syndrome

A young man in his thirties suddenly developed a little tingling in his hands and a weak grip. He reached a well known private hospital in Delhi and was diagnosed with one of the rare diseases known as Guillain Barre Syndrome(GBS). “This rare disease Guillain Barre Syndrome, occurs at the rate of one or two cases per one lakh population and therefore should not create any fear or panic among people.” said former head of Indian Council of Medical Research’s Division of Epidemiology and Communicable Diseases, Dr Raman Gangakhedkar. He was reacting to the news story that there was a surge in the cases of GBS in Mumbai. He said claims that GBS cases had increased in recent times is just “too much exaggeration”. He assured that GBS is not a contagious disease and is usually triggered by acute viral or bacterial infection. However, as it is a “self limiting” disease, it reduces on its own, he pointed out. “Most GBS patients fully recover from GBS,” assured , Dr Anshu Rastogi, Senior Consultant,Neurology, Sir Ganga Ram hospital. He explained it is an auto-immune disease in which the body’s natural defence system the anti-bodies cannot differentiate between body’s own cells and foreign cells and attack body’s own cells in this case nerve cells. He said, “GBS does not affect the brain even though its effects are seen in the hands.” He said, it goes from below the body upwards and is known as “ascending paralysis”. “It starts from legs, goes to the arms and it can affect the face and the shoulders and also respiratory muscles.” GBS can be recurring in very rare cases, “In the last 30 years I may have seen only 10 patients with recurring GBS.” No one seems to know why the anti bodies start acting against the nerves of the body. In GBS the body’s immune system begins to attack the peripheral nervous system (parts of nervous system beyond the brain and spinal cord) which means that the movement of your hands and legs are first to be affected. A person slowly starts losing sensations in the feet and as it moves upward, other organs of the body also may be impacted. The patient may find it difficult to breathe, in some cases. Some patients may have to be put on a ventilator. So,people suspected to have GBS must be admitted at a place where there is good tertiary care and where ventilators are available. There are known treatment methodologies which are followed like blood plasma may be exchanged removing anti bodies or immunoglobulin injections may be given intravenously with healthy anti bodies which fight against and dilute the GBS anti bodies responsible for harming the body’s nerves. Flu and viral infection can give rise to GBS and following Covid 19, one is supposed to have seen a hike in GBS. However, Dr Raman Gangakhedkar, said, it is not right to say that vaccines used against Covid in India could have also given rise to GBS. India did not use any such vaccine which could have a possibility of doing that, he added. He said that one should be very wary of “anti-vaccine” lobby which is interested in creating this kind of a scare. Renowned Neurologist L.K.Malhotra said, “GBS is a common disease. Usually happens post viral. No increase seen in such patients in recent days . The disease progresses for about two weeks and then it stabilises but then during the progression of the disease all the muscles get affected including respiratory muscles and therefore sometimes the patients have to be put on a respirator.” Rapidly advancing disease has to be given Immono globulin medicine by weight of patient in a five day course to slow down the progression of disease. It is not a cure, he added. “We have to control any complications like fluctuating heart rate , sometimes patients stay on ventilator for long periods of time depending on severity of disease,”Dr Malhotra added. Such cases are seen to increase after infections therefore there was a slight increase seen after Covid,he added. Scientist Enna Dogra at ICMR said that GBS is a post infection condition with neurological problems in the nervous system. There are no permanent cure. You cannot avoid it. Very rare disease. Prevention involves like hand washing, avoiding infection, she added. People of all ages are usually affected though mostly adult males are more prone to get it. However even from most severe cases of Guillain-Barré syndrome one recovers from it. As it affects the nerves you get unusual sensations from your body parts including tingling, insects crawling under the skin and pain. There might be difficulty walking, unsteadiness, difficulty with eye muscles and vision, difficulty swallowing, speaking, or chewing, abnormal heart beat, blood pressure or problems with digestion and or bladder control at times, if the condition becomes severe. The nerve called the axon carries an electric signal. The axon (an extension of a nerve cell) is surrounded by a covering, like insulation, called myelin. The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances. In GBS, the immune system damages the myelin sheath that surrounds the axons of many peripheral nerves and the axons. The nerves cannot transmit signals efficiently. This causes muscle weakness . Usually GBS cases happen a few days or weeks following a respiratory or gastrointestinal viral infection. Because GBS can affect several parts of your body, you may need different methods and approaches to prevent or treat complications. Injections of blood thinners can help prevent dangerous blood clots from forming in leg veins. The Guillain-Barré syndrome cannot be taken lightly because the sudden weakness can in some cases lead to paralysis. Recovery at times takes up to a few years, though everyone eventually fully recovers. Usually there are no long-term, severe neurological problems. All GBS patients should be monitored for complications, which can include abnormal heart beat, infections, blood clots, and high or low blood pressure. One must watch out for GBS symptoms like weakness or tingling sensations in the legs after suffering from any severe infection. It is a medical emergency requiring immediate hospitalization as there is a fear of paralysis, your breathing may become hard and your heart and blood pressure may become affected. Family Physician and Public Health Consultant, Bengaluru, Suresh Kishanrao, says, “ In GBS cases most often recover completely with 10-20% muscular weakness. In elderly if respiratory muscles are affected, it may lead to respiratory failure and even deaths if they do not get timely support, but very rarely” Dr Antony Kollannur, Paediatrician and Public Health Consultant in Kochi, says, “In spite of the serious conditions the patient is in while in ICU, they come out of it happily.Some require ventilatory support in ICU.” Dr. Sanjiv Kumar, Public Health expert and chair of Three Domain Health Leadership Foundation, New Delhi, stated,“GBS is an auto immune disease, not an infectious disease. New cases (incidence) in India is around 1.55/100,000 population.Most patients recover fully. A few have permanent nerve damage.” “Last case I saw was a 64 year old hypertensive lady whose BP shot up because she could not take her daily oral medicines that morning.” “When I visited her, I realized she was not able to swallow as her muscles associated with swallowing were paralyzed. We rushed her to Holy Family hospital, New Delhi. She had GBS and recovered fully after two weeks in hospital followed by physiotherapy.”

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