All about Guillain-Barré: Symptoms of the syndrome, their intensity and the way patients experience them.

If you suspect that you have Guillain-Barré syndrome (GBS), it is extremely important that you seek qualified medical attention as soon as possible. The sooner you are diagnosed and treated, the faster recovery begins, thus reducing the risk of permanent physical damage.

The medical examination
It is important that the patient is thoroughly examined by a physician, in order for the diagnosis to be made correctly. There are a number of other diseases with symptoms that resemble GBS, that the physician has to exclude from the list of probables, before the patient can begin treatment. It can therefore take some time to make a correct diagnosis.

The diagnosis is based on a clinical examination of the symptoms and their distribution. Among other things, the physician checks whether the symptoms are symmetrical, i.e. appear on both sides of the body, if there are signs of increasing weakness, loss of tendon reflexes and signs of preceding infection.

In order to facilitate the ruling-out process, the patient is asked if he or she has been in contact with poisons (pesticides, chemicals, toxins, etc.), about his or her alcohol consumption, recent infections, other diseases (diabetes, family history of nerve disease, etc.), tick bites, etc. The physician also asks about the course of the disease so far, and can often diagnose the disease on the basis of all these factors. In some cases, further examinations may be required to confirm the diagnosis.

These examinations may include one or more of the following laboratory tests and electrodiagnostic studies: Blood and urine tests, x-rays, scans, lumbal puncture, Nerve Conduction Velocity test (NCV), electromyogram (EMG). An electrocardiogram (ECG) may be undertaken to confirm or rule out irregular heartbeat. A stool test may be done to check for the presence of stomach infections that triggered the attack.
These tests are explained below. They can, in some cases, indicate whether the disease is of the demyelinating or the axonal type, indicating what the course of the disease is likely to be.

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What is a lumbar puncture?
A lumbar puncture is an examination of the patient's spinal fluid. It is also known as a spinal tap.
The cerebrospinal fluid (CSF) surrounds the brain and spinal cord, and acts as a buffer. It is normally clear and colourless, and changes in its colour, quantity or composition may be an indication of neurological damage or disease. If the patient has GBS, the CSF will contain more protein than normal, with no increase in the number of white blood corpuscles or the pressure. A lumbar puncture is done to check if this is the case.
The patient lies still, in the foetal position, while a local anaesthetic is administered to his or her lower back. A needle is carefully inserted into the patient's spinal column, between the third and fourth vertebrae, into the fluid-filled area that surrounds the nerve roots. A little liquid is sucked out for testing. Nervous patients may be given a mild sedative or sleeping pill, and the examination carried out while they are asleep.

Some patients complain about headaches, hours or days after the examination. Patients are advised to lie down for 1-3 hours after the spinal tap. Very rare side effects include bleeding and infection.

A test undertaken early in the course of the disease can sometimes show very little, and it may be necessary to repeat it after some days, during which time the protein level may increase.

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What is a Nerve Conduction Velocity test?
The Nerve Conduction Velocity test (NCV) is a test that investigates how well the nerves function. Nerves with damaged myelin transmit signals slower than undamaged nerve cells, while nerves with destroyed axons cannot transmit signals at all.
An NCV reveals whether the ability of the tested nerves to transmit signals is reduced, i.e. if there are signs of myelin damage, as well as how advanced the damage is. The test can, in some cases, also indicate what may have caused the disease.
If the symptoms are displayed in a very slow manner, the first examination may show very little, and it can be necessary to repeat it after a couple of weeks.

During the test, flat electrodes are placed on the patient's skin, at intervals, above the nerve to be examined for damage. One of the electrodes stimulates the nerve by transmitting a very weak electrical impulse through it. The other electrodes pick up and measure the strength of the impulse that reaches them. See diagram.
The conduction velocity of the nerve is calculated from the distance between the electrodes and the time it takes for the impulse to move between them. The speed of transmission is related to the diameter of the nerve and its myelination. The result is therefore compared with the speed of transmission of an undamaged nerve.

The impulse may feel a little like an electric shock, and depending on how strong it is, it will be felt by the patient in varying degrees and may be uncomfortable for some patients.
The test carries no risk of electrical shock.

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What is an electromyogram?
A myogram or electromyography (EMG) examines the activity in the muscles for any signs of slowing down or blocking of response to nerve signals. It is used to differentiate between muscle disorders and muscle weakness caused by neurologic disorders.
When a nerve is stimulated with a brief electrical impulse, that feels like a tiny jolt, it creates activity in the adjoining muscle. This activity can be measured.

During the test, a thin little electrode is pushed through the patient's skin, into the muscle to be examined. It is connected to a screen that shows the electrical activity being measured by the electrode. When the patient contracts the muscle, e.g. by bending it, the muscle fibres affected by the movement produce electrical activity that is measured and shown on the screen.
A muscle not in use produces no electrical impulses, and hence no signal will be seen on the screen to begin with. Inserting the electrode will cause electrical activity, that gradually dissipates, after which the screen gradually goes blank. Upon contraction of the muscle, activity will be seen on the screen, increasing as the patient contracts increasing numbers of muscle fibers.
The presence, as well as the form and size of the resultant reading provides information on the muscle's ability to respond to the nerve signals transmitted. See diagram.

The test takes approximately half an hour. Insertion of the electrodes may cause some pain. Exactly how much pain is involved depends on the extent of the patient's sensory disturbances. The muscle may also be tender for some days.
An electromyogram is often carried out together with the Nerve Conduction Velocity test described above.

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What is an electrocardiogram?
An electrocardiogram (ECG) records the electrical activity of the heart, and indicates any irregularities in the heart's rhythm.

To administer the test, the patient is asked to lie down, and the areas to which the electrodes are to be fastened are cleaned, shaved if necessary. Several electrodes are secured to the patient's skin and connected to a screen. The patient is asked to lie still and hold his or her breath briefly. The activity of the heart produces small electrical impulses that are picked up and measured by the electrodes, after which the heart rhythm can be seen on the screen. See diagram.

The test is sometimes undertaken on patients walking on an indoor running machine, or in some other way made to undergo light physical exertion. This is done to monitor changes in the heart's activity. The test is painless.

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What is a nerve biopsy?
In rare cases, a nerve biopsy may be necessary. This requires the removal of a tiny piece of nerve, under local anaesthesia. The section is examined under a microscope for signs of damage.
Some patients have complained of sensory disturbances in the area a long time after the biopsy was done.

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As mentioned earlier, it can take a while before the diagnosis can be made: the tests may show results that are inconclusive, and may therefore have to be repeated. The physician also has to rule out other diseases whose symptoms resemble those of GBS, before the treatment can begin.

- Case histories
English and foreign-language case histories that inspire and support patients and their families. Many contain descriptions of examinations and diagnostic procedures, some describe the frustration of not being able to get a diagnosis.

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Jsmarcussen.com/gbs takes no responsibility for any errors, omissions or misinterpretations. These pages should be used for information only and you are strongly advised to seek professional help particular to your circumstances. For more information, please visit the website http://www.jsmarcussen.com/gbs or e-mail jsmarcussen@mail.tele.dk