Guillain Barré Syndrome - What is GBS?
Published: 17 September 2020
Published: 17 September 2020
Let’s face it: you’re probably thinking, ‘How do I say it?’
Guillain Barré is pronounced ‘ghee-yan bah-ray’, named after the three French neurologists who first described the condition (Brain Foundation 2020).
It is an autoimmune disease in which the peripheral nerves and nerve roots are damaged by the immune system’s antibodies and lymphocytes (Brain Foundation 2020).
The myelin (nerve insulation) and sometimes the axon (the inner covered part of the nerve) of the nerves are damaged, causing delays and changes to the signals being transmitted between the nerves and the brain (Better Health Channel 2014).
Patients will often present with progressive bilateral and symmetrical weakness and paralysis of the lower limbs, as well as disturbing sensory sensations (Better Health Channel 2014).
These abnormal sensations are known as paraesthesia. Patients may experience feelings such as tingling, formications or pain (NINDS 2020).
Symptoms usually begin in the feet or legs, gradually spreading up the body as the condition progresses. Less commonly, they begin in the arms and progresses downward (Better Health Channel 2014).
Although the exact cause of GBS is unknown, it usually seems to be triggered by a viral or bacterial infection and is not considered contagious (Better Health Channel 2014).
Patients may experience:
(Better Health Channel 2014)
Possible complications of GBS include deep vein thrombosis, respiratory failure, pressure injuries and pneumonia, among others (Better Health Channel 2014; Mayo Clinic 2020).
Generally, symptoms will begin over a period of roughly 12 hours before reaching a plateau. The time in which a patient will reach this plateau varies but it is approximately four weeks after the initial onset of symptoms (Mayo Clinic 2020; Vellozzi et al. 2014).
GBS can range from mild to severe. In the most severe cases, the nerves controlling respiratory function and the autonomic nervous system may be affected and the individual may require life support. Once the autonomic nervous system is affected, the individual may experience changes to their blood pressure, heart rate, vision, kidney function and temperature regulation (Better Health Channel 2014; NINDS 2020).
Note that GBS is relatively rare, with roughly 2 to 8 people affected out of every 100,000. It seems to be more common in the 30 to 50 years age group but can affect people of any age (Better Health Channel 2014).
The cause of GBS remains unknown. However, it is important to note that the onset of symptoms is often preceded one to three weeks earlier by a bacterial or viral infection (Better Health Channel 2014).
While the specific infectious agent is unknown in over half of GBS cases, there are several infections that are often associated with the condition, including respiratory and gastrointestinal infections, herpes zoster, glandular fever and Zika virus (Vellozzi et al. 2014; Better Health Channel 2014; NINDS 2020).
Other events that seem to be associated with GBS include pregnancy, dengue fever, surgical procedures, insect bites and Bell’s palsy (Better Health Channel 2014).
The difficulty in diagnosing GBS is mainly due to the range of symptoms the individual presents with, as they may appear vague and unrelated to each other. Diagnosis often requires several tests including physical examination, muscle strength and activity tests, reflex tests, nerve conduction tests and spinal taps to check for increased protein in the cerebral spinal fluid (Better Health 2014).
Due to the unpredictability of GBS, most patients are admitted to hospital for monitoring. If any complications occur that might affect vital functions, treatment can be initiated immediately (Better Health Channel 2014).
There is no cure for GBS, but there are some treatment options. Gammaglobulin (IVIG) infusions can be administered over a period of five days to help lessen the immune attack on the nervous system. However, it is not completely known how or why this works (Better Health Channel 2014).
Plasmapheresis can also be undertaken. This involves taking blood from the patient, removing the immune cells and then returning the remaining red blood cells to the body (Better Health Channel 2014).
Both options are effective in reducing the severity of GBS and assisting in recovery, though IVIG infusions are easier to administer (NINDS 2020).
While IVIG is easier to administer, both treatment options are effective in reducing the severity of GBS and assisting in recovery. There do not appear to be any benefits in using both treatments at once (NINDS 2020).
Recovery from GBS varies. About 90% of patients survive, with 75 to 90% recovering completely. Approximately 10 to 15% of patients will live with a permanent disability as a result of GBS. Recovery may take between six months to up to three years in some cases. Generally, the recovery time is better for patients whose symptoms begin to ease earlier (Better Health Channel 2014; Mayo Clinic 2020).
As with any neurological condition, assessment of the patient upon entry to rehabilitation is essential. This assessment should include the clinical history of the patient, initial presentation and any other medical conditions as well as other presenting symptoms such as paralysis, sensation disturbances, fatigue, spasticity and muscle tone (Mauk 2012).
Assessment is important in order to plan and implement a successful rehabilitation program for the patient. A rehabilitation program will often include extensive therapy from an interprofessional team (Better Health Channel 2014).
The role of a nurse during rehabilitation is complementary to the rest of the interprofessional team and involves providing critical education to the patient and family, as well as support and reassurance during recovery.
This education can encompass a variety of areas and will differ depending on the specific individual and their lifestyle. Often, the education will be provided to help ensure adherence to treatment recommendations made by the interprofessional team (Mauk 2012). Education may involve strategies for mobilising and eating safely or medication management for when the patient is discharged home.
As mentioned above, recovery from GBS varies. 30% of patients will still have some residual weakness three years following the event, with 3% suffering further relapses of muscle weakness and tingling for many years after the initial illness (NINDS 2020).
Recovery may also be hampered by the emotional and psychological difficulties associated with GBS, especially for those with residual and permanent disabilities following the illness (NINDS 2020).
The nursing care of patients with GBS should be varied and holistic, taking into account where the patient is at in their recovery.