A Passage through Paralysis

Abstract

lthough many people may know of Guillain-Barr6 syndrome (GBS) only through No Laughing Matter, Joseph Heller's autobiographical account of his battle with the disease, it is, in fact, the most frequently acquired demyelinating neuropathy, striking 1.5 people out of 100,000 each year. Adults and children of all ages and both sexes, in all countries, in all seasons, are equally potential GBS victims. In most cases, a mild upper respiratory infection precedes the neurologic symptoms by a few days to three weeks(1). The first neuritic symptom is usually an evolving, symmetrical weakness, beginning in the lower extremities and then progressing to the upper extremities, trunk, intercostal, neck, and cranial muscles. (This order of motor involvement can vary.) The weakness develops so rapidly--usually to a total motor paralysis within a few days-that muscles do not atrophy until weeks later. The degree of severity of motor involvement varies depending upon which nerves are involved. Deep tendon reflexes may be initially depressed, and then disappear. Sensory loss is variable and may include a reduced perception of joint position, vibration, pain, and temperature. Muscle tenderness and paresthesias are frequent complaints(1,2). Autonomic disturbances, causing tachycardia, bradycardia, labile blood pressures, flushing, and sweating, usually do not persist for longer than two weeks. Approximately one fourth of all patients develop respiratory weakness as the paralysis reaches the respiratory muscles(3). While GBS overtakes the peripheral How to help an