Guillain-Barre syndrome: A Demyelinating Disorder

Abir Sur

We should be known of GBS first while studying it. Guillain-Barre Syndrome is a rare neurological disorder characterized by weakness or tingling in the legs or sometimes in the arms and upper body.

It is mainly characterized by a relative sudden, unexpected onset of symptoms. They usually develop over the course of about 3 weeks, but can develop as rapidly as days or hours. The sensations— weakness, tingling, numbness, and sometimes paralysis-usually begin in legs, but may then spread to the arms and upper body (breathing muscles and face). The nerves do also lose their reflexes (e.g. knee jerks).

There is a wide range of symptom severity, from mild cases with brief weakness that may not even be enough for the person to seek medical care, to life threatening paralysis with an inability to swallow and use breathing muscles. It depends on which particular nerves are affected by the demethylation. In addition to paralysis and abnormal sensations, patients with GBS may also have symptoms of damage to the autonomic nerves, such as abnormal heartbeat or blood pressure, impotence, urine retention or bowel paralysis.

In a country like Bangladesh the term GBS is a protocol that to be removed but the protagonist is to be antagonized easily. GBS in its early stage is unpredictable, so most newly diagnosed patients are hospitalized. It is extremely important to keep the patient’s body functioning while the nervous system gradually recovers. This is usually done in the Intensive Care Unit, where changes in heart rate, breathing and other functions can be carefully monitored.

GBS is usually self-limited, with recovery occurring on its own, eventually, as long as the patient’s vital functions (e.g. breathing) are supported during the recuperation time. GBS usually does not occur more than once in the same patient.

There is no known cure for Guillain-Barre syndrome, but there are treatments that can shorten its course:

  • Plasmapheresis (plasma exchange) and
  • High dose immunoglobulin therapy

The acute phase of GBS can vary from days to months, but over 90% of patients move into the rehabilitative phase by 4 weeks. Then a stable time of lower-level impairment (e.g. weakness) can linger for additional days.

It is regarded that patient care involves the coordinated efforts of a team, such as: Physiatrist, Neurologist, Internist, Physical and Occupational Therapist, Social worker, Psychologist or Speech therapist if speech muscles have been affected.

The rehabilitative phase is important, but rehabilitation itself does not improve nerve regeneration. The main goal is to help the patient with optimal use of their muscles as their nerve supply returns, and to adapt to a lifestyle within their functional limitations. In addition, rehabilitation centers can treat minor medical conditions and help prevent complications.

If we consider the risk factors of GBS we may parentheses these. Such as:

  • Viral infections, such as HIV/AIDS, herpes, respiratory infections, and mononucleosis
  • Bacterial infections
  • Hodgkin disease, a malignant disease of the lymphatic system
  • Systemic lupus erythromatosus, an autoimmune disease of the skin and other organs
  • Recent surgery

Prevention is better than cure, as we all know this but recovering GBS is not rendered any prognosis. There is no cure for Guillain-Barre syndrome but several treatments can alleviate the symptoms and accelerate recovery of the affected nerves. In the majority of cases, the symptoms resolve completely or almost completely within weeks.

The GBS occupies a venture in its pathological conditions of patients. Early neurophysiological studies revealed that, despite the demyelinating pathology, many patients retained normal conduction velocities until the disease was well established. The earliest changes appear to be a delay in F waves (implying root demyelination) and reduction in nerve motor action potentials. This last abnormality may be difficult to determine precisely for technical reasons until the abnormality is severe. Patients with early Guillain Barre syndrome frequently have conduction block or dispersion of the responses at sights of natural nerve compression, such as carpal tunnel. The extent of reduction in the motor nerve action potentials appears to correlate with prognosis. It is exceptional for extensive neurophysiological tests to be normal in Guillain Barre syndrome, but this does sometimes occur, presumably because demyelinating lesions have occurred in anatomical sites that are exclusively proximal and not amenable to easy neurophysiological study.

In Bangladesh GBS exceeds more than a verge to its supreme onset. Guillain-Barre syndrome has a diverse clinical phenotype related to geographical origin. To date, the majority of large-scale studies on Guillain-Barre syndrome (GBS) have been conducted in developed countries. We aimed to evaluate the key diagnostic features and assess the suitability of the Brighton criteria in 344 adult GBS patients from Bangladesh. All patients fulfilled the National Institute of Neurological Diseases and Stroke (NINDS) diagnostic criteria. Standardized data on demographic characteristics and clinical features, cerebrospinal fluid (CSF) analysis, and nerve conduction study (NCS) results were elaborated to measure the sensitivity of Brighton criteria. Most patients (88%) were admitted to hospital after the nadir weakness. Symmetrical weakness and reduced reflexes were found in 98% of patients. CSF albuminocytologic dissociation was detected in 238/269 (89%) cases and abnormal nerve physiology in 258/259 (>99%) cases. Only 27 (8%) patients received either intravenous immunoglobulin (IVIg) or plasmapheresis. In total, 200 (58%) patients met level 1 of the Brighton criteria; 97 (28%) patients met level 2; 42 (12%) patients met level 3; and 5 (2%) patients met level 4. This analysis showed that despite the heterogeneity of GBS in Bangladesh, the Brighton criteria showed a high sensitivity in the diagnosis of GBS.

From the pronominal data it can be concluded that Bangladesh is not very superb condition to avoid the risk of GBS but rationally it is to be overcome soon. And I would promptly say that the proper medicaments and very other superficial techniques would help us to get aware of GBS.

Abir Sur is an undergrad student in Department of Pharmacy East West University, Bangladesh. He can be reached at

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