By Diana Castro, MD
Despite recovery of muscle weakness in most children, many patients experience persistent fatigue, pain and anxiety/depression. These symptoms can be incapacitating and can affect academic and social development.
The mechanism underlying post-GBS fatigue is unclear. Fatigue can be secondary to stress and psychological factors. Other possibilities are deconditioning due to the lack of physical activity or side effects from pain medications. Exercise programs directed by physical therapists, especially water therapy, have been shown to be useful in reducing fatigue.
Pain is not as common in young children compared to adults, but it can be present in teenagers and young adults. Pain can be neuropathic in origin, often described as burning, stabbing or electric. Chronic pain post-GBS can also originate from the muscles, especially lower back and limbs, or in the joints. Muscle and joint pain can be attributed to immobility, and neuropathic pain may be caused by regeneration of the nerve. It is very important to keep pain well controlled, as this will allow the patient to continue physical and occupational therapies, which are fundamental in the recovery phase. Medications that can be used to treat neuropathic pain include: anti-seizure medication (gabapentin, pregabalin and carbamazepine) and antidepressant medication (duloxetine, amitriptyline). Muscle pain can be managed with non-steroidal anti-inflammatory drugs (ibuprofen, naproxen), muscle relaxants (cyclobenzaprine) or topical agents (lidocaine patches).
Anxiety and depression are most likely due to the sudden and rapid loss of physical function, often in previously healthy individuals. Early identification and treatment of psychological symptoms is vital in the recovery of patients with GBS. Some of the medication used to treat neuropathic pain can also control symptoms of anxiety and/or depression. Regular psychologic support should be part of the overall management.
It is worthwhile to remember that most patients will have significant , if not, total recovery. Medical team, family and community support are essential in assuring the best possible outcome.