The immune system is a shield that guards against foreign invaders like bacteria and the virus. That’s the actual functioning of the immune system. When the immune system senses the existence of any foreign particle in the body, it immediately makes the antibodies to eliminate them. In autoimmune diseases, the immune system becomes a war zone. It misinterprets the body’s healthy nerves as foreign bodies and attacks them, reducing the ability to fight against infection and viruses.
One such condition is Guillain Barre Syndrome (GBS), one of the rarest autoimmune disorders that affect one in one lakh people in the USA. It affects the peripheral nervous system, severity ranging from mild weakness to depending on the life support system for breathing. Fortunately, there is 80% recovery after diagnosis and 5 – 10% delayed or incomplete recovery. It can affect anyone irrespective of the age group.
The reason for GBS onset is not known, but it is evident that the immune system attacks itself. The immune system produces antibodies when foreign bodies try to attack; these antibodies are nothing but the immune response towards the foreign bodies.
The reason for GBS onset is not known, but it is evident that the immune system attacks itself. The immune system produces antibodies when foreign bodies try to attack; these antibodies are nothing but the immune response towards the foreign bodies. But in the case of autoimmune disorder, when any viral or bacterial infection attacks the body, these bacteria or the virus start to resemble the nerves, and the immune system attacks the healthy nerves by mistake.
The onset of symptoms can be a very mild tingling sensation in the limbs to severe breathing difficulty. It starts from the lower body and moves up to the lungs leading to breathlessness, and sometimes occasionally, it starts from the upper body and moves down the lower body. The severity of the symptoms may vary from person to person, depending on the level of nerve damage. Weakness leading to restriction in the limb movement seeks immediate medical treatment.
Additional symptoms may include:
- Severe pain in the nights
- Blood pressure as a secondary symptom
- Indigestion and loss of control over bladder
- Sometimes coordination problems due to nerve damage which fails to send signals
The symptoms can get severe with the period if not treated immediately and sometimes may lead to paralysis, which can be life-threatening. When a person is affected with GBS, his nerves are damaged. Nerves are nothing but conducting wires. Nevers have axons covered with an insulating layer called myelin sheath that carries electric signals from the brain to the central and peripheral nervous system leading to immediate action or response towards the brains’ command.
In GBS patients, the myelin sheath is damaged and sometimes the entire axon results in complete failure in signal transmission, and the muscles start to lose their ability to respond to the brain’s command. Breathing can be weak, leading to a dependency on the life support system. Nerve damage may also cause abnormal transmission of signals that give spontaneous sensations called paresthesias, which is nothing but the tingling sensation that generates difficulty in limb movements.
The nerve damage occurs due to molecular mimicry theory, where the molecules of the nerve resemble the molecules of some microorganisms. Hence the microbes and the myelin sheath look similar, and when these microbes attack the immune system, they mistake the microbes for myelin sheath and attacks the healthy nerves treating them as foreign bodies. As a result, the immune system fails to recognise its nerves.
So the immune system basically produces antibodies for bacterial infection caused by Campylobacter jejuni, which attacks the axon in the motor nerves causing acute motor axonal neuropathy, which is one variant of GBS having acute paralysis, loss of reflexes but no sensory loss. This bacterial infection is caused by consuming contaminated food or uncooked food, especially meat.
This syndrome cannot be diagnosed in the initial stages due to the symptoms’ variation and intensity. Generally, the physician will examine and check if the symptoms are shown on both sides. Initially, the reflexes start to slow down in the joints. Sometimes, these reflexes are absent as the velocity of signal transmission slows down, which brings us to nerve conduction velocity tests the ability to transmit signals. So in GBS, the cerebrospinal fluid starts to change, and there has been some evidence stating that in GBS patients, the cerebrospinal fluid contains higher protein levels than usual. So the sample is collected from the lumbar region to examine the fluid.
Other diagnostic symptoms include
- Abnormal sensation like tingling in the feet along with weakness
- Diminished reflexes
- High protein levels in cerebrospinal fluid
Treatment
Generally, short-term therapies can treat it to reduce the severity and lessen the recovery time. So the treatment includes Plasma exchange, and the other one is high dose immunoglobulin therapy (IVIg). Plasma exchange removes the blood with the help of a catheter via veins. Fresh plasma is extracted and returned to the patient. Plasma contains antibodies, so the PE removes the nerve-damaging plasma and reduces the severity of GBS.
Immunoglobulins are the proteins that produce antibodies against disease-causing microorganisms.
Immunoglobulins are the proteins that produce antibodies against disease-causing microorganisms. In IVIg therapy, the immunoglobulins are injected through intravenous infusion into the patient’s body. These immunoglobulins have been developed from healthy donors. Researchers have stated that this therapy shortens the recovery time, has fewer complications, and lowers the chances of the antibodies attacking its nerves by diluting with non-specific antibodies.
As the patients recover, they are moved to rehabilitation care for physical and mental health improvement. Physiotherapy for the muscles and limbs movement and therapy for mental health is a must to regain confidence during the recovery stage. It is a slow process, and the patient may tend to lose hope.
Composed by: “Sunayana is presently working as research Associate for Hetero Labs limited Hyderabad in formulation R&D injectables department (Non Onco).”
