Guillain-Barre Disease - Medical Malpractice Lawyers

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Guillain-Barre Disease - Medical Malpractice

Guillain-Barré syndrome is an immune disorder in which the immune system attacks a portion of the peripheral nervous system. It begins with tingling sensation and weakness of the legs that spreads upwards to include the trunk and arms. The symptoms worsen so that some muscles become completely paralyzed. The disorder can be life threatening, interfering with breathing, heart rate and blood pressure. Such patients need respirator support in order to save their lives. Abnormal heart beat and blood clots are possible with this disease. The disease affects men and women equally but is rare, affecting only about one in 100 thousand patients. The cause of Guillain-Barré disease is unknown. It is believed that certain vaccines can contribute to the syndrome and can be subsequent to a respiratory and GI viral syndrome.

In Guillain-Barré syndrome, it is believed that the immune system begins to attack itself in what is known as an autoimmune disease. The cells of the immune system attack normal cells as though they are foreign to the body. The myelin sheath is what is attacked by the body's immune system. The myelin sheath surrounds nerves and promotes fast action of the nerve. The axons themselves can be attacked by the immune system so that the end result is paralysis.

Because the myelin sheath and axons are damaged, there is a reduction in both the motor aspect of muscles and in the sensation the brain receives from peripheral body areas. The sensation of "crawling skin" is felt and the disease can be painful. It is often preceded by a bacterial or viral infection and possibly the organisms change the nature of the cells in the nervous system so that they are attacked by the immune system. Autoantibodies are made and these attack the nervous system.

The major symptoms of Guillain-Barré symptoms include peripheral weakness that ascends up the body, paresthesias, loss of reflexes and breathing problems eventually requiring ventilator support. The weakness is maximal about 2-3 weeks after onset.

The disease is diagnosed through a careful history and physical examination. There will be generalized ascending weakness and diminished reflexes. The syndrome can be difficult to diagnose because the symptoms can be very variable, especially in the early phases of the disease. There are symptoms similar to other diseases so doctors must be careful to diagnose the disease accurately. Doctors can use a nerve conduction velocity test to show the damage to the peripheral nerves. A spinal tap can show an increase in the amount of protein in the cerebrospinal fluid.

There is not any cure for Guillain-Barré disease. Patients are often supported with nursing care and with a ventilator if necessary. Plasmapheresis or plasma exchange has been found to be helpful in some cases. High doses of immunoglobulins can be given in order to block the disease. In plasmapheresis, the blood plasma is exchanged with fresh frozen plasma that has been thawed. This removes the proteins causing the disease, or so it is believed. In some cases, the plasma is not exchanged with donor plasma but is instead allowed to be replaced by the body on its own.

When doctors give high dose immunoglobulin therapy, IV injections are given of immunoglobulins from normal donors that seem to lessen the immune response on the part of the patient with Guillain-Barre.

Steroid hormones have been tried to block the immune response going on in Guillain-Barre disease but it has no positive effect on the disease. In fact, it sometimes has negative effects on the syndrome. The key to treatment is support of the patient until the symptoms pass. This includes providing ventilator support, feeding support, oxygen, and pneumonia prevention. Even before recovery begins, caregivers often manually move the limbs to keep blood flowing and to prevent contractures.

Guillain-Barre can be a very devastating syndrome that attacks a person suddenly and unexpectedly. Recovery can happen over several days, weeks or months. It can even take years to progress enough to say you are relatively cured of the disease. Thirty percent of sufferers have residual weakness after three years. About three percent suffer some sort of relapse of the muscle weakness, even years after the initial event. Guillain-Barre disease has both physical and emotional effects on the patient. Sudden paralysis is a difficult thing to come to terms with.

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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here