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This year’s monsoon in Mumbai has seen an unusual spurt in patients coming in with Guillain-Barré syndrome (GBS), a rare autoimmune neurological disorder. They are complaining of muscle weakness, numbness and some kind of atrophy, usually after a bout of flu infection. Usually, the immune system fights back any alien bacteria or virus when they attack your body but in some people, the same immune system malfunctions and mistakenly attacks and damages the nervous system with symptoms manifesting mostly in the peripheral nerves.
Dr Pavan Pai, consultant interventional neurologist, Wockhardt Hospitals, Mira Road, explains that GBS often begins with weakness and tingling in the legs and can progress to muscle weakness or even paralysis. “Symptoms typically ascend, starting from the legs and moving upwards towards the torso. Other common symptoms include difficulty in walking, moving facial muscles and problems with coordination and balance,” he says.
What causes this syndrome?
GBS happens as the result of a preceding infection, most commonly linked to the bacteria campylobacter jejuni. However, the exact cause of GBS is not completely understood. According to Dr Pankaj Agarwal, Senior Consultant Neurologist, and Head of the Department of Neurology at Global Hospitals, GBS usually manifests within a few days or weeks of a respiratory or digestive tract infection. “Additionally, vaccinations can also serve as triggers for GBS. It can occur in individuals who have been infected with various viruses, including COVID-19 or the Zika virus,” he says.
Dr Megha Dhamne, Consultant Neurologist at PD Hinduja Hospital in Khar, who conducted the largest series globally on COVID-19 and GBS cases in Maharashtra during the pandemic, says, “The overall incidence of GBS is relatively low, ranging from 0.4 to four cases per 100,000 people per year, with even lower rates in children. Rare instances of GBS have been reported following parasitic infections such as malaria. Dengue, caused by an arbovirus infection, has also been associated with GBS, although such cases are infrequent. Notably, there was an increase in GBS cases during the Zika outbreak in 2014, which was linked to arbovirus infection.”
Are those who had viral infections more susceptible to GBS or is it more prevalent among those who have had a bout of dengue or malaria?
Studies have shown that patients with viral infections may be more prone to developing GBS compared to those with dengue or malaria. As Dr Agarwal explains, “Viral infections such as influenza, Epstein-Barr virus, and Zika virus have been linked to an increased risk of GBS. This connection can be attributed to the body’s immune response triggered by these viruses. When a person is infected with a virus, their immune system produces antibodies that help fight off the infection. In some cases, these antibodies can also attack the body’s own nerve cells, leading to neurological complications like GBS. So, patients with viral infections seem to be at higher risk for developing GBS compared to individuals with dengue or malaria.”
How soon can patients recover from GBS?
The recovery period for patients with GBS can vary greatly depending on the individual and the severity of their symptoms. While some patients may start to see improvements within a few weeks, others may require a longer and more gradual recovery process that takes several months or even years. “One important factor that influences the recovery time is prompt diagnosis and treatment. Early intervention, such as intravenous immunoglobulin therapy or plasma exchange, can help manage symptoms and speed up the recovery process,” says Dr Agarwal.
Additionally, physical therapy and rehabilitation can also greatly improve outcomes for GBS patients by helping them regain independence. “Severe cases may take a few months, typically six to 12 months, or even years to improve. About 80 per cent of patients with severe disease can walk by six months. About five to ten per cent may take longer or have some residual weakness,” says Dr Dhamne.
Have you come across cases that require hospitalisation?
Dr Agarwal says most cases require hospitalisation, either due to severe disability, rendering patients non-ambulatory, or milder forms that may need observation in the hospital for a few days to prevent worsening of the condition. Assessing the risk among Indians, Dr Dhamne says, “A population-based study in India found the mean age of GBS patients to be 40 years, affecting all age groups but showing a higher incidence in men than women. Globally, GBS incidence estimates vary from 0.16 to 3.0 per 100,000 person-years for all age groups.”
