Taking Charge of Your Health

Guillain-Barré syndrome is named after two
neurologists- Georges Guillain and Jean Barré, and it’s a demyelinating disease of the
peripheral nervous system, which includes all of the neurons that extend beyond the
brain and the spinal cord. Guillain-Barré, or GBS for short, is also called acute inflammatory
demyelinating polyneuropathy. Neurons are made up of three main parts. The
dendrites, which are little branches that receive signals from other neurons, the soma
or cell body, which has all of the neuron’s main organelles, and the axon, which transmits
the signal to the next neuron in the series. For peripheral nerves, the cell body can either
be located in the spinal cord, where it’s called a spinal nerve, or the brain, where
it’s called a cranial nerve. Myelin is the protective sheath that surrounds the axons
of the peripheral neurons, allowing them to quickly send electrical impulses. This myelin
is produced by Schwann cells, which are a group of cells that support neurons. In Guillain-Barré syndrome, demyelination
happens when the immune system inappropriately attacks and destroys the myelin, which makes
communication between neurons break down, ultimately leading to all sorts of sensory,
motor, and cognitive problems. The cause of Guillain- Barré syndrome is unknown, but
it’s known to develop after a bacterial infection, like Campylobacter jejuni and Mycoplasma
pneumoniae, or a viral infection, like cytomegalovirus and Epstein-Barr virus. To be clear, these
bacteria and viruses don’t directly damage the myelin sheath, instead it’s thought
that they have antigens on their surface that look similar to the lipid in the myelin sheath.
As a result, immune cells mistakenly attack and destroy the myelin sheath This is called
molecular mimicry, because from the perspective of the immune cells, a host substance is mimicking
a foreign protein. When a normal component of the cells triggers an immune response that
component is called an autoantigen. So in Guillain-Barré syndrome, myelin autoantigens
get picked up by antigen presenting cells, like dendritic cells, which present it to
the helper T cells. These helper T cells produce small signalling molecules called cytokines,
which activate B-cells and macrophages. Once activated, the B-cells make antibodies that
mark the autoantigens, and the macrophages use those antibody markers to bind to and
strip the myelin sheath off of the peripheral neurons. The demyelination occurs in patches
along the length of the axon, so it’s called segmental demyelination. Early on in Guillain-Barré
syndrome, the Schwann cells make new myelin to cover the neurons, which is called remyelination.
But over time, the Schwann cells just can’t keep up, and there’s irreversible damage.
Absence of myelin sheath means that nerve impulses become slow and sluggish. Symptoms of Guillain-Barré syndrome are based
on the nerves that are affected. Initially there’s a loss of sensation, also called
paresthesia, and it particularly affects nerves that convey vibration and touch sensation.
When motor nerves supplying the muscles are affected, there’s initially muscle weakness
and an absence of reflexes. First the ankle reflexes are lost and over soon after, the
patellar, and arm reflexes are lost as well. These are considered lower motor neuron signs.
The cranial nerves can also be involved, and that can cause symptoms like double vision
and difficulty speaking. In severe cases, nerves supplying the respiratory muscles like
the diaphragm can be involved, and that can eventually lead to death. When autonomic nerves,
which regulate various organ functions, are involved, there can be a variety of symptoms
like bowel and bladder symptoms like constipation and urinary incontinence or orthostatic hypotension,
which is when there’s a decrease in blood pressure when a person stands up. To help diagnose Guillain-Barré syndrome,
a lumbar puncture can be done to obtain cerebrospinal fluid. The cerebrospinal fluid typically shows
an albuminocytologic dissociation which means that there’s an increase in protein or albumin
levels, without an increase in white blood cells. In addition, nerve conduction tests
and electromyographic studies can be done to assess nerve and muscle function, but sometimes
these tests can be normal early on in the disease. In addition, pulmonary function tests
can be done to evaluate an individual’s respiratory function. Treatment of Guillain-Barré syndrome is aimed
at reducing the symptoms, and involves medications which suppress the immune system like intravenous
immunoglobulins. In addition, plasmapheresis can be effective as well, which is when the
plasma is filtered to remove the troublesome autoantibodies. Typically, individuals slowly
recover over several months, as there’s regrowth of the myelin on peripheral nerves.
Finally, in rare cases, individuals have developed Guillain-Barré syndrome soon after getting
the flu vaccine. In those situations, individuals are often advised to avoid the flu vaccine
in future years. All right, as a quick recap, Guillain-Barré
syndrome is an autoimmune demyelinating disorder, where the immune cells attack the myelin sheath
produced by Schwann cells that covers the peripheral nerves. The result is a progressive
loss of nerve impulse conduction, which causes loss of sensation and muscle paralysis in
the limbs, and can eventually lead to respiratory failure. Typically, individuals slowly recover
over several months, as there’s regrowth of the myelin on peripheral nerves.

17 thoughts on “Guillain-Barre Syndrome – causes, symptoms, diagnosis, treatment, pathology

  1. You know what 's funny😂? Every time I think about different conditions or find diseases while doing research…Osmosis happens to upload another video. Awesome video, thank you.

  2. My father actually has GBS. He showed signs during high school and soon become wheelchair bound. During college he went into a face and depression and began drinking. Now years and years later he is a physician in U.S and is able to wear braces on his legs. This comes to show you that the toughest of people come out of hardships on top. My dad will always be my hero.

  3. From the CDC: "There have been several studies of the risk of GBS after flu vaccine and CDC monitors for GBS during each flu season. The data on an association between seasonal influenza vaccine and GBS have been variable from season-to-season. When there has been an increased risk, it has consistently been in the range of 1-2 additional GBS cases per million flu vaccine doses administered."
    With the anti-vax hysteria about, your specific inclusion of this minor risk is inappropriate. The verbiage "rare cases" is not descriptive enough of the low risk of flu vaccination vs. the benefits, one of which is NOT getting the flu. The risk of GBS post-flu infection is much higher than vaccination risk. You should clarify this.

  4. My best friend's dad had GBS and my brother's doctor had it too. The latter died. The first one was in hospital for 9 months and on a respirator. It's a Miracle that he's alive! And yes the flu vaccine in his case was the culprit. I found this video a bit "light", but good. Thanks.

  5. The detail about the flu vaccine causing gbs in some people is interesting in particular – cause everyone's getting essentially the same thing during that given year, right? So GBS cases traced back to vaccines might actually be an interesting look at this kind of autoimmune mimicry and what makes someone more likely to be susceptible to it.

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