Guillain-Barre Syndrome 1 Guillain-Barre Syndrome Guillain-Barre Syndrome, although a rare disease, is considered the most common cause of acute flaccid paralysis.1 Guillain-Barre Syndrome is also known as acute inflammatory demyelinating polyneuropathy, and it is a condition that involves the demyelination of nerves causing pain and weakness in extremities. This paper is going to discuss the background of Guillain-Barre Syndrome, different classifications of the disease, possible etiologies, signs and symptoms, pathology, diagnosis process, patient treatment, as well as patient prognosis. Disease Background: Guillain-Barre Syndrome is defined as a type of peripheral neuropathy with symptom severity progressing within days to weeks.1 The presence of the disease dates back to the 1830s when an English physician reported a thirty-five-year-old man, that developed numbness progressing into loss of strength. Given the period in time, it was not uncommon to be diagnosed with poliomyelitis rather than Guillain-barre syndrome. In the early 1900s, it was discovered that those who developed acute weakness were not from Polio, due to the nature of their cerebrospinal fluid being increased without an increase in the number of white blood cells, which was an indicator associated with Polio.1 In 1927, this observation was what French neurologists, Draganescu and Claudian used to designate Guillain-Barre syndrome as another cause of acute weakness. Classifications: Given the nature of Guillain-Barre syndrome and its form of neuropathy, there are four main classifications of this disease that differentiate the type of neuropathy it is. Acute Guillain-Barre Syndrome 2 inflammatory demyelinating polyneuropathy (AIDP): the primary neurological damage is to the myelin sheath of the neurons, causing acute weakness of the extremities, along with numbness and tingling. Due to the demyelination of the neurons, there is an issue with motor transmission thus resulting in weakness of extremities and possible loss of motor function. Acute motor axonal neuropathy (AMAN) is another classification of Guillain-barre syndrome: unlike AIDP, the primary damage is towards the motor axons. The symptoms experienced with this classification are similar to those that may have AIDP classification. What differentiates this classification from the AIDP classification is that the person will only experience weakness without sensation involvement. If the Guillain-barre syndrome is affecting the axonal neurons; the patient is experiencing both sensory and motor function implications – this would be classified as acute motor and sensory axonal neuropathy (AMSAN). Lastly, there is a form of Guillain-barre syndrome where it is possible to develop paralysis of the eye muscles and loss of balance and coordination – classifying this form of Guillain-barre syndrome as Miller Fisher syndrome. Considering all these classifications that fall under the Guillain-Barre syndrome diagnosis, shows that this disorder is not a single form of disease but contains subgroups of this disorder.1 Etiologies Guillain-Barre syndrome is classified as an autoimmune disorder but is idiopathic. In most cases, Guillain-Barre syndrome is preceded by an infectious disease or an incident that requires the immune system to respond.2 As for what specific infections, whether it is viral or bacterial are still relatively unknown. The disorder is more likely to occur in males than women but still rare. Although Guillain-Barre syndrome can be Guillain-Barre Syndrome 3 preceded by an infectious disease or immune response, the correlation between disorder occurrence and vaccination status of certain infectious diseases is also unknown. The risk of developing Guillain-Barre is simply potential, not a given factor.3 Pathology In the early discovery of the disorder, it was believed that it was a single entity but it has been prevalent that there are multiple classifications of this disorder.3 The pathogenesis of each classification varies as far as the direct site of damage, along with signs and symptoms and the type of recovery that is made.1(p. 3,4,5) As indicated before, GuillainBarre syndrome is usually preceded by an infectious disease. Still, a rare disease, about two-thirds of those that have been diagnosed reported a previous infection before experiencing onset weakness and numbing. Although it is unspecified what types of infectious specifically lead to the development of Guillain-Barre; in some cases, it is possible to trace it back to a certain infection and it is most prevalent for those who have dealt with a bacterial infection from C. Jejuni.2,4 Although, some have reported onset weakness symptoms up to four weeks post-respiratory or gastrointestinal infections; C. Jejuni remained the predominant infection, with it being found in 25-50% of adult Guillain-Barre patients – being most prevalent in Asian countries.2 With those that appeared with a positive correlation between disorder development and preceding C. Jejuni infection, it was Signs and Symptoms Since Guillain-Barre is a form of neuropathy, those that have been diagnosed will likely be experiencing similar signs and symptoms for other neuropathy disorders, like Chronic Inflammatory Demyelinating Polyradiculoneuropathy Guillain-Barre Syndrome 4 Given the type of signs and symptoms patients experience with this disease, they can be misdiagnosed due to being similar to other neurological disorders. There is a hallmark sign that can help differentiate other neuropathic disorders, that being acute widespread nerve inflammatory demyelination, sometimes accompanied by secondary axonal degeneration.5 Although, it is a common hallmark for the early stages of GuillainBarre, it is not a definitive hallmark.