Guillain-Barré syndrome is an acute illness involving the peripheral nervous system that usually occurs two to three weeks after a flu-like disease or other infections. It is mostly a motor neuropathy, meaning that its symptoms are largely related to the involvement of the motor nerves.
Despite the primarily motor nature of the disease, the earliest symptoms may be numbness and tingling felt in the lower extremities followed shortly by weakness of the distal muscles of the lower extremities. The common early symptoms reported by patients are those of tripping on the toes that later results in a footdrop. The weakness usually ascends to involve the entire lower extremities and later the upper extremities. The danger occurs when the weakness involves the muscles of respiration. At that time prompt intubation and admission to the Intensive Care Unit is required. Although Guillain-Barré syndrome is usually a self-limiting illness, prompt recognition of the symptomatology and correct diagnosis are required for intensive observation and therapeutic intervention.
The diagnosis of Guillain-Barré syndrome is suggested when the patient presents with a history of ascending weakness and a physical examination consistent with a primarily motor neuropathy. The diagnosis is confirmed with the performance of a spinal tap, which usually shows elevation of the protein level in the spinal fluid without an increase in the number of white cells and by an electromyogram. All other conditions resembling Guillain-Barré syndrome must also be excluded.
Once the diagnosis is confirmed, treatment is initiated with intravenous gamma globulin or plasma exchange. Both of these treatment modalities have been shown to reduce the duration of illness and to affect the extent of final recovery. When diagnosed early and appropriately treated, patients usually start recovering within a few days. Full recovery usually occurs after two or more months of the illness. The treatment, however, is not effective in all patients and a few patients fail to recover full strength. Guillain-Barré syndrome is usually a monophasic illness that rarely recurs.
