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What is Guillain-Barr� Syndrome (GBS)?
Guillain-Barr� (Ghee-yan Bah-ray) Syndrome, also
called acute inflammatory demyelinating polyneuropathy and Landry's
ascending paralysis, is an inflammatory disorder of the peripheral
nerves those outside the brain and spinal cord. It is characterized
by the rapid onset of weakness and, often, paralysis of the legs,
arms, breathing muscles and face. GBS is the most common
cause of rapidly acquired paralysis in the United States today,
affecting one to two people in every 100,000.
The disorder came to public attention briefly
when it struck a number of people who received the 1976 Swine
Flu vaccine. It continues to claim thousands of new victims
each year, striking any person, at any age, regardless of gender
or ethnic background.
It typically begins with weakness and/or abnormal sensations of
the legs and arms. It can also affect muscles of the chest,
face and eyes. Although many cases are mild, some patients
are virtually paralyzed. Breathing muscles may be so weakened
that a machine is required to keep the patient alive. Many
patients require an intensive care unit during the early course
of their illness, especially if support of breathing with a machine
is required. Although most people recover, the length of
the illness is unpredictable and often months of hospital care
are required. The majority of patients eventually return to a
normal or near normal lifestyle, but many endure a protracted
recovery and some remain wheelchair-bound indefinitely.
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How is
GBS Diagnosed?
Quite often, the patient's symptoms and physical
exam are sufficient to indicate the diagnosis. The rapid onset
of (ascending) weakness, frequently accompanied by abnormal sensations
that affect both sides of the body similarly, is a common presenting
picture. Loss of reflexes, such as the knee jerk, are usually
found. To confirm the diagnosis, a lumbar puncture to find elevated
fluid protein and electrical test of nerve and muscle function
may be performed.
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How is GBS Treated?
Because progression of the disease in its early
stages is unpredictable, most newly diagnosed patients are hospitalized
and usually placed in an intensive care unit to monitor breathing
and other body functions. Care involves use of general supportive
measures for the paralyzed patient, and also methods specifically
designed to speed recovery, especially for those patients with
major problems, such as the inability to walk. Plasma exchange
(a blood "cleansing" procedure) and high dose intravenous
immune globulins are often helpful to shorten the course of GBS.
Most patients, after their early hospital stay and when medically
stable, are candidates for a rehabilitation program to help learn
optimal use of muscles as nerve supply returns.
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What Causes GBS?
The cause is not known. Perhaps 50% of cases
occur shortly after a microbial� (viral or bacterial) infection
such as a sore throat or diarrhea. Some theories suggest
an autoimmune mechanism, in which the patient's defense system
of antibodies and white blood cells are triggered into damaging
the nerve covering or insulation, leading to weakness and abnormal
sensation.
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