Guillain-Barre Syndrome (GBS) is a neurological disease in which the immune system attacks the peripheral nerves.
Published Aug 28, 2023 | 8:30 AM ⚊ Updated Aug 28, 2023 | 8:30 AM
During the rainy season, there tends to be an increase in cases of Guillain-Barre syndrome (GBS). (Creative Commons)
In July, the World Health Organisation (WHO) issued an alert regarding an unusual rise in Guillain-Barré Syndrome (GBS) instances in different parts of Peru. In response, the Peruvian government declared a national health emergency, reinforcing public health measures.
“Compared to historical data, excluding the 2019 outbreak, the average monthly count of suspected GBS cases nationwide is typically under 20. However, in the period from 10 June to 15 July, 2023, a notable surge has been observed with 130 suspected cases of GBS reported, out of which 44 have been confirmed. This upsurge surpasses the anticipated numbers,” said WHO in its alert.
In recent days, cases of GBS have emerged in Mumbai. Medical professionals noted a 30-50 percent increase compared to the usual numbers witnessed during the monsoon season.
Now, even hospitals in South India are seeing an uptick in GBS cases.
“Guillain-Barre Syndrome (GBS) is a neurological disease in which the immune system attacks the peripheral nerves,” Consultant Neurologist and Stroke Physician Dr Shobha N of Bengaluru’s Manipal Hospital told South First.
Imagine your body’s nerves as wires that help your brain talk to your muscles. In Guillain-Barre Syndrome, the body’s defence system gets confused and starts attacking these nerves, as if fighting an enemy.
When this happens, the nerves can’t do their job properly, which leads to problems.
“When infections attack our body, our immune system creates antibodies to fight off the infecting agents. Sometimes, these same antibodies meant for viruses end up attacking our own nervous system. This is what’s known as an autoimmune disease. The unusual antibodies produced by the person’s own body end up harming the nerves, leading to GBS,” said Consultant Neurologist at Hyderabad’s Apollo Hospital Dr Sudhir Kumar.
“There are two common types of GBS. One is a viral infection, often resembling a viral fever and affecting the upper respiratory tract. The second type is a diarrheal disease,” Dr Kumar told South First.
“Interestingly, both respiratory and diarrheal infections are more prevalent during the monsoon season. GBS tends to develop around two weeks after contracting these infections,” he added.
There are some unusual types of GBS, where only the cranial nerves (those connected to the head) are affected. Tests on how the nerves work show two main types: One where the protective covering of the nerves is harmed (called demyelinating), and another where the nerve fibres are damaged (called axonal).
“There can also be cases where both types of damage occur together. This is what takes place in GBS,” said Dr Kumar.
According to Dr Shobha, the symptoms typically start with a person feeling weak, like they can’t move their muscles well. Sometimes, they might feel tingly or numb in their arms and legs.
In severe cases, they might even have trouble walking or moving their body, which then progresses to the upper limbs.
Dr Kumar added that the weakness typically begins in the legs, and patients might find it hard to walk or get up from the sitting position. Climbing stairs can be challenging. Within a day or so, the weakness can extend to their hands, making it difficult to do things like picking up objects, dressing, or eating.
“Cranial nerves are typically the facial nerves that can be involved. Patients can develop difficulty in swallowing and breathing,” said Dr Shobha.
“Around the third or fourth day without treatment, moving becomes even tougher. They might struggle to change positions in bed or turn from side to side. If left untreated, swallowing and speaking become problematic around the fourth day. In severe cases, breathing becomes difficult, and some patients even need a ventilator,” said Dr Kumar,
This progression usually takes a few days, but in very serious cases, it can happen in just two or three days. In other cases, it might take up to seven days for these symptoms to appear.
The most critical symptom is the paralysis of respiratory muscles. Once patients need a ventilator, it can take quite a while for them to recover.
However, the good news is that GBS is treatable, but early diagnosis and treatment are crucial.
Diagnosing GBS involves a few steps. When a patient reports symptoms like weakness that progresses quickly, beginning in the legs and moving to the hands, it gives us a hint.
“We then perform nerve conduction studies, which involve stimulating the nerves in the hands and legs and measuring their responses on a computer. This test takes around 30 minutes and can often be enough to make a diagnosis,” said Dr Kumar.
He added that in some cases, doctors might also conduct a lumbar puncture. “This procedure helps us examine the cerebrospinal fluid (CSF). In GBS cases, we usually find that the protein levels in CSF are high, while cell counts are normal or only slightly elevated,” he said.
“This is important because it helps us distinguish GBS from conditions like encephalitis (brain fever), where both CSF cell count and protein levels tend to be high. In GBS, only the protein levels are elevated, and CSF may appear normal or only slightly raised,” he added.
There are two main types of treatment approaches for GBS, said the doctors.
“To help treat Guillain-Barre Syndrome, doctors use a method called immunotherapy. This could mean getting special proteins called intravenous immunoglobulin (IVIG) through a vein,” said Dr Shobha.
IVIG involves giving patients an injection of a special type of antibody through an infusion. This process takes around five days. “The goal of IVIG is to eliminate the abnormal antibodies from the bloodstream,” said Dr Kumar.
The second treatment method is known as plasmapheresis. “It involves removing the patient’s abnormal plasma (which contains those troublesome antibodies) and replacing it with fresh plasma obtained from other sources,” he added.
Both of these treatments are widely accepted as standard for GBS, and it’s crucial to start them early.
“When treatment begins promptly, around 95 percent of the people tend to recover. However, if treatment is delayed or not administered for some reason, the situation can turn dire, with a mortality rate of 30-50 percent,” said Dr Kumar.
“This underlines the importance of early treatment of GBS. It’s a disease where treatment can make a significant positive difference, and not treating it can have severe consequences.
Dr Shobha said that there have been an increase in GBS cases over the last two weeks in Bengaluru
“Mumbai is currently witnessing a surge in GBS cases. There has been a 10-15 percent increase in GBS cases over the last two weeks in Bengaluru,” she said.
“As for the outlook, some GBS patients are showing positive progress, whereas others have required more intensive interventions such as ventilator support and tracheostomy,” added the doctor.
“Notably, the GBS cases in Bengaluru do not appear to be linked to travel history; rather, they seem to be associated with a viral infection other than Covid-19,” said Dr Shobha.
Dr Kumar said that GBS cases generally increase during the monsoon.
“Such fluctuations are relatively normal, and various factors can contribute. For example, viral flu, red-eye syndromes, or even measles in specific areas can lead to a surge in GBS cases post-infection,” he said.
GBS cases tend to cluster around healthcare hubs. In Hyderabad, for instance, nearly half the patients come from outside the city.
“This pattern has been observed in other developed healthcare cities like Mumbai as well. People seek specialised care and are often willing to travel to receive the best treatment,” said Dr Kumar.
He added that increased awareness also played a role in the rise of reported cases. As people became more informed about GBS and healthcare, they prioritised seeing the best doctors and seeking treatment promptly.
This focus on early detection and care leads to more cases being identified in healthcare centres.
During the rainy season, there tends to be an increase in cases of Guillain-Barre Syndrome.
“This is because most cases of GBS are post-infection. Common antecedent infections are respiratory-tract infections and diarrhoeal diseases. Incidences of these infections generally rise during monsoons,” said Shobha.
GBS can occur after various infections, not limited to just the monsoon season.
“With the Covid-19 pandemic, we’ve seen a notable number of individuals recovering from Covid-19 also experiencing GBS. The immune system fights the virus with antibodies, but in some cases, these antibodies can damage the nerves, leading to GBS. This post-viral occurrence applies not just to Covid-19 but to other viral infections and even vaccinations,” said Dr Kumar.
He added that the risk of GBS after vaccination was relatively low. For instance, GBS might occur in about one case out of 10,000-15,000 vaccinations. This risk remained consistent across various vaccines, including Covid-19 vaccines. “It’s important to note that the effects of vaccines are usually seen within the first couple of weeks after vaccination, similar to the timeline of viral infections,” he said.
