Guillain-Barr Syndrome (Acute Inflammatory Demyelinating Polyradiculoneuropathy)

Progressive muscle weakness on both sides of the legs, arms, and facePrickly, tingling sensations, usually in the feet or handsPain is a significant complaint (Lower back pain is the most common complaint.)Loss of normal reflexesSymptoms may develop over a period of hours, days, or weeks. They will vary in severity from minimal to total paralysis including respiratory weakness. The symptoms grow progressively worse. Most people experience the greatest weakness during the second or third week. Related complications include: Facial weaknessBlood pressure instabilityHeart rate changesSweating abnormalitiesCardiac arrhythmiasUrinary/gastrointestinal dysfunctionMost patients recover fully, but as many as 25% will have some residual symptoms. Five to ten percent have permanent, disabling deficits, and for 5% the condition is fatal. Diagnosis Your doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is dependant on the physical exam and history, cerebrospinal fluid findings, and nerve conduction studies . You may have a lumbar puncture, also called a spinal tap . For this test, a needle is inserted into your lower back to remove a sample of cerebrospinal fluid for testing. If high levels of a certain protein are detected, and there is no infection, this is an indication that you may have Guillain-Barr syndrome. Electrodiagnostic studies are usually done, which test the electrical conduction in the peripheral nerves and help differentiate Guillain-Barr from other disorders with similar symptoms.

Treatment Treatment aims to reduce the bodys autoimmune response and decrease complications that result from immobility. Hospitalization is important because symptoms may rapidly become more severe, including respiratory failure, cardiac arrhythmias , and blood pressure instability. Most patients need to be in the hospital for at least one month. Common treatments include: Plasmapheresis During plasmapheresis , blood is removed from your body and passed through a machine that separates blood cells. The separated cells are then returned to your body with new plasma. This procedure may help shorten the course and severity of Guillain-Barr syndrome. High-dose Immunoglobulin Therapy Intravenous infusion with immunoglobulin (IVIg) may help reduce the severity of a Guillain-Barr attack. Immunoglobulins are proteins that are naturally produced by the bodys immune system. Mechanical VentilationIn 30% of cases, muscles necessary for breathing become paralyzed. This is treated with immediate emergency support from a mechanical ventilator. Pain ControlYour doctor may prescribe medication to reduce the pain. These may include nonsteroidal anti-inflammatory drugs, gabapentin, carbamezepine, or narcotic analgesics.

PreventionThere are no guidelines for the prevention of Guillain-Barr syndrome. RESOURCES: Guillain-Barr Syndrome Foundation Internationalhttp://www.Guillain-Barr.com National Institute of Neurological Disorders and Strokehttp://www.ninds.nih.gov CANADIAN RESOURCES: BC Healthguidehttp://www.bchealthguide.org Canadian Institute for Health Informationhttp://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=home_e References: Amyotrophic lateral sclerosis. EBSCO Publishing Dynamed website. Available at: Available at: http://www.ebscohost.com/dynamed . Updated January 31, 2008. Accessed February 23, 2008. Bradley WG, Daroff RB. Neurology in Clinical Practice . Philadelphia, PA: Butterworth Heinemann Pulishing; 2004. Brown B Amyotrophic lateral sclerosis. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. Available at: http://www.medlink.com . Accessed February 23, 2008. Goetz S. Acute inflammatory demyelinating polyradiculoneuropathy. In: Clinical Neurology. 3rd ed. Philadelphia, PA: Saunders; 2007. National Institute of Neurological Disorders and Strokewebsite. Available at: http://www.ninds.nih.gov .

Textbook of Clinical Neurology . WB Saunders Company; 1999. Last reviewed February 2008 by J. Thomas Megerian, MD, PhD, FAAPPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.