DR. WALKER

About Guillain-Barré Syndrome

What is Guillain-Barré syndrome (GBS)?

Guillain-Barré is a rare, autoimmune condition in which the immune system attacks the body’s nerves. When this occurs, it becomes difficult to control muscle movement and, in some instances, could result in a severe breathing disorder which may require hospitalization. The condition is not fully understood by medical professionals, but it is thought to be secondary to viral or bacterial infections. It is estimated that almost 6000 people may develop GBS annually and although many people recover, some people will continue to have permanent nerve damage. Some may also have permanent weakness, numbness, or fatigue. GBS can affect people of all ages.

What are some signs and symptoms for Guillain-Barré?

More generalized symptoms could include:
· Back pain.
· Rapid heart rate.
· Poor bowel or bladder control.
· Numbness or tingling in the hands or feet.
· Low or high blood pressure.
· Muscle weakness (usually starts in the feet and moves upward).
· Breathing difficulty.
· Difficulty swallowing.
· Double vision, or irritability of the eyes.

What are typical causes for Guillain-Barré?

It is thought that GBS is triggered by viral or bacterial infections. Other things that have been considered triggers of GBS could include surgical intervention, prior injury, and post immunizations. Generally, about 6 weeks after an infection, the body’s own immune system begins to attack itself, destroying the myelin sheath that surrounds the axons of the nerve cells. As the myelin sheath gets destroyed, the nerves are unable to send signals effectively and the ability to receive sensory signals from the body becomes diminished. Initially, symptoms may include weakness, numbness, and tingling. This usually begins in the legs, then may progressed to arms and chest. GBS is the leading cause of flaccid paralysis in Western countries.

Are there risk factors for Guillain-Barré?

A common risk factor for developing GBS is Campylobacter infection. There are other bacterial causes however, to include mycoplasma and cytomegalovirus, but campylobacter is usually more severe than the other causes. Campylobacter is often associated with undercooked food specifically poultry. Some other associated infectious cause would include:
· Flu
· Epstein-Barr virus (EBV)
· Mononucleosis, which is typically caused by EBV
· HIV or AIDS

How is GBS diagnosed?

Diagnosing GBS can be challenging as it is mostly based on symptoms and neurologic assessment. Some additional test may include:
Physical examination: Your physician may be looking for symptoms which appear to affect the body on both sides, symmetric. Additionally, the rate at which the symptoms appear; often days to weeks. Your provider can also check your reflexes in your lower extremity, specifically, legs and knees. Reflexes may be absent.
Lumbar puncture (spinal tap): A small needle is placed in the lower back into the spinal canal, which allows sampling of the cerebrospinal fluid. The fluid is then sent for analysis looking for findings that could support the diagnosis of GBS.
Electromyography (EMG): Although electrodiagnostic examinations are not required for the diagnosis, it is often recommended and may be helpful in supporting the diagnosis. With these procedures, thin needle electrodes are placed into the muscle to be evaluated. The electrodes will then measure nerve activity that could suggest GBS.

What are some common medical interventions?

Plasmapheresis. This process removes and filters the liquid part of the blood called plasma. The plasma exchange is usually 5 times over a 2 week period. The antibodies that have been attacking your own immune system are then removed and once cleaned, the fluid is then returned to your body.
Immunoglobulin therapy/IVIG. IVIG is infusion of blood products that traditionally have been collected from other people. This fluid helps to decrease the risk in which the immune system can attack itself. This is generally recommended for people who are unable to ambulate without assistance who are also within 4 weeks of symptom onset. Patients undergoing IVIG therapy may develop symptoms to include fever, myalgia, headache, nausea, and vomiting.

Management of Guillain-Barré syndrome.

Cardiac management. With GBS, there may be excessive sympathetic over activity. These complications range from blood pressure management to potentially fatal arrhythmias. Specifically, tachyarrhythmia, fast heart rate or tachycardia is a common disorder where the heart rate is in excess of 100 bpm. Additionally, hypertension / high blood pressure or hypotension/low blood pressure may also be present. It should be reminded that patients with hypotension should not be left unattended as they are at risk for falling.
Respiratory management. Respiratory failure contributes to significant morbidity and mortality in GBS patients. GBS is one of the most common causes of neuromuscular respiratory failure due to respiratory muscle weakness, dysautonomia, and nosocomial infections. GBS is also one of the most common causes of acute flaccid quadriparesis which has high risks of respiratory failure. Almost 30% of GBS patients require mechanical ventilation. That being said, an early determination should be made in identifying which patients require admission to intensive care unit (ICU), especially those with severe or rapidly progressive weakness, or autonomic instability. These patients are at extremely high risk for requiring mechanical ventilation.
Pain management. Pain occurs during the whole spectrum of GBS. Often the pain begins in the lower back. Patients often report painful paresthesias, radicular pain, and arthralgia. The majority of patients with GBS report a pain intensity that is moderate to severe. This pain typically starts in the 2 weeks preceding weakness with about a third of patients continuing to have pain after 1 year. Opioids and NSAIDs have traditionally been used in pain management plans of GBS patients.
Movement/motion. Physical therapy is an integral part in caring for patients with Guillain-Barré syndrome. Movement of the arms and legs are important to reduce the risk of contracture and maintain flexibility. Physical therapy is also important to enable the GBS to patient maintain strength and proper movement. Keep in mind that the intensity of the exercise should be closely monitored to prevent muscle fatigue.
Deep vein thrombosis/DVT. DVT/pulmonary embolism (PE) are recognized complications of GBS. This is in part due to decreasing movement and a decrease in ambulation. For these reasons, new onset of lower extremity edema, shortness breath, or chest pain should warrant evaluation for DVT/PE evaluation.
Nutrition. It is often difficult to maintain adequate nutrition in patients with GBS. Additionally, these patients are afflicted with intermittent, constipation/diarrhea, as well as stomach pain. These disorders could lead to dehydration and weight loss even before initiation of therapy. Inadequate nutrition is also associated with increased risk for electrolyte imbalance and decubitus ulcers. High-protein diet and sulfa containing vegetables, such as broccoli, brussel sprouts, and kale have been known to protect against some of these diseases, as well as being protective against peripheral nerve damage. Also, naturally fermented foods may strengthen your gut Microbiome for better gut health and immunity. These fermented foods could include kimchi, pickled vegetables, and sauerkraut. Additionally, green tea/EGCG acts as a potent antioxidant, which protects against nerve damage by decreasing free radicals. Free radicals can damage cells, and are often implicated in certain chronic diseases.

Self-Care Tips:

Healthy options for GBS patients.

Dark green, leafy vegetables.

Leafy green vegetables are an abundant source of folate, which helps stabilize DNA information and could also repair DNA. These vegetables are also high in Beta Carotene, and zeaxanthin which are powerful antioxidants. Health options also include foods like broccoli, kale, and cabbage. Be sure to also include some healthy fats like olive oil, and avocado oil. Aldo, focus also on foods which are high in omega-3 (like wild-caught salmon, and walnuts.
Turmeric/curcumin. Turmeric is a bright-colored spice, yellow in color with an active compound called curcumin. Curcumin offers up many health benefits not the least of which is its ability to help reduce inflammation and maintain a healthy inflammatory response. Curcumin helps to protect against the oxidative stress.

Beneficial Dietary Supplements

B complex/B Vitamins

The vitamins B1, B6 and B12 are essential for nerve health. B complex vitamins help prevent inflammation and preserve the myelin sheath covering around nerves. Deficiencies of Vitamins B1 and B12 may cause numbness, tingling, and pain in the hands and feet; this is why they are called 'neurotropic' vitamins. These vitamins might be able to improve symptoms of peripheral neuropathy or prevent symptoms from getting worse.
Coenzyme Q10 Coenzyme Q10, or CoQ10, is an energy producing substance that the human body makes that helps prevent nerve damage and alleviates neuropathic pain. Research shows that taking coenzyme Q10 improves nerve damage and nerve pain and helps to prevent inflammation and oxidative stress.
Magnesium Magnesium is the fourth most abundant mineral ion in the human body and is involved in more than 300 enzymatic reactions. Published studies have found that people who had high levels of magnesium in their diet were less likely to experience neuropathy. Magnesium is also implicated in promoting peripheral nerve regeneration and in treating neuropathy.
Vitamin D3 Several studies have shown that vitamin D deficiency was significantly associated with peripheral neuropathy. In patients with neuropathic pain, vitamin D levels should be evaluated to ensure normalized D3 levels. D3 may be an integral part in resolving neuropathic symptoms.
Alpha-Lipoic Acid Alpha-lipoic acid (ALA) is an antioxidant that may be the remedy to treat the pain associated with polyneuropathy. ALA helps to reduce oxidative stress which may help patients who have pain, itching, tingling, and numbness in arms and legs from neuropathic pain. ALA also helps to kill free radicals and may also help people with peripheral neuropathy. Remember that free radicals that can damage nerves. High doses of ALA supplements have been used in certain parts of the world to help treat different types of numbness and tingling associated with nerve damage.
Food to Limit: There are certain foods, that people with Guillain-Barré syndrome should limit consumption of, specifically, foods that are high in lectin concentration. These foods could include:
· Legumes such as cashews.
· Seeds like pumpkin seeds, and chia.
· Peanut-based products such as peanut butter and peanut oil.
· Foods high in trans fats.
· Dairy/milk.
· High fructose corn syrup.
· Nightshade products: tomatoes, yellow squash, red bell peppers, purple eggplant, and peppers.
· Whole grains like oatmeal, barley, and quinoa.
· Inflammatory/processed foods - added sugar and processed vegetable oils.