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Transcript
Guillain-Barré Syndrome What is Guillain-Barré syndrome (GBS)? 'Guillain-Barré syndrome' (pronounced Ghee-yan Bar-ray), or GBS, is a disorder in which the body’s immune system attacks the nerves that carry the signals between your body and your brain. The nerves’ protective covering (myelin sheath) is damaged. The nerves in the arms and legs become inflamed and stop working. This causes muscle weakness and limb paralysis. As well, patients may lose feeling in their arms and legs; sometimes with pain. Who can get GBS? Anyone around the world – young or old, male or female – can get GBS. The illness is not hereditary. In Canada, GBS affects about one in 50,000 people. Although many illnesses or other events seem to trigger Guillain-Barré syndrome, why the disorder occurs in certain people is still not known. Is GBS contagious? No, GBS is not contagious. However, because Guillain-Barré syndrome often follows a viral or bacterial illness, it is sometimes mistakenly thought to be contagious. In fact, there is no evidence that GBS is passed from person to person. Often the virus or bacteria that caused the initial illness is no longer present when the syndrome appears. Can vaccines cause GBS? What causes GBS? The cause of Guillain-Barré syndrome is not known. Scientists believe that the body’s immune system begins to attack the body itself, causing what is known as an autoimmune disorder. A number of different events seem to trigger the illness. Between 50% and 60% of cases occur a few days to a few weeks after an infection. These infections include the common cold, sore throat, infectious mononucleosis, and viral hepatitis. GBS may also follow infections with stomach and intestinal viruses or bacteria that cause vomiting and diarrhea. Others cases of GBS have occurred with a rare disease of red blood cells called porphyria. Some cases have occurred after such seemingly unrelated events such as surgery, insect stings and various injections, including vaccines. In 1976, GBS was found to occur somewhat more often after influenza vaccine than usual (about 10 extra cases of GBS per million doses of the vaccine given in 1976 – 1977). Since then, the risk of GBS occurring after influenza vaccine has been determined to be about one case of GBS per million doses of vaccine given. Experts around the world agree that the risk of serious and deadly illness from influenza is far greater than the risk of GBS. In the same way that GBS may follow a natural infection, rare cases of Guillain-Barré syndrome have also followed vaccination with tetanus toxoid, BCG, rabies, smallpox, mumps, rubella, poliovirus, hepatitis B vaccines, and also with meningococcal conjugate vaccine - Menactra™. What are the symptoms of GBS? The first symptoms of GBS are usually tingling and numbness in the fingers and toes. This tingling is followed by increasing weakness in the legs during the next few days. In the mildest of cases, the weakness may stop at this point and cause only moderate difficulty in walking. These patients would need canes, crutches or a walker to get around. In many cases, the weakness and tingling also spreads to the arms and upper body. In some cases the weakness spreads further and leads to complete paralysis of the legs and arms. In a quarter of cases, the paralysis progresses up the chest. The patient is unable to breathe on his or her own and needs to rely on a mechanical breathing machine (ventilator). The muscles in the throat and face may be affected, making swallowing impossible. These patients need to be fed through a tube inserted up the nose or directly into the stomach. How is GBS diagnosed? The illness is diagnosed from the history and clinical examination. Diagnosis is difficult because the symptoms may be confused with those of other conditions. Two types of confirmatory tests may be helpful and are performed in most cases: • • lumbar puncture – under a local anaesthetic, a needle is inserted between the lower back bones and a small amount of spinal fluid is drawn off for analysis; and nerve function tests – electromyogram (EMG) or nerve conduction velocity test; these tests produce an electrical recording of nerve conduction and muscle activity What is the treatment for GBS? GBS improves by itself. However, certain factors can assist recovery: • good nursing and medical/intensive care; • physiotherapy and hydrotherapy, therapies that relieve discomfort and prevent stiffness; • high doses of immunoglobulins (proteins that form part of the body’s infection fighting system) given by intravenous; • the exchange of blood plasma (plasmapheresis); this generally reduces the duration of the disease in severe cases if it is done in the first few days; and counselling to reassure the patient and encourage the patient towards recovery. • Do people recover from GBS? Most people (80%) make a total recovery. Many spend three months or more in hospital and take a year to recover. About 30% of people with GBS still have some weakness in the affected muscles three years after they first became ill. A small number are unable to resume their normal occupation. Modern intensive care makes death from GBS a rare occurrence, but is does occur in about 3% of cases. It is rare to have GBS a second time. Where can I get more information about GBS? For more information about GBS, talk to your health care provider or contact the Halton Region Health Department at the number listed below. For more information contact Halton Region 905-825-6000 Toll free: 1-866-4HALTON (1-866-442-5866) TTY 905-827-9833 www.halton.ca January 2008