Guillain-Barré Syndrome (GBS) is a collection of syndromes that are caused by nerve damage after an infection. In GBS, it isn't a virus or a bacterium itself that causes the damage. Instead, it's hyperactivity by the immune system after the infection is gone that damages nerves and causes symptoms. White blood cells infiltrate nerves and strip away the myelin that "insulates" them and keeps electrical signals going through the right channels.
GBS usually shows up two to four weeks after a relatively benign infection. At first there can be dysesthesias, frighteningly painful sensations, to normal stimulation of the tips of the fingers and toes. Just touching a finger or a toe can provoke a burning or cutting sensation. Alternatively, there can be parasthesias, no sensation at all, and an inability to locate the limbs in space, a reaction on the lines of "I don't know where my hands are." Patients can experience both dysethesias and parasthesias sequentially, and there often is intense pain from even slight movement of the hips, shoulders, or buttocks.
Adjacent muscles weaken, and the weakness spreads up the arms and legs to the trunk of the body, where it can cause problems with breathing. Someone who has GBS may not be able to stand or walk even if the muscles are not weakened because of balance problems. The can be slow heartbeat (bradycardia) or racing heartbeat (tachycardia). People may sweat profusely, or be unable to sweat at all. They can be pale or flushed. There can be slurred speech, difficulty swallowing, profuse salivation, or dry mouth. Up to about 1/3 of people who develop GBS will need to be on a ventilator in hospital to assist breathing at some point in the course of their disease. When people with GBS have to go on a ventilator, the are typically on it for an average of 50 days.
In the best circumstances, the bizarre collection of symptoms get worse for about twelve days, but they tend to dissipate over, on average, about 200 days. About 80 percent of people who get GBS are able to walk unassisted again in about six months. About 60 percent full recovery of muscle strength is achieved in a year. In about 5 to 10 percent of people who have GBS, recovery takes 18 months or longer, and 7 to 40 percent experience lifetime problems. In the United States, about one in eight people who goes to the intensive care unit with this disease dies of it.
Many people who get GBS periodically experience relapses of their symptoms. There are at least two sets of antecedent events for these problems:
- Many people suffer relapses when they get a vaccination. Rabies vaccine, which isn't really optional, is especially likely to cause symptoms to come back. There were also many problems with swine flu vaccine and GBS in 1976, although there have not been as many problems with any of the flu vaccines since then. Sometimes you simply have to have a vaccination, even if it can aggravate symptoms of GBS. Generally it will be best to avoid them.
- Many people suffer relapses when they get a new infection, especially with the organism Campylobacter jejuni. This is a bacterium that is found in sewage-contaminated water, and that is transmitted in anal-oral sex. It's the most common cause of traveler's diarrhea. Exposure to this specific bacterium is especially likely to cause a relapse of GBS. It's also a good idea to avoid it when you can. If you know the area where you live is about to experience a flood, for example, evacuate it early. Avoid sexual experiences that can expose you to Campylobacter jejuni.
Beyond these simple measures, the most important thing you can do to avoid relapses of GBS is to avoid fatigue. Overexertion results in a cascade of problems that bring old symptoms back. It's more common for people with relatively mild symptoms to overexert and relapse than it is for people with severe disability to encounter this problem.
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