EC Pharmacology and Toxicology

Guillain Barre's Syndrome (GBS) is a rare neurological disorder and is the most common and most severe acute paralytic neuropathy, with about 100,000 cases every year. Pathogen Campylobacter jejuni (C. jejuni) is the most frequently responsible for the initial infection that leads to GBS. Abnormal heart rate or blood pressure, weakness, sensation changes, coordination problems are some of the symptoms that are seen in GBS. A knowledge of variants of GBS is important in differentiating GBS from other mimics. There are three classic variants of GBS - clinical, electrophysiological and sensory variants. GBS is an immune-mediated attack against various parts of peripheral nerve - myelin or axon as a result of molecular mimicry. Disease activity and treatment response are currently monitored through interval neurological examination and outcome measures. Novel treatment strategies are in development depending on the pathophysiology of GBS variants. In this article we review the number of cases, history, etiology, symptoms, classification, pathophysiology, diagnosis and treatments of GBS.

 Keywords: Guillain Barre's Syndrome (GBS); Paralytic Neuropathy; Immunity; Novel Treatment; Neuropathy

1. Guillain G. “Sur un syndrome de radiculo-nevrite avec hyperalbuminose du liquide cephalo-rachidien sans reaction cellulaire. Remarques sur les caracters cliniques et graphiques des reflexes tendineux”. Bulletins et Mémoires de la Société Médicale des Hôpitaux de Paris 40 (1916): 1462-1470.
2. Guillain G., et al. “Radiculoneuritis syndrome with hyperalbuminosis of cerebrospinal fluid without cellular reaction. Notes on clinical features and graphs of tendon reflexes”. Annales de Médecine Interne (Paris)1 (1916): 24-32.
3. Sejvar JJ., et al. “Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis”. Neuroepidemiology 2 (2011): 123-133.
4. Matsui N., et al. “Guillain-Barré syndrome in a local area in Japan, 2006-2015: an epidemiological and clinical study of 108 patients”. European Journal of Neurology 5 (2018): 718-724.
5. Cheng Q., et al. “Distinct pattern of age specific incidence of Guillain-Barré syndrome in Harbin, China”. Journal of Neurology 1 (2002): 25-32.
6. Howlett WP., et al. “Guillain-Barré syndrome in northern Tanzania: a comparison of epidemiological and clinical findings with western Norway”. Acta Neurologica Scandinavica 1 (1996): 44-49.
7. Sipilä JOT., et al. “Epidemiology of Guillain-Barré syndrome in Finland 2004-2014”. Journal of the Peripheral Nervous System 4 (2017): 440-445.
8. Rivera-Lillo G., et al. “Incidence of Guillain-Barré syndrome in Chile: a population-based study”. Journal of the Peripheral Nervous System 4 (2016): 339-344.
9. Islam Z., et al. “High incidence of Guillain-Barré Syndrome in children, Bangladesh”. Emerging Infectious Diseases 7 (2011): 1317-1318.
10. Webb AJ., et al. “Seasonal variation in Guillain-Barré syndrome: a systematic review, metaanalysis and Oxfordshire cohort study”. Journal of Neurology, Neurosurgery, and Psychiatry 11 (2015): 1196-1201.
11. Jackson BR., et al. “Binational outbreak of Guillain-Barré syndrome associated with Campylobacter jejuni infection, Mexico and USA, 2011”. Epidemiology and Infection 5 (2014): 1089-1099.
12. Styczynski AR., et al. “Increased rates of Guillain-Barré syndrome associated with Zika virus outbreak in the Salvador metropolitan area, Brazil”. PLOS Neglected Tropical Diseases 8 (2017): e0005869.
13. Shahrizaila N., et al. “Guillain-Barré syndrome”. Lancet 10280 (2021): 1214-1228.
14. Islam Z., et al. “Axonal variant of Guillain-Barre syndrome associated with Campylobacter infection in Bangladesh”. Neurology 7 (2010): 581-587.
15. Rees JH., et al. “Campylobacter jejuni infection and Guillain-Barré syndrome”. New England Journal of Medicine 21 (1995): 1374-1379.
16. Jacobs BC., et al. “The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study”. Neurology4 (1998): 1110-1115.
17. Mori M., et al. “Haemophilus influenzae infection and Guillain-Barré syndrome”. Brain 10 (2000): 2171-2178.
18. Geurtsvankessel CH., et al. “Hepatitis E and Guillain-Barre syndrome”. Clinical Infectious Diseases9 (2013): 1369-1370.
19. van den Berg B., et al. “Guillain-Barré syndrome associated with preceding hepatitis E virus infection”. Neurology6 (2014): 491-497.
20. Schonberger LB., et al. “Guillain Barre syndrome following vaccination in the National Influenza Immunization Program, United States, 1976-1977”. American Journal of Epidemiology 2 (1979): 105-123.
21. Lehmann HC., et al. “Guillain Barré syndrome after exposure to influenza virus”. Lancet Infectious Diseases 10 (2010): 643-651.
22. Salmon DA., et al. “Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis”. Lancet9876 (2013): 1461-1468.
23. Guillain-Barré syndrome common concerns (2016).
24. Kuitwaard K., et al. “Recurrences, vaccinations and long-term symptoms in GBS and CIDP”. Journal of the Peripheral Nervous System4 (2009): 310-315.