Common Complaints: The Guillain-Barre syndrome

THE Guillain-Barre syndrome is the most common cause of paralysis in the young. It affects several hundred people in Britain each year. The term derives from the names of two French army doctors who wrote the first description of the disease in 1916; it is also known as ascending paralysis or acute polyneuritis.

The cause of the Guillain-Barre syndrome is unknown, but it often seems to be triggered by a respiratory or gastrointestinal infection a week or two before the start of symptoms. Some cases have been triggered by immunisations against infections such as influenza. Sometimes the disease comes completely out of the blue. The actual defect is inflammation of the nerves, damaging their outer coverings. The brain itself is usually not affected and consciousness and thinking are unimpaired.

The first symptom is usually a tingling sensation and numbness in the feet and legs. Within a few hours the arms are also affected, and over the next few days there is a progressive loss of sensation and muscle power affecting the whole body. Symptoms may continue to worsen for two to three weeks. In the worst cases, the muscles that control speech, eye movements and breathing may be paralysed. The disease is of variable severity; in mild cases the victim can still walk, while in the most severe he or she may be totally paralysed and need prolonged artificial ventilation to maintain respiration.

The diagnosis of the syndrome is rarely in doubt after the first few days: typically, the weakness and loss of sensation is symmetrical and progressive. Confirmatory tests include measurement of the slowing of the movement of impulses along the nerves, and abnormalities in the cerebrospinal fluid. Tests on the fluid will show a high protein content but no immune cells.

Anyone with the disease will need treatment in a hospital with an intensive care unit, since one-third of all patients develop breathing problems and one-fifth require artificial ventilation.

In the past the main treatment was with steroid drugs, but trials showed this therapy to be ineffective. Two high-technology treatments have been shown to speed recovery. Plasma exchange involves the removal of the plasma - the liquid part of the blood that contains antibodies. The blood is passed through a machine that separates the cells and returns them to the body with a salt and protein solution to replace the plasma. Treatment is usually given on alternate days for eight to 10 days. Another treatment

is the daily infusion into the bloodstream of

antibodies obtained from blood donors - pooled gamma globulin.

Around 95 per cent of people who get the Guillain-Barre syndrome recover. The mortality rate of up to 5 per cent is seen even in specialist units; deaths occur from respiratory complications or from heart problems. Recovery may be very slow. Many patients are left with some long-term weakness or numbness, usually slight. Children and teenagers are more likely to make a rapid and complete recovery.

Diseases named after their discoverers are usually given a more precise name when their cause has been found. In the case of the Guillain-Barre syndrome, the hunt is still on.