound motor action potential (CMAP) is a predictor of prognosis. If the CMAP amplitude is less than 20% of normal limits at 3-5 weeks, it predicts a prolonged or poor outcome. 3%-5% die from systemic organ failure. The most common long-term effects are a weakness of pretibial muscles and less often in hands, feet, quadriceps, and gluteal muscles. Most of the recovery is during the first year, with the greatest within 6 months. Studies show 1/5 of patients noted improvements 2.5 years or 6.5 years after GBS.

53. What are the treatment methods for Guillain-Barre Syndrome?
Plasmapheresis, intravenous immunoglobulins, intubation, and glucocorticoids.

54. What is the etiology of GBS?
Evidence supports that it is an immune-mediated disorder. Causative factors are, Bacterial: campylobacter jejuni that is identified cause of preceding infections in 60% of patients and axonal type; and, Viral: CMV, greater sensory, demyelination, Epstein Barr, and mycoplasma pneumonia.

55. What is required for the diagnosis of GBS?
Progressive weakness on more than one extremity (symmetrical presentation) and areflexia.

56. What is the sensory pattern for Guillain-Barre Syndrome?
Tocking and glove pattern.

57. Why is range of motion an important aspect of Guillain-Barre therapy?
The patients are expected to fully recover, so maintaining ROM is an important aspect so that it does not hinder recovery.

58. What cerebrospinal fluid features are seen in Guillain-Barre patients?
CSF protein (albumin) levels increased after 1 week; continue to increase on serial examinations, and, CSF contains 10 or fewer mononuclear leukocytes/mm3.

59. What are the comorbidities of Guillain-Barre Syndrome?
Essential hypertension, urinary tract infection, acute respiratory failure, diabetes mellitus, anemia, and constipation.

60. What are the complications of Guillain-Barre Syndrome?
Pressure sores, wounds, contractures, DVT, pulmonary embolism, HTN, sinus tachycardia, cardiac dysrhythmia, bladder dysfunction, G.I. motility disorder, depression, and pneumonia.

61. What type of disease is Guillain-Barre classified as?
Acute polyneuropathy and peripheral nervous system disease.

62. How does Guillain-Barre Syndrome start?
It is often preceded by an event such as a mild respiratory or GI infection, viral or bacterial infection, or surgical procedure.

63. What types of bacterial and viral infections are associated with Guillain-Barre Syndrome?
Cytomegalovirus (herpes), Epstein-Barr (mono), and HIV.

64. What is the overall difference when treating Guillain-Barre patients versus MS patients?
GBS patients will be improving, so we need to plan accordingly and minimize any type of compensations or adaptations. For MS patients, as they get worse, we may teach them adaptations and compensations.

65. What are the symptoms of Guillain-Barre Syndrome?
Paresthesia, LE weakness, sensation deficits, respiratory problems, and autonomic abnormalities.

66. How is Guillain-Barre diagnosed?
CSF protein and nerve conduction velocities.

67. What type of motor weakness is seen with Guillain-Barre Syndrome?
Ascending paralysis

68. What must be noted about the history of Guillain-Barre Syndrome?
The onset and pattern of symptoms provides significant information about whether or not the patient is improving or getting worse, and this guides therapy.

69. How do you test MMT with patients of Guillain-Barre?
Specific and regularly (1x week) to monitor improvement.

70. What must be avoided when strengthening patients who have Guillain-Barre Syndrome?
Working them to fatigue.

Final Thoughts

Guillain-Barré Syndrome is a severe neurological disorder characterized by the rapid onset of muscle weakness and sensory abnormalities.

Early recognition and intervention are crucial to mitigate its impacts, and research continues to explore underlying mechanisms and novel therapeutic approaches to improve outcomes for affected individuals.

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

References

  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
  • Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.
  • “Guillain Barre Syndrome.” National Center for Biotechnology Information, U.S. National Library of Medicine, 19 Nov. 2020.
  • “Diagnosis and Management of Guillain–Barré Syndrome in Ten Steps.” PubMed Central (PMC), 2019.
  • “Guillain-Barré Syndrome: Clinical Profile and Management.” PubMed Central (PMC), 2015.

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