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.