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GBS and variants (also Lyme Disease, ME, etc.)
Diagnostic procedures (EMG, MRI,...)
Medical bit (a brief description of some common terms)
Medication (drugs, vitamins, alternative therapies, etc.)
Side effects (variously experienced symptoms)
Other worries (pregnancy, sex, etc.)
also included (but not variants of GBS):
Medical bit (a brief definition of some common terms)
Medication (drugs, vitamins, alternative therapies, etc.)
see also -
Side effects (variously experienced symptoms)
GBS - Guillain-Barré Syndrome - A demyelinating condition of the peripheral nerves that usually develops 1-3 weeks after a viral infection and is thought to be an allergic response. The main symptoms are numbness and weakness of the limbs, with some sensory loss. In one in five cases the respiratory and facial muscles are affected and paralysis may set in. In 1993 a US report on vaccination risks provided evidence that tetanus and oral polio vaccine could cause Guillain-Barré syndrome. GBS affects one person in 50,000 across all ages, sexes and races. Each year there are about 1,000 new cases in the UK. It is an autoimmune illness, usually triggered by a viral infection, in which the body's defences fight off the virus and then go on to damage the nerves. The first signs are normally pins and needles in the legs and sometimes the hands, eventually leading to a total or partial paralysis. Most people who develop the syndrome need to spend time in intensive care , mainly to help with breathing difficulties brought on by paralysis. There is no specific treatment but some patients benefit from plasmapheresis or injections of immunoglobulin to counter symptoms in the early stages, which are the worst. Nine out of 10 people make a good recovery and live a normal life, but the recovery time can vary from a few weeks to many years. A small number of patients - about 2-3% - have long term problems and often remain wheelchair bound.
AIDP/AIP - Acute idiopathic demyelinating polyradiculoneuropathy / acute idiopathic polyradiculoneuropathy. See CIDP/CIP
CIDP/CIP - Chronic idiopathic demyelinating polyradiculoneuropathy / chronic idiopathic polyradiculoneuropathy. CIDP is a very rare disease of the peripheral nervous system involving gradual development of weakness and loss of sensation predominantly in the arms and legs. 'Chronic' refers to the gradual course of the illness. 'Idiopathic' means that no specific cause has been identified. 'Demyelinating' means that the damage is primarily to the insulating myelin sheaths around the nerve fibres. 'Poly' means many; 'radiculo' means root (the point of origin of the nerve from the spinal column); 'neuro' means nerve and 'opathy' means disease (so 'a disease of many peripheral nerves and their roots'). CIDP is closely related to GBS. In GBS the low point is reached within a few weeks whereas in CIDP the initial progressive phase lasts much longer. Some CIDP patients are initially diagnosed with GBS. The incidence of CIDP is fairly difficult to determine because of it's rarity. It is estimated that 7-25% of GBS patients develop CIDP each year. Some patients only suffer a single instance of CIDP which may last from a few months to several years. Others have many relapses and in between each relapse may have a spontaneous 'recovery', though they may be left with some residual weakness and pain. For many, this will not interfere too greatly with their everyday lives, but for a very small number there can be severe disability. There are an unfortunate few for whom the illness continues to progress without remission. Amongst treatments found to be helpful are steroids , immunosuppressive drugs , plasmapheresis and intravenous immunoglobulin .
AMAN/AMSAN - Acute motor nerve damage is axonal neuropathy / acute motor and sensory axonal neuropathy. A variant of GBS where the damage is predominantly to the axon rather than the myelin sheath.
Miller Fisher syndrome - also known as MFS, was originally described by Miller Fisher in 1956 as consisting of opthalmoplegia (paralysis of the eye muscles), incoordination, and loss of tendon reflexes. This, and only this , is Miller Fisher Syndrome. Some patients with Guillain-Barré Syndrome do develop opthalmoplegia and of course patients GBS lose their tendon reflexes and are usually weak rather than clumsy, but they may be clumsy as well. It is confusing to talk about patients who have GBS with opthalmoplegia as having MFS. There is a lot of electrophysiological evidence that MFS is different from GBS. On the other hand it is true that one or two patients with MFS have had subsequent attacks which have resembled GBS or CIDP . There is therefore a relationship between the two. It is an ill-defined area and it is becoming clearer that more is being found out about the specific antibodies which are associated with MFS, which are different from those occurring in GBS. They are directed against a special ganglioside called ganglioside GQIb. These antibodies are not found in patients with the ordinary form of GBS but may be found in patients with GBS who have the opthalmoplegia.
Lyme disease - (see also the Lyme Disease web pages) A disease transmitted by tick bites that affects all the systems of the body. It has a 10% mortality rate. First described in 1975 following an outbreak in children living around Lyme, Connecticut, USA, it is caused by the microorganism Borrelia burgdorferi, isolated by Burgdorfer and Barbour in the USA in 1982. Symptoms include a red 'bull's eye' rash around the bite, but this only occurs in about two-thirds of cases and otherwise the early stages are difficult to distinguish from flu. Untreated, the disease attacks the joints, nervous system, heart, liver, kidneys, and eyes, but responds to penicillin or tetracycline. The tick that carries the disease, Ixodes dammini, lives on deer, while Borrelia burgdorferi relies on mice during its life cycle. There has been a dramatic increase in the incidence of Lyme disease in the USA since 1982, when there were only 500 cases recorded. By 1996 there were more than 16,000 cases in the year. In June 1998 a US Food and Drug Administration (FDA) advisory committee recommended that a new vaccine be approved for commercial use. In December 1998 the US FDA approved the vaccine against Lyme disease. In the UK it is still very rare and the sheep tick is the main carrier.
Chronic Fatigue Syndrome - (see also the Chronic Fatigue Syndrome - FAQ ) A common debilitating condition also known as myalgic encephalomyelitis (ME), postviral fatigue syndrome, or `yuppie flu´. It is characterized by a diffuse range of symptoms present for at least six months including extreme fatigue, muscular pain, weakness, depression, poor balance and coordination, joint pains, and gastric upset. It is usually diagnosed after exclusion of other diseases and frequently follows a flulike illness. The cause of CFS remains unknown, but it is believed to have its origin in a combination of viral, social, and psychological factors. Theories based on one specific cause (such as Epstein-Barr virus) have been largely discredited. There is no definitive treatment, but with time the symptoms become less severe. Depression is treated if present, and recent research has demonstrated the effectiveness of cognitive therapy. CFS was not officially recognized as a genuine disease by the British medical profession until October 1996. In 1996 there were up to one million sufferers in Britain. The term myalgic encephalomyelitis was replaced with the more accurate term CFS because sufferers do not have encephalomyelitis (inflammation of the muscle membranes) and many do not have myalgia (muscle pain). Stereotypes of the typical sufferer being a middle-class, middle-aged woman have also been found to be unjustified. CFS is not a new phenomenon, with cases documented worldwide for more than 50 years.
Seasonal Affective Disorder - (SAD) A form of depression that occurs in winter and is relieved by the coming of spring. Its incidence decreases closer to the Equator. One type of SAD is associated with increased sleeping and appetite. It has been suggested that SAD may be caused by changes in the secretion of melatonin, a hormone produced by the pineal body in the brain. Melatonin secretion is inhibited by bright daylight. Research into winter sleep patterns 1994 showed that volunteers deprived of artificial light slept for part of the 14-hour winter nights, but also laid awake for as long as 5 hours at a time. During this period of quiet wakefulness their brainwaves resembled those produced during meditation. They felt more rested and energetic after these 'natural' winter nights. Hormone production was also affected with the volunteers secreting more growth hormone, prolactin, and melatonin. Both a shortage of sleep and a disruption in natural hormone production may contribute to SAD. Visit the Seasonal Light (SAD Home Page)
Biopsy - Excision of tissue from a living body for microscopic examination as an aid to diagnosis. In GBS this usually involves the removal of a tiny portion of nerve or muscle tissue often from the upper arm and/or thigh. Occasionally the procedure is carried out without the use of an anaesthetic (as this sometimes destroys the structures that are to be looked at) but, although uncomfortable, it is not painful.
Electromyography - (EMG). A continuous recording of the electrical activity of voluntary muscle. It is obtained by means of an electrode inserted into the muscle and the recording is viewed on an oscilloscope. It is used to aid diagnosis of GBS and other nerve and muscle disorders.
Lumbar puncture - or spinal tap. The insertion of a special hollow needle with a stylet either through the space between the third and fourth lumbar vertebrae or into the subarachnoid space to obtain cerebrospinal fluid (CSF) for examination. A local anaesthetic is used to numb the skin, and a small amount of CSF is drawn out through the needle. Normally clear and colourless, the CSF acts as a fluid buffer around the brain and spinal cord. Changes in its quantity, colour, or composition may indicate neurological damage or disease. The test is uncomfortable but not painful. You may be required to lie flat for a few hours afterwards, otherwise a headache may develop. Sometimes you may be required to stay overnight at the hospital in order for the CNS to replenish.
Magnetic resonance imaging (MRI) is a diagnostic scanning system based on the principles of nuclear magnetic resonance. MRI yields finely detailed three-dimensional images of structures within the body without exposing the patient to harmful radiation. The technique is invaluable for imaging the soft tissues of the body, in particular the brain and the spinal cord. Claimed as the biggest breakthrough in diagnostic imaging since the discovery of X-rays, MRI is a noninvasive technique based on a magnet which is many thousands of times stronger than the Earth's magnetic field. It causes nuclei within the atoms of the body to align themselves in one direction. When a brief radio pulse is beamed at the body the nuclei spin, emitting weak radio signals as they realign themselves to the magnet. These signals, which are characteristic for each type of tissue, are converted electronically into images on a viewing screen. Also developed around magnetic technology, magnetic resonance spectroscopy (MRS) is a technique for investigating conditions in which there is a disturbance of the body's energy metabolism, including ischaemia and toxic damage due to drugs or other chemicals. MRS is also of value in diagnosing some cancers.
Analgesic - Agent for relieving pain. Opiates alter the perception or appreciation of pain and are effective in controlling 'deep' visceral (internal) pain. Non-opiates, such as aspirin, paracetamol, and NSAIDs (nonsteroidal anti-inflammatory drugs), relieve musculoskeletal pain and reduce inflammation in soft tissues. Pain is felt when electrical stimuli travel along a nerve pathway, from peripheral nerve fibres to the brain via the spinal cord. An anaesthetic agent acts either by preventing stimuli from being sent (local), or by removing awareness of them (general). Analgesic drugs act on both. Temporary or permanent analgesia may be achieved by injection of an anaesthetic agent into, or the severing of, a nerve. Implanted devices enable patients to deliver controlled electrical stimulation to block pain impulses. Production of the body's natural opiates, endorphins , can be manipulated by techniques such as relaxation and biofeedback (see Alternative therapies ). However, for the severe pain of, for example, terminal cancer, opiate analgesics are required. US researchers found 1996 that some painkillers were more effective and provided longer-lasting relief for women than men.
Antibody - (see also Antibody Resource Page ) Protein molecule produced in the blood by lymphocytes in response to the presence of foreign or invading substances ( antigens ); such substances include the proteins carried on the surface of infecting microorganisms. Antibody production is only one aspect of immunity in vertebrates. Each antibody acts against only one kind of antigen, and combines with it to form a 'complex'. This action may render antigens harmless, or it may destroy microorganisms by setting off chemical changes that cause them to self-destruct. In other cases, the formation of a complex will cause antigens to form clumps that can then be detected and engulfed by white blood cells, such as macrophages and phagocytes. Each bacterial or viral infection will bring about the manufacture of a specific antibody, which will then fight the disease. Many diseases can only be contracted once because antibodies remain in the blood after the infection has passed, preventing any further invasion. Vaccination boosts a person's resistance by causing the production of antibodies specific to particular infections. Antibodies were discovered 1890 by German physician Emil von Behring and Japanese bacteriologist Shibasaburo Kitasato. Large quantities of specific antibodies can now be obtained by the monoclonal technique. In 1989 a Cambridge University team developed genetically engineered bacteria to make a small part of an antibody (single domain antibodies) which bind to invaders such as toxins, bacteria, and viruses . Since they are smaller, they penetrate tissues more easily, and are potentially more effective in clearing organs of toxins. They can be produced more quickly, using fewer laboratory mice, and unlike conventional antibodies, they also disable viruses. In addition, single domain antibodies can be used to highlight other molecules, such as hormones in pregnancy testing.
Antigen - Any substance that causes the production of antibodies by the body's immune system. Common antigens include the proteins carried on the surface of bacteria, viruses , and pollen grains. The proteins of incompatible blood groups or tissues also act as antigens, which has to be taken into account in medical procedures such as blood transfusions and organ transplants.
Anti-inflammatory - Any substance that reduces swelling in soft tissues. Antihistamines relieve allergic reactions; aspirin and NSAIDs are effective in joint and musculoskeletal conditions; and rubefacients (counterirritant liniments) ease painful joints, tendons, and muscles. Steroids, because of their severe side effects, are only prescribed if other therapy is ineffective, or if a condition is life-threatening. A corticosteroid injection into the affected joint usually gives prolonged relief from inflammation.
Antispasmodic - Any drug that reduces motility, the spontaneous action of the intestine wall. Anticholinergics are a type of antispasmodic that act indirectly by way of the autonomic nervous system , which controls involuntary movement. Other drugs act directly on the smooth muscle to relieve spasm (contraction).
Autoimmunity - A condition where the body's immune responses are mobilized not against 'foreign' matter, such as invading germs, but against the body itself. Diseases considered to be of autoimmune origin include GBS, myasthenia gravis, rheumatoid arthritis, and lupus erythematous. In autoimmune diseases T- lymphocytes reproduce to excess to home in on a target (properly a foreign disease-causing molecule); however, molecules of the body's own tissue that resemble the target may also be attacked, for example insulin-producing cells, resulting in insulin-dependent diabetes; if certain joint membrane cells are attacked, then rheumatoid arthritis may result; and if myelin, the basic protein of the nervous system, then multiple sclerosis results. In 1990 in Israel a T-cell vaccine was produced that arrests the excessive reproduction of T-lymphocytes attacking healthy target tissues.
Autonomic Nervous System - In mammals, the part of the nervous system that controls those functions not controlled voluntarily, including the heart rate, activity of the intestines, and the production of sweat. There are two divisions of the autonomic nervous system. The sympathetic system responds to stress , when it speeds the heart rate, increases blood pressure, and generally prepares the body for action. The parasympathetic system is more important when the body is at rest, since it slows the heart rate, decreases blood pressure, and stimulates the digestive system. At all times, both types of autonomic nerves carry signals that bring about adjustments in visceral organs. The actual rate of heartbeat is the net outcome of opposing signals. Today, it is known that the word 'autonomic' is misleading - the reflexes managed by this system are actually integrated by commands from the brain and spinal cord (the central nervous system).
Axon - The long threadlike extension of a nerve cell that conducts electrochemical impulses away from that cell body towards othe r nerve cells or an effector organ such as a muscle; the essential part of the nerve fibre and a direct lengthening of the nerve cell. The axon is often described as the central conducting core of an electric cable. It is covered by a protective myelin sheath. Axons terminate in synapses, junctions with other nerve cells, muscles, or glands.
Campylobacter - Genus of bacteria that cause serious outbreaks of gastroenteritis. They grow best at 43ºC, and so are well suited to the digestive tract of birds. Poultry is therefore the most likely source of a Campylobacter outbreak, although the bacteria can also be transmitted via beef or milk. Campylobacter can survive in water for up to 15 days, so may be present in drinking water if supplies are contaminated by sewage or reservoirs are polluted by seagulls. Incidences of notified cases of Campylobacter poisoning exceeded 50,000 in Britain during 1997. See also the Campylobacter - Public Information web page.
Cerebrospinal Fluid - (CSF). Clear fluid that buffers the brain and spinal cord. It is present in the subarachnoid space, the four ventricles of the brain and the central canal of the spinal cord. It is secreted in clusters of blood vessels in the ventricles known as choroid plexuses, and is eventually absorbed into the bloodstream. Its normal contents include glucose, salts, proteins and some white cells. Small amounts of CSF may be withdrawn by lumbar puncture for diagnostic tests.
Cocktail effect - The effect of two toxic, or potentially toxic, chemicals when taken together rather than separately. Such effects are known to occur with some mixtures of drugs, with the active ingredient of one making the body more sensitive to the other. This sometimes occurs because both drugs require the same enzyme to break them down. Chemicals such as pesticides and food additives are only ever tested singly, not in combination with other chemicals that may be consumed at the same time, so no allowance is made for cocktail effects. 'Gulf War syndrome' may have resulted from the cocktail effect of an anti-nerve gas drug and two different insecticides.
Demyelination - A pathological process in which the myelin sheath insulating some nerve fibres is damaged. It leads to weakness and loss of function in the parts of the body served by damaged nerves. It is the central feature of GBS and multiple sclerosis and also occurs in severe diabetes, and in some other conditions involving neurological disease or damage.
Endorphin - Natural substance (a polypeptide) that modifies the action of nerve cells . Endorphins are produced by the pituitary gland and hypothalamus of vertebrates. They lower the perception of pain by reducing the transmission of signals between nerve cells. Endorphins not only regulate pain and hunger, but are also involved in the release of sex hormones from the pituitary gland. Opiates act in a similar way to endorphins, but are not rapidly degraded by the body, as natural endorphins are, and thus have a long-lasting effect on pain perception and mood. Endorphin release is stimulated by exercise.
Myelin - myelin sheath. Myelin is the white, fatty insulating layer that surrounds the axon and nerve cells in vertebrate animals. It serves to speed up the passage of nerve impulses. Myelina ted fibres transmit neural impulses roughly 20 times faster than demyelinated fibres. Myelin is made up of fats and proteins and is formed from up to a hundred layers, laid down by special cells (the Schwann cells) , this insulation being interrupted every 2mm or so by the nodes of Ranvier.
Neuron (neurone) - An elongated cell, the basic functional unit of the nervous system that transmits information rapidly between different parts of the body. Each nerve cell has a cell body, containing the nucleus, from which trail processes called dendrites, responsible for receiving incoming signals. The unit of information is the nerve impulse, a travelling wave of chemical and electrical changes involving the membrane of the nerve cell. The cell's longest process, the axon , carries impulses away from the cell body. The impulse involves the passage of sodium and potassium ions across the nerve-cell membrane. Sequential changes in the permeability of the membrane to positive sodium (Na+) ions and potassium (K+) ions produce electrical signals called action potentials. Impulses are received by the cell body and passed, as a pulse of electric charge, along the axon. The axon terminates at the synapse, a specialized area closely linked to the next cell (which may be another nerve cell or a specialized effector cell such as a muscle). On reaching the synapse, the impulse releases a chemical neurotransmitter, which diffuses across to the neighbouring cell and there stimulates another impulse or the action of the effector cell. Nerve impulses travel quickly - in humans, they may reach speeds of 160 m/525 ft per second.
T-cell - or T lymphocyte. An immune cell that plays several roles in the body's defences. T cells are so called because they mature in the thymus. There are three main types of T cells: T helper cells (Th cells), which allow other immune cells to go into action; T suppressor cells (Ts cells), which stop specific immune reactions from occurring; and T cytotoxic cells (Tc cells), which kill cells that are cancerous or infected with viruses . Like B cells, to which they are related, T cells have surface receptors that make them specific for particular antigens .
Tracheotomy - or tracheostomy. A surgical opening in the windpipe (trachea), usually created for the insertion of a tube to enable the patient to breathe. It is done either to bypass an airway impaired by disease or injury, or to safeguard it during surgery or a prolonged period of mechanical ventilation.
Virus - Infectious particle consisting of a core of nucleic acid (DNA or RNA) enclosed in a protein shell. Viruses are acellular and able to function and reproduce only if they can invade a living cell to use the cell's system to replicate themselves. In the process they may disrupt or alter the host cell's own DNA. The healthy human body reacts by producing an antiviral protein, interferon , which prevents the infection spreading to adjacent cells. There are around 5,000 species of virus known to science (1998), though there may be as many as 0.5 million actually in existence. Many viruses mutate continuously so that the host's body has little chance of developing permanent resistance; others transfer between species, with the new host similarly unable to develop resistance. The viruses that cause AIDS and Lassa fever are both thought to have 'jumped' to humans from other mammalian hosts. Among diseases caused by viruses are canine distemper, chickenpox, common cold, herpes, influenza, rabies, smallpox, yellow fever, AIDS, and many plant diseases. Recent evidence implicates viruses in the development of some forms of cancer (see oncogenes). Bacteriophages are viruses that infect bacterial cells. Retroviruses are of special interest because they have an RNA genome and can produce DNA from this RNA by a process called reverse transcription. Viroids, discovered in 1971, are even smaller than viruses; they consist of a single strand of nucleic acid with no protein coat. They may cause stunting in plants and some rare diseases in animals, including humans. It is debatable whether viruses and viroids are truly living organisms, since they are incapable of an independent existence. Outside the cell of another organism they remain completely inert. The origin of viruses is also unclear, but it is believed that they are degenerate forms of life, derived from cellular organisms, or pieces of nucleic acid that have broken away from the genome of some higher organism and taken up a parasitic existence. Antiviral drugs (see the Antiviral Agents Bulletin web page) are difficult to develop because viruses replicate by using the genetic machinery of host cells, so that drugs tend to affect the host cell as well as the virus. Acyclovir (used against the herpes group of diseases) is one of the few drugs so far developed that is successfully selective in its action. It is converted to its active form by an enzyme that is specific to the virus, and it then specifically inhibits viral replication. Some viruses have shown developing resistance to the few antiviral drugs available. Viruses have recently been found to be very abundant in seas and lakes, with between 5 and 10 million per millilitre of water at most sites tested, but up to 250 million per millilitre in one polluted lake. These viruses infect bacteria and, possibly, single-celled algae. They may play a crucial role in controlling the survival of bacteria and algae in the plankton.
IVig - (see also immunoglobulin ) intravenous immunoglobulin (gamma globulin). A therapy common in the treatment of GBS.
Immunisation - Immunisation is an extremely complicated issue and so I will only place pointers as to where further information should be sought. A few people appear to have contracted GBS following 'flu shots, but this claim is difficult to evaluate as there is hardly any correlation between the two. GBS is an illness of unknown causes. It seems more likely that GBS is a side effect of 'flu shots and not caused by 'flu shots. Saying 'flu shots cause GBS is like saying broken legs cause pneumonia. There are a combination of factors involved which would go some way to explaining why some are susceptible to GBS and others aren't. It must be remembered that in GBS there is damage to the nervous system caused by a bad immune response, or rather, the bodies antibodies are attacking the nerves. Innoculations, particularly with live vaccines, contribute to the creation of antibodies that are potentially harmful to the patient. GBS is an autoimmune disease and as such anything that causes an upset within the immune system can be a catalyst or trigger for autoimmunity. GBS can be elicited by many factors, including stress, gastroenteritis, chronic fatigue and vaccinations, but none of these are directly responsible for GBS. This trigger (as above) causes the macrophages (cells that attack foreign bodies) to attack the nerves. You see, the virus contains differently patterned structures which occasionally imitate the structures of our nerves and the immune system produces the antibodies to fight off the infection. These antibodies have their own set of 'codes' that only recognise particular types of structure, and once recognised the infection would be attacked. Therefore if your nerves have similar structures to the infection they will also be attacked, thereby producing the symptoms of your GBS, MS etc. It is believed by some that the 'flu vaccine should only be given to those to whom 'flu poses a great threat, such as the frail or elderly. As yet there is no straightforward answer to that question. The patient must discuss the situation with their MD. A history of GBS is a caution that must be acknowledged. Although the tetanus vaccination is offered in the case of cuts and bruises the risk of tetanus is very small. The danger is more likely in wounds of a serious nature.
The Department of Health guidelines say amongst other things, "... Live vaccines should not be given to individuals with impaired immune responsiveness whether occurring naturally or as a result of radiotherapy, or treatment with high doses of corticosteroids or other immunosuppressive drugs ." It is important to note that live vaccination should be postponed until at least 3 months after stopping corticosteroids and 6 months after stopping chemotherapy. Influenza viruses are not antigenically stable and are constantly altering their structure so each year the necessary recommendations from the World Health Organization highlight which viral strains should be included in the vaccine. The recommended strains are grown in chick embryos and are therefore contra-indicated in those hypersensitive to eggs. Since the 'flu vaccine will NOT control epidemics they should only be used for persons of high risk.
Antibiotic - Drug that kills or inhibits the growth of bacteria and fungi. It is derived from living organisms such as fungi or bacteria, which distinguishes it from synthetic antimicrobials. The earliest antibiotics, the penicillins, came into use from 1941 and were quickly joined by chloramphenicol, the cephalosporins, erythromycins, tetracyclines, and aminoglycosides. A range of broad-spectrum antibiotics, the 4-quinolones, was developed in 1989, of which ciprofloxacin was the first. Each class and individual antibiotic acts in a different way and may be effective against either a broad spectrum or a specific type of disease-causing agent. Use of antibiotics has become more selective as side effects, such as toxicity, allergy, and resistance, have become better understood. Bacteria have the ability to develop resistance following repeated or subclinical (insufficient) doses, so more advanced and synthetic antibiotics are continually required to overcome them. (See also the Antibiotics: How do antibiotics work? web page)
Antiserum - Substance used to treat or give temporary protection against a particular disease. It contains antibodies against the antigens associated with the disease. The term is used in connection with preparations made from animal plasma; protective antibodies acquired from human plasma are called immunoglobulins . See also immunisation .
Immunosuppressive - Any drug that suppresses the body's normal immune responses to infection or foreign tissue. It is used in the treatment of autoimmune disease (see autoimmunity ); as part of chemotherapy for leukaemias, lymphomas, and other cancers; and to help prevent rejection following organ transplantation. Immunosuppressed patients are at greatly increased risk of infection.
Drugs - Once over it was impossible for doctors to be able to offer any medication that could alter the course of GBS. While it is still true that there is no cure, and no certainty that there is a treatment that can halt GBS, recent research is promising. It is worth talking to your neurologist each time you meet so that you can be updated on further developments. Meanwhile, efforts should be concentrated on the alleviation of the various specific symptoms.
Corticosteroids - Many people are reluctant to take this kind of medication because they are worried that the possible side effects may outweigh the benefits. This is because they are often confused with the related, but different, anabolic steroids used by body builders and athletes. Corticosteroids should be used with caution, it is true, but they are extremely successful in relieving nerve inflammation and shortening the duration of possible relapses. They also have an effect on the immune system itself, helping to damp down its abnormal reaction. Not everyone will feel the benefits of corticosteroids as sometimes they may be inappropriate or unnecessary. Used at the right time on the right person they can be extremely useful. Steroids are administered either in tablet form or intravenously (IV). The IV forms (usually methylprednisolone) have few side effects and do not affect the gut. IV therapy is usually given over three to five days and may sometimes be completed by tablets. The tablets (prednisone) have more, though controllable, side effects and can be just as effective. With tablets you are started off on a high dose which is gradually reduced every few days. The big advantage with tablets is that you do not have to go into hospital for treatment. The most noticeable side effects are an increase in appetite, facial swelling, and sometimes a slight growth of facial hair - but these are temporary. Some people become irritable, unable to sleep, and have to urinate frequently. A small number of people benefit from long-term therapy but this isn't the norm. Many people with GBS have used steroids at some stage, some more than once, with varying results.
Muscle relaxants - Drugs such as Baclofen, Diazepam , Clonazepam, quinine and Dantrolene sodium are often used to relieve spastic muscles making movement easier. Baclofen inhibits transmission at spinal level and also depresses the central nervous system. Diazepam and other benzodiazepines have muscle relaxant properties. Clonazepam can help reduce myoclonic jerks. Quinine is effective in relieving nocturnal leg cramps. Dantrolene acts directly on skeletal muscle and produces few side effects. If a problem with spastic muscles exists and a muscle relaxant hasn't been tried before, it is worth giving it a go. It won't be suitable for everyone as sometimes you can end up substituting weakness for involuntary muscle contraction. Some people find that when their legs are no longer stiff they find it more difficult to walk. In this case physiotherapy would best be employed to encourage muscle strength.
Antidepressants - Whilst it is true that most GBS patients will suffer depression from time to time not everyone will require treatment by antidepressants. Antidepressants aren't a cure for depression though they do afford some relief. GBS is an illness that will affect some people for most of their lives and it is probably far better to be able to share the experience of your illness with other sufferers or counsellors than to resort to medication. It is true that sometimes the depression can take such a hold that there seems to be no way forward and this is the only time that antidepressants are helpful. They can lift your mood enough to help you to begin to work through your own feelings about your GBS. Sometimes your doctor may prescribe an antidepressant even when you are psychologically healthy. There would be no need to be worried as some antidepressants are extremely effective in pain relief, especially the burning pains that sometimes occur in the hands and feet of some GBS patients.
Pain relief - see pain relief
Cortisone - Natural corticosteroid produced by the adrenal gland, now synthesized for its anti-inflammatory qualities and used in the treatment of rheumatoid arthritis. Cortisone was discovered by Tadeus Reichstein of Basel, Switzerland, and put to practical clinical use for rheumatoid arthritis by Philip Hench (1896-1965) and Edward Kendall (1886-1972) in the USA (all three shared a Nobel prize 1950). A product of the adrenal gland, it was first synthesized from a constituent of ox bile, and is now produced commercially from a Mexican yam and from a by-product of the sisal plant. It is used for treating allergies and certain cancers, as well as rheumatoid arthritis. The side effects of cortisone steroids include muscle wasting, fat redistribution, diabetes, bone thinning, and high blood pressure.
Diazepam - Tranquillizer in the benzodiazepine group that is also useful for its muscle-relaxant and anticonvulsant effects. Besides being prescribed for anxiety , it is used in premedication or sedation for surgery, as a hypnotic, to treat muscle spasm and for some epileptic conditions, including status epilepticus. Side effects include drowsiness, disorientation and dependence. It is better known by the trade name Valium.
Interferon - Naturally occurring cellular protein that makes up part of the body's defences against viral disease. Three types (alpha, beta, and gamma) are produced by infected cells and enter the bloodstream and uninfected cells, making them immune to virus attack. Interferon was discovered in 1957 by Scottish virologist Alick Isaacs. Interferons are cytokines, small molecules that carry signals from one cell to another. They can be divided into two main types: type I (alpha, beta, tau, and omega) interferons are more effective at bolstering cells' ability to resist infection; type II (gamma) interferon is more important to the normal functioning of the immune system. Alpha interferon may be used to treat some cancers; interferon beta 1b has been found useful in the treatment of multiple sclerosis.
Pain relief - There are many forms of pain relief under discussion. Some of the more common ones are mentioned here. Drugs commonly used in acute pain are quinine sulphate, codeine phosphate and morphine sulphate. For chronic pain - carbamazapine (Tegretol), Baclofen, amitriptyline and neuroleptics (antipsychotics). Capsaican has been used to treat local pain but has been found to sometimes damage nerve fibres beneath the skin. At the present morphine is the main drug used for treatment for intense and unrelenting pain. According to Science magazine, there are 30 million to 40 million Americans with moderate to severe pain that is not affected by common analgesics , such as aspirin or ibuprofen . And there are thousands with chronic pain who depend on morphine, despite its side effects, just to get through the day. Research has found that morphine can suppress breathing. This means the drug often cannot be used to control pain in patients who already have respiratory problems. Morphine also can stop the digestive movement inside the intestines and bowel, which can lead to dangerous constipation. The condition can become so serious that some patients will stop taking morphine and endure their pain to avoid constipation. The effectiveness of morphine also declines from chronic use and can become addictive. Many in the medical field say there is an urgent need for new drugs against pain.
Codeine - Opium derivative that provides analgesia in mild to moderate pain. It also suppresses the cough centre of the brain. It is an alkaloid, derived from morphine but less toxic and addictive.
Cannabis - Dried leaves and female flowers (marijuana) and resin (hashish) of certain varieties of hemp, which are smoked or swallowed to produce a range of effects, including feelings of great happiness and altered perception. (Cannabis sativa, family Cannabaceae.) Cannabis is a soft drug in that any dependence is psychological rather than physical. It is illegal in many countries and has not been much used in medicine since the 1930s. Cannabis is claimed to have beneficial effects in treating chronic diseases such as AIDS and multiple sclerosis. The main psychoactive ingredient in cannabis is delta-9- tetrahydrocannabinol (THC) which is available legally as a prescribed drug in capsule form. In 1998 US researchers found that THC targets the same pain centres in the brain that morphine does, proving its usefulness in pain relief and in November 1998, cannabis was legalized for medical use in six US states. In the same month in Britain a House of Lords Select Committee recommended that it is legalized for use as a prescription only drug. Growing cannabis is illegal in the UK and USA except under licence.
Ibuprofen - A non-steroidal anti-inflammatory drug (NSAID) that is used to relieve pain and inflammation. Ibuprofen acts by inhibiting the formation of prostaglandins that mediate inflammation and so is used to treat conditions that are characterized by pain and inflammation, such as arthritic conditions, dental pain, period pain, sprains, and sports injuries. It is usually taken by mouth. Adverse effects include irritation of of the gut, which can be reduced by taking ibuprofen at the same time as food. It should not be taken by patients with gastric ulceration and caution is required in patients with allergic disorders. Creams and gels are available that can be applied directly to the inflamed area.
Marijuana - Dried leaves and flowers of the hemp plant cannabis, used as a drug; it is illegal in most countries. It is eaten or inhaled and causes euphoria, distortion of time, and heightened sensations of sight and sound. Mexico is the world's largest producer. A report released on 17 March 1999 by the Institute of Medicine in the USA said that marijuana should have clinical tests because it helps fight pain and nausea.
Morphine - A narcotic alkaloid C17H19NO3 derived from opium and prescribed only to alleviate severe pain. Its use produces serious side effects, including nausea, constipation, tolerance, and addiction, but it is highly valued for the relief of the terminally ill. The risk of addiction arising from the use of morphine for pain relief is much lower than for recreational use (about 1 in 3,000) as the drug is processed differently by the body when pain is present. It is a controlled substance in Britain.
Vitamins and other supplements - (as with any supplement to be used as a medical aid your doctor should be consulted first. Some vitamins and minerals are contraindicated, especially in heart complaints).
Allergies - Cobalamin (B12) and pantothenic acid (B5), Vitamin C with bioflavinoids, Vitamin E, Zinc
Chronic Fatigue Syndrome - Vitamin B-complex, Vitamin C, Magnesium, Coenzyme Q10
Depression - Biotin Folic acid and pyridoxine (B6), Cynacobalamin (B12), Vitamin C
Fatigue - B vitamins, Vitamin C, Iron
Headaches and Migraines - Niacin (B3), Magnesium, Fish oil
High blood pressure - Beta carotene, Vitamin D, Magnesium and calcium, Garlic
Inflammation - Vitamin C, Vitamin E, Copper and zinc, Selenium, Evening primrose oil and fish oils
Muscle weakness - Riboflavin (B2), Vitamin C, Magnesium
Oedema - Pyridoxine (B6), Vitamin C with bioflavinoids, Vitamin E
Stress - B-complex, Vitamin C
Weakened immune system - Beta carotene, Pyridoxine (B6), Cobalamin (B12), Vitamin C, Vitamin E, Selenium, Zinc
Immunoglobulin - or immune serum globulin (gamma globulin) is a relatively small portion of the plasma which contains the antibodies or chemical substances which help fight disease caused by invading bacteria and viruses . Most of these antibodies are highly specific and have developed in the human body as a result of former contact with a specific organism or virus . Thus, the individual who has had an attack of measles, develops specific antibodies or chemicals which attack the germ causing the measles and thereby prevent its usual recurrence. Or when such antibodies in gamma globulin are injected into a susceptible person, they protect the recipient for a matter of three or four weeks. Whereas formerly measles and its complications were an important cause of death in children and invalids, the proper use of gamma globulin altered this situation radically. Later, following field trials in epidemic areas, it was found that infantile paralysis may be temporarily prevented or extensive crippling avoided by injection of gamma globulin into susceptible contacts...... and, of course, the rest is history.
Plasmapheresis - Basically, plasmapheresis is the taking of blood from the patient, removing some desired fraction then returning the red cells and repeating the whole process. It is thought to be beneficial in the early stages of GBS, particularly in CIDP.
Diet - I am finding the issue of diet to be a very complicated and controversial one. If anyone can recommend or has been recommended any diets in the treatment of their GBS I will be interested in their testimonials. Many people recommend cutting out saturated fats in dairy foods and meat and replacing these with unsaturated fats of vegetable oils. Fish, liver, fresh fruit, natural unrefined and unprocessed wholefoods and fresh raw salads all contribute to a healthy and balanced diet.
Anxiety - Unpleasant, distressing emotion usually to be distinguished from fear. Fear is aroused by the perception of actual or threatened danger; anxiety arises when the danger is imagined or cannot be identified or clearly perceived. It is a normal response in stressful situations, but is frequently experienced in many mental disorders. Anxiety is experienced as a feeling of suspense, helplessness, or alternating hope and despair together with excessive alertness and characteristic bodily changes such as tightness in the throat, disturbances in breathing and heartbeat, sweating, and diarrhoea. In psychiatry, an anxiety state is a type of neurosis in which the anxiety either seems to arise for no reason or else is out of proportion to what may have caused it. `Phobic anxiety´ refers to the irrational fear that characterizes phobia). Sigmund Freud, the founder of psychoanalysis, identified two forms of anxiety: signal anxiety, which alerts the ego to impending threats that might unbalance it, and primary anxiety, which occurs when its equilibrium is upset, as for example in trauma or a nightmare. He maintained that anxiety was the result of unsatisfied libido and repression, and that the most primitive form of anxiety originated in the individual's birth experience.
Depression - Depression is a common and unsurprising reaction. It would take a very unusual person if the reality of living with GBS had no effect on you emotionally or psychologically, though it is often the case that neurological damage gives rise to psychological symptoms. Depression is an emotional state characterized by sadness, unhappy thoughts, apathy, and dejection. Sadness is a normal response to major losses such as bereavement or unemployment. Clinical depression, which is prolonged or unduly severe, often requires treatment, such as antidepressant medication, cognitive therapy, or, in very rare cases, electroconvulsive therapy (ECT), in which an electrical current is passed through the brain. Periods of depression may alternate with periods of high optimism, over- enthusiasm, and confidence. This is the manic phase in a disorder known as manic depression or bipolar disorder. A manic depressive state is one in which a person switches repeatedly from one extreme to the other. Each mood can last for weeks or months. Typically, the depressive state lasts longer than the manic phase. US researchers identified 1996 a connection between depression in women and low bone density, leading to an increased risk of fractures in later life. This is possible due to the increased levels of the steroid hydrocortisone during depressive periods.
Fatigue - Fatigue is an all too common symptom of GBS. Almost everyone with GBS suffers this at some time and it is extremely frustrating to live with. Anyone who hasn't suffered it may think you're just tired, or at the worst 'swinging the lead', but it can wipe you out in minutes. Although it is in part the result of the demyelination it is not properly understood why it occurs. Many people find that fatigue strikes without warning when they are in the middle of some ordinary task, but sometimes it can creep up on you slowly. As anyone who has experienced it knows, it often takes more than a good nights sleep to cure it. It often goes hand in hand with weakness and often there may be other sensory impairments. It helps to try to become aware of the situations that cause fatigue and avoid them, or develop new strategies.
Headache - Most headaches are caused by stress or tension, but some may be symptoms of brain or systemic disease, including fever. Chronic daily headache may be caused by painkiller misuse, according to the European Headache Foundation in 1996. People who take daily analgesics to treat chronic headaches may actually be causing the headaches by doing so. Migraine is an acute, sometimes incapacitating headache (generally only on one side), accompanied by nausea, that recurs, often with advance symptoms such as flashing lights. No cure has been discovered, but ergotamine normally relieves the symptoms. Some sufferers learn to avoid certain foods, such as chocolate, which suggests an allergic factor. The bacterium Helicobacter pylori has been linked to migraine by Italian researchers who found, in 1998, that 48% of migraine sufferers harboured the bacterium and that their migraine symptoms were greatly alleviated following antibiotics to eradicate Helicobacter pylori. Advances in treatment Belgian researchers trialled vitamin B 2 successfully as a preventative for migraine, in 1998. The trial group took 400 mg doses of vitamin B2 daily and 59% of them experienced a halving or more in their headache frequency. Some success has also been reported in Britain using goggles that depress beta waves in the brain (associated with stress) and stimulate alpha waves (whose effect is calming). A funny story. I was monitoring a peripheral neuropathy chat session when a young man came on to ask about cluster headaches. As I suffer from these too I wrote to him to ask if he was GBS as well. For some time I received no reply until his wife came back to me and explained that his reticence was due to the fact that he thought I was Gay/Bi-Sexual!
Irritability - Irritability is often mentioned by sufferers of GBS in terms of, "Is it just me?" I have been asked this so many times that I got to thinking that this irritability is a fact of life for most of us. I believe that much of this comes from the frustration and stress that patients of GBS suffer, though the many I have met all seem to be a hardier perennial than one who is given to frustration. Sometimes it seems as if the GBS patient has had a complete change in personality, almost as if they no longer have any concern or consideration for anyone but themselves, and is prone to lash out for the slightest provocation. Many partners find these mood swings difficult to live with, the change from calmness to anger being sudden and dramatic and seemingly for no reason at all. This is by no means the norm for all GBS patients and is most likely to be a loss of control of emotions due to neurological damage.
Restless Legs Syndrome - Also known as RLS. Restless Legs Syndrome is a neurological disorder characterised by unusual sensations felt in the legs, and sometimes arms, usually at night. These feelings cause the patient to constantly move the feet and legs in an effort to relieve these unbearable sensations. The disorder can be hereditary or it may be a complication of alcoholism, iron deficiency, anaemia, pregnancy, or diabetes. A related disorder, Periodic Limb Movements in Sleep (PLMS) or Periodic Limb Movement Disorder (PLMD) is characterized by episodes of jerking of the limbs during sleep and sometimes while awake. You are not alone!! (For more information see the Restless Legs Syndrome Foundation pages at www.rls.org )
Skin discolouration - particularly in the fingers and toes often due to the peripheral neuropathy affecting the capillary blood vessels.
Sleeplessness - Sleeplessness (insomnia) is related to many problems. In the majority of cases insomnia is caused by anxiety or pain. Insomnia may also occur due to the withdrawal from drug treatment or a change in medication. Visit the web page @ Insomnia? Just go to sleep and forget it
Stress - In psychology, any event or situation that makes heightened demands on a person's mental or emotional resources. Stress can be caused by overwork, anxiety about exams, money, job security, unemployment, bereavement, poor relationships, marriage breakdown, sexual difficulties, poor living or working conditions, and constant exposure to loud noise. Many changes that are apparently 'for the better', such as being promoted at work, going to a new school, moving to a new house, and getting married, are also a source of stress. Stress can cause, or aggravate, physical illnesses, among them psoriasis, eczema, asthma, and stomach and mouth ulcers. Apart from removing the source of stress, acquiring some control over it and learning to relax when possible are the best responses. Occupational stress is a major cause of absenteeinsm at work and of poor working performance. In 1997 occupational stress was recognized by the British government as a health and safety issue. Pregnant women with stress might pass this along to their fetuses' nervous systems, it was reported in March 1999 by the University of Kentucky College of Medicine in Lexington, Kentucky, USA.
Teeth - Problems with teeth are fairly commonplace in various neuropathies, particularly cracking around the neck of the tooth. Regular dental checks are important.
Weight gain - It is important not to put on too much weight as this may make mobility problems worse and have an undesirable effect on your health. Unfortunately this can be a bit of a problem, especially if your GBS prevents you from being as active as you once were or makes exercise virtually impossible. There may be the temptation to nibble out of boredom or for comfort if your lifestyle has become restricted. If you need advice arrange to see a dietician.
Weight loss - Weight gain is fairly common (see above). If anyone has suffered weight loss, attributed to GBS, then I will cover that here.
Death - Death due to GBS is extremely rare though GBS can produce complications in some patients that are life threatening.
Intensive Care Unit - (ICU) or intensive therapy unit (ITU). A high-technology medical facility concerned with the care of patients with acute life-threatening conditions. It is characterized by the use of the most advanced medical technology - electronic monitoring, mechanical ventilation, and other life-support measures - combined with skilled nursing and drugs. Intensive care medicine developed largely from doctors' experiences with tetanus and polio (formerly widespread). Both diseases could culminate in respiratory failure, but if breathing could be mechanically assisted patients could be sustained through the crisis and many then survived. The earliest ICUs, developed in the 1950s, were largely ventilation units, but the central principle of supporting vital organs through a crisis was soon more widely applied. Today, the ICU is also vital to the practice of most high-profile surgery (including open-heart procedures and organ transplants), which could not be undertaken without life-support back-up in the immediate post-operative period. APACHE III (acute, physiology, age, and chronic health evaluation) is a computer that predicts the survival chances of patients in intensive care using 19 separate health markers. In the USA in 1993 200 intensive care units used APACHE III to decide when to switch off life support systems. It is not approved in the UK. (See also "The GBS Patient in Intensive Care - A guide for relatives and friends" )
Pregnancy - Pregnancy is not usually affected by GBS, and does not carry a risk of prematurity. Management of the pregnant GBS patient may not necessarily differ that much from managing the non-pregnant patient. GBS may affect delivery procedures. For example, one patient, because of severe GBS and respiratory insufficiency, was delivered by Caesarian section. Other treatments such as plasmapheresis can also be considered. The use of plasmapheresis during pregnancy has been reported without complications to the mother or foetus. At least 35 cases of GBS in pregnancy have been reported and although GBS during pregnancy can be challenging to both the mother and doctor the overall outcome is good.
Sexuality and GBS - It has been mentioned that sex-drive may be affected in GBS. This is a fairly complex issue due to the many different factors involved. There is very little in medical literature about sexuality following GBS so much of this information is derived from the experiences of GBS patients. GBS affects the peripheral nervous system and some sensation may be lost. Numbness in the genital area results in the sexual act being less than satisfying so other forms of stimulation may need to be practised to initiate a pleasurable response. Residual weakness can make the sexual act difficult, and in the case of some women, painful. Another problem for women is decreased lubrication of the vagina causing pain in coitus, but this can be helped with artificial lubricants. Post GBS women seem to suffer significant sexual problems leading to a change in sexual habits though satisfactory sexual function can be restored by experimentation. A major problem in males is damage to the peripheral nerves, which involve sensation, sensory input and penile blood-flow in order to maintain rigidity. There are many options for men suffering impotence regardless of it's cause. Prostoglandin injections are practical and effective with very few side effects. Another successful method is the use of a vacuum device on the penis that helps the male maintain a satisfactory and prolonged erection. (This is quite a commonly used device in cases of neurological impairment in males). Most impotent GBS males believe the GBS to be the cause of the problem. In conclusion sensual and sexual pleasure can be satisfactorily attained, even when there is a GBS residual impairment, between understanding couples who are sympathetic and supportive of one another.
Last modified on: 4 July, 2008.
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