Dear Friends,

GBSFI Summer 2003 Newsletter, [I]The Communicator,[/I] has the following Article: [B]Can Guillain-Barre Syndrome Recur?[/B] By Joel S. Steinberg, MD, PhD

After patients have recovered from Guillain-Barre syndrome (GBS), it is not uncommon to worry about developing GBS again. Many patients whose GBS was triggered by a respiratory tract infection await the aftermarth of their next URI to see if it will again be followed by GBS. Fortunately, recurrence of GBS is rare.

Some simple calculations indicate the theoretical risk of recurrence of GBS. Each year about 0.5 to 2 people in a population of 100,000 persons develop GBS. The literature suggests that about 3% of patients who have had GBS will get it again. Thus, having had GBS does potentially increase the chance of developing another episode. However, a second case of GBS in a recovered patient is an uncommon event.

Afer a patient has had GBS, it is possible to again develop symptoms that may suggest a recurrence. For example, some recovered patients may start to experience limb weakness and/or abnormal sensations-numbness, tingling, impaired snesations, etc., in the feet, legs and/or fingers or hands, symptoms that they may have had during their GBS. Of course, recurrence of these symptoms naturally raises a fear that GBS, or perhaps its neurologic cousin, a chronic form, is developing. It is certainly well known that chronic inflammatory demyelinating polyneuropathy (CIDP) can develop in a patient who had GBS. But this sequence of events occurs rarely. Rather, it is much more common for newly developed symptoms that are similar to how the patient’s original GBS started to actually reflect some other disorder. There are many examples.

Weakness can be caused by many disorders other than GBS. Examples include damage of the axon of the motor nerve (the nerves that go to muscles), from many causes (diabetes, hypothyroidism [a small gland in the neck that regulates the body’s metabolism], heavy metal poisoning, vasculitis, etc.). Simple blood tests (HbA1c, fasting or random blood sugar; thyroid stimulating hormone [TSH]); analysis of a 24 hour urine collection for lead, mercury, and thallium; sedimentation rate and antinuculear antibody test, etc.) can help to diagnose these disorders. The list of actual disorders and corresponding test for these is longer.

Abnormal sensations can also develop from several disorders other than GBS. Examples include some of the disorders listed above (diabetes, etc.). Tingling and/or numbness of the first three fingers, especially upon awakening, is a typical finding in carpal tunnel syndrome (pinching or compression of the median nerve in the wrist). If the nerve compression progresses, the grip can weaken, often a criterion to surgically release to nerve from entrapment. Pinched nerves at the lower back or neck, even in the absence of pain at these areas, can lead to abnormal sensations and/or weakness in the feet and legs (often called sciatica) or arms.

A larger list of disorders that can mimic GBS is described in the GBS Foundation’s [I]Overview[/I] booklet. The important thing to remember about recurrence of GBS or a variant, it is prudent to perform a thorough diagnostic evaluation for the many possible causes of peripheral neuropathies. The first step is usually a detailed history, to determine the patient’s current symptoms, and family history, followed by an examination. Quite often, an updated nerve conduction velocity-electromyography (NCV-EMG) study is very helpful. And various blood and urine tests may then help to pin point the cause of the patient’s new symptoms. Then appropriate treatments can be instituted. Especially as we get older, many of the disorders mentioned above are more apt to develop. [B]End[/B]

Well, that takes a lot of the guess work out, doesn’t it? As rare as GBS is, and as hard to find a component doctor and neurologist familiar with GBS…if it were me, I would just get plenty of rest, fluids, and monitor the tingling/weakness and other obvious GBS signs – If it got bad enough, I would go to the ER, explain my symptoms of GBS and demand IVIG treatments. But, keep in mind, I am not a doctor.

Take care.

Jethro

JayDee and All:

GBSFI (Guillain Barre Syndrome Foundation International) sends out a Newsletter 4 times a year – It’s called [I]The Communicator.[/I] Each year they publish a special Doctor’s Medical Edition…which is good to share with your doctor. Or, your doctor could request to be put on the mailing list too.

If you are not getting [I]The Communicator[/I], you can call GBSFI and request your name be put on the mailing list: (610)-667-0131

Warmest regards.

Jethro