Overview of Guillain-Barré Syndrome (GBS)

Guillain-Barré Syndrome (GBS) is a rare but serious autoimmune disorder that affects the peripheral nervous system. It occurs when the body's immune system mistakenly attacks the nerves, leading to muscle weakness, numbness, and in severe cases, paralysis. The condition can be life-threatening, particularly when it affects respiratory muscles. Recent reports indicate a concerning rise in GBS cases in India, particularly in Pune and Maharashtra, leading health authorities to investigate the situation thoroughly.

Current Situation in India

As of late January 2025, 127 suspected cases of GBS have been reported across India, with 101 confirmed cases in Pune alone. This includes one suspected death attributed to the syndrome. The Maharashtra health department has mobilized a Rapid Response Team to investigate the sudden increase in cases and determine any potential links to recent viral outbreaks or environmental factors.

Demographics

• Age Distribution: The affected individuals range from young children to older adults, with notable cases across various age groups:
  • Below 9 years: 19 cases
  • 10-19 years: 15 cases
  • 20-29 years: 20 cases
  • 30-39 years: 18 cases
  • 40-49 years: 12 cases
  • Above 50 years: 43 cases

This wide age distribution suggests that GBS can affect anyone but may be more prevalent among older adults.

Symptoms and Diagnosis

The initial symptoms of GBS typically include:

• Weakness and tingling in the legs, which can progress rapidly to the upper body and arms.
• Loss of reflexes.
• Difficulty walking or climbing stairs.
• Severe pain or cramping in the muscles.
• Double vision or difficulty with eye movements.
• Difficulty speaking or swallowing.

Symptoms often develop over days or weeks and can vary significantly from person to person.

Diagnosis

Diagnosis is primarily clinical and relies on a thorough medical history and neurological examination. Key diagnostic criteria include:

• Recent history of infection (viral or bacterial).
• Progressive weakness.
• Atypical reflexes.

Additional tests such as nerve conduction studies and lumbar puncture (to analyze cerebrospinal fluid) may be used to confirm the diagnosis. The Brighton Working Group criteria are often recommended for diagnosing GBS effectively, especially in resource-limited settings like India.

Causes and Triggers

While the exact cause of GBS remains unclear, it is often preceded by infections. Common triggers include:

• Campylobacter jejuni, a bacterium linked to food poisoning.
• Viral infections such as influenza, Zika virus, cytomegalovirus, and COVID-19.
• Recent vaccinations (though this is rare) or surgeries may also be associated with GBS onset.

Environmental Factors

Experts suggest that seasonal changes and increased viral infections could contribute to the rising incidence of GBS cases observed in Pune. Additionally, factors such as pollution, dietary changes, and stress may play a role in triggering autoimmune responses.

Treatment and Management

Currently, there is no specific cure for GBS; however, treatments aim to reduce symptoms and speed recovery. Common interventions include:

Intravenous Immunoglobulin (IVIG)

IVIG therapy involves administering high doses of immunoglobulin intravenously. This treatment can help reduce the severity of symptoms and hasten recovery by modulating the immune response.

Plasmapheresis

Plasmapheresis is a procedure that removes antibodies from the blood plasma. This treatment is particularly effective in severe cases of GBS and can lead to quicker recovery when administered early.

Supportive Care

Supportive care is crucial for managing complications associated with GBS:

• Physical Therapy: Rehabilitation plays a vital role in recovery. Physical therapists work with patients to improve mobility, strength, and coordination.
• Respiratory Support: In severe cases where respiratory muscles are affected, patients may require mechanical ventilation.
• Pain Management: Pain relief through medications or alternative therapies can significantly improve quality of life during recovery.

Prognosis

The prognosis for individuals with GBS varies widely. Many people experience significant improvement within weeks to months; however, some may have lingering symptoms such as weakness or fatigue for years. Early diagnosis and treatment are critical factors that influence recovery outcomes.

Conclusion

The rise of Guillain-Barré Syndrome cases in India highlights an urgent need for increased awareness among healthcare providers and the general public. Prompt medical intervention can significantly impact patient outcomes. Ongoing investigations by health authorities aim to understand better the causes behind this surge and implement effective treatment strategies.

Dr Manohar K N

MD, DNB, MNAMS,  
Triple FRCP (Edinburgh, Glasgow & London), 
FEAC - Fellow of Euro-Asian Academy of Cardiology 
Fellow of RSSDI, Fellow Diabetes India
www.drmanoharkn.com/