What is Guillain-Barre Syndrome

The recent deaths of three persons (till last reports) in Pune due to Guillain-Barre Syndrome has brought the spotlight on this rare autoimmune disorder. Landy-Guillain-Barre Syndrome (LGBS or GBS) is an autoimmune disease in which the body’s own immune cells start attacking the nerves because of molecular mimicry, i.e. body’s nerves are mistaken as foreign cells by the immune system. This autoimmune damage can be triggered by the immune response to some viral or bacterial infections associated with diarrhoea or flu, and sometimes post-surgery. However, it can occur without any evident preceding infection. The Pune outbreak, where the number of cases has risen to 130 since early January, has been traced to contaminated water sources that led to a diarrhoea outbreak.

Symptoms

• The most common symptom is tingling or weakness in arms and legs. It affects muscle control and sensory signals and can begin as difficulty in walking, heaviness of legs, difficulty in sitting or getting up or turning in bed, falls (due to marked weakness), difficulty in using hands.
• It can progress to difficulty in eating and swallowing, breathing and breathlessness, sometimes causing paralysis.
• There can be numbness of limbs, back pain or limb pain.
• Anyone from infants to the elderly can be affected, but it is most common between 25-50 years.

Is it contagious or preventable

GBS is not a communicable disease as it is not directly caused due to any infection. As it is an autoimmune disorder, it does not spread from one person to another, occurring within one to two weeks after some viral or bacterial infections like common cold, blocked nose, diarrhoea, dengue fever, etc. To prevent GBS, it is best to prevent any community-acquired infection like common cold, sore throat, upper respiratory tract infections, diarrhoea, etc.

The exact cause behind GBS is not clear. However, it is important to adopt basic hygiene practices and take precautions to prevent infections, especially those linked to diarrhoea, flu, etc, and keep a healthy lifestyle with nutritious food, regular exercise, and adequate sleep.

During the Covid-19 lockdown, GBS cases decreased markedly as everyone was confined indoors or maintained social distancing and took extra precautions in food hygiene.

Is it treatable

GBS is treatable and various treatment modalities are intravenous immunoglobulins and plasmapheresis (plasma transfusion), along with nursing care. If the patient cannot afford either, intravenous steroids have been tried as an alternative therapy with good results.

Early treatment immediately after the patient is diagnosed is critical to stop progression of the symptoms to other body parts and hastening recovery. Not all patients with GBS need hospitalisation. However, those with breathing problems and having difficulty in swallowing require hospitalisation for close monitoring of breathing and other vital parameters. In patients having problems with breathing, ventilatory support is needed till recovery. Physiotherapy or limb exercises are important for regaining muscle strength and mobility and must be started as soon as the patient is stable, continuing till full recovery. Most of the patients recover in approximately 3-6 months.

Common in India

GBS is not an uncommon disorder and approximately 1 lakh people get affected by it annually worldwide. It is also the most common cause of acute paralysis of upper and lower limbs in the general population. In a research study on GBS, including in 26 centres in India (PGIMER, Chandigarh and major institutes of India were a part of this study), a total of 555 adult patients were reported in a period of 6 months (May-Aug 2019). We see 10-15 cases in a month in the PGI emergency. The number of cases increases during peak of any viral respiratory illnesses or dengue fever every year.

To conclude, GBS is not an infective disease and is due to abnormal immune response to a past infection. It is a common neurological disease affecting the body and is treatable.

Keep in mind

GBS is not an infectious disease. It does not spread from one person to another. GBS is treatable.

Preventive steps

• Maintain basic hygiene.
• Wash hands frequently, particularly before eating or handling food.
• Drink boiled or filtered water. Experts recommend boiling water for at least 1 minute to create a rolling boil.
• Eat well-cooked food.
• Keep food fresh and clean.
• Avoid infection by keeping cooked and uncooked food items separate.
• Maintain social distancing and use a face mask when meeting people with common cold, cough, sore throat.

— Shree is Assistant Professor and Lal is Director, PGIMER, & Head, Dept of Neurology, PGIMER, Chandigarh