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Guillain-Barré syndrome A rare disorder in
which the IMMUNE SYSTEM attacks the myelin
sheaths of the PERIPHERAL NERVES, causing weakness
or PARALYSIS, diminished reflexes, and loss of feel-
ing. The loss of myelin strips the NERVEaxons of
insulation, inhibiting their ability to conduct elec-
trical impulses. Doctors do not know what causes
Guillain-Barré syndrome but believe it is a compli-
cation of bacterial or viral INFECTION. The most
common association is with Campylobacter jejuni,
which causes the foodborne illness CAMPYLOBACTE-
RIOSIS. Other associations are with INFLUENZA, PNEU-
MONIA, GASTROENTERITIS, and some vaccinations.

Symptoms and Diagnostic Path
Symptoms typically are acute, beginning 7 to 10
days after the precipitating event (such as viral
infection) and reaching peak severity within 14
days. Commonly, tingling and weakness, and
sometimes PAIN, begin with the feet and move sym-
metrically up the body. The weakness may become
paralysis, depending on the extent of demyeliniza-
tion that takes place. Some people experience mild
symptoms and others experience symptoms that
result in complete paralysis including respiratory
distress. Some people experience irregularities in
HEART RATE, RESPIRATION RATE, BLOOD PRESSURE, and
other autonomic functions. About half of people
who develop Guillain-Barré syndrome have mod-
erate to severe pain with movement.
The diagnostic path includes careful assessment
of recent PERSONAL HEALTH HISTORY, notably for viral
or bacterial infection, and procedures such as LUM-
BAR PUNCTURE, nerve conduction studies, and COM-
PUTED TOMOGRAPHY(CT) SCANor MAGNETIC RESONANCE
IMAGING(MRI) to rule out other causes of the symp-
toms. Though there is no single conclusive test for
Guillain-Barré syndrome, the pattern of symptoms

and findings allow the neurologist to make a clini-

cal diagnosis.

Treatment Options and Outlook

Treatment is primarily supportive though some

people improve with intravenous IMMUNOGLOBULIN,

which helps restore normal immune system func-

tion, or plasmapheresis, which removes antibodies

from the BLOOD. Most people require hospitaliza-

tion. About 30 percent of people require tempo-

rary MECHANICAL VENTILATIONuntil function returns

to the muscles that conduct breathing.

About 85 percent of people make a complete

recovery, without residual effects, in six months to

a year though may need PHYSICAL THERAPY and

other supportive treatment to regain MUSCLE

STRENGTHand function. About 10 percent of people

have residual neurologic complications such as

altered sensation or weakness of the hands and

feet. Very rarely, paralysis persists. Guillain-Barré

syndrome is fatal in about 5 percent of people,

usually in those who are older (age 65 or more) or

who experience very rapid progression to com-

plete paralysis and respiratory failure.

Risk Factors and Preventive Measures

About two thirds of people recall a viral or bac-

terial infection within 2 to 12 weeks of their neu-

rologic symptoms. The most significant risk for

Guillain-Barré syndrome is C. jejuni infection

(campylobacteriosis). CYTOMEGALOVIRUS (CMV),

EPSTEIN-BARR VIRUS (infectious mononucleosis),

and varicella-zoster virus (CHICKENPOX) are other

infections commonly associated with Guillain-

Barré syndrome. There are no measures known to

prevent the syndrome.

See also ANTIBODY; MONONUCLEOSIS, INFECTIOUS;

MULTIPLE SCLEROSIS.