Guillain-Barré syndrome (GBS) is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances the symmetrical weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until certain muscles cannot be used at all and, when severe, the person is almost totally paralyzed. In these cases the disorder is life threatening - potentially interfering with breathing and, at times, with blood pressure or heart rate - and is considered a medical emergency. Such an individual is often put on a ventilator to assist with breathing and is watched closely for problems such as an abnormal heart beat, infections, blood clots, and high or low blood pressure. Most individuals, however, have good recovery from even the most severe cases of Guillain-Barré syndrome, although some continue to have a certain degree of weakness.
Guillain-Barré syndrome can affect anybody. It can strike at any age and both sexes are equally prone to the disorder. The syndrome is rare, however, afflicting only about one person in 100,000. Usually Guillain-Barré occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally surgery will trigger the syndrome. In rare instances vaccinations may increase the risk of GBS.
After the first clinical manifestations of the disease, the symptoms can progress over the course of hours, days, or weeks. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest.
What causes Guillain-Barré syndrome?
No one yet knows why Guillain-Barré — which is not contagious — strikes some people and not others. Nor does anyone know exactly what sets the disease in motion.
What scientists do know is that the body's immune system begins to attack the body itself, causing what is known as an autoimmune disease. Usually the cells of the immune system attack only foreign material and invading organisms. In Guillain-Barré syndrome, however, the immune system starts to destroy the myelin sheath that surrounds the axons of many peripheral nerves, or even the axons themselves (axons are long, thin extensions of the nerve cells; they carry nerve signals). The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances.
In diseases in which the peripheral nerves' myelin sheaths are injured or degraded, the nerves cannot transmit signals efficiently. That is why the muscles begin to lose their ability to respond to the brain's commands, commands that must be carried through the nerve network. The brain also receives fewer sensory signals from the rest of the body, resulting in an inability to feel textures, heat, pain, and other sensations. Alternately, the brain may receive inappropriate signals that result in tingling, "crawling-skin," or painful sensations. Because the signals to and from the arms and legs must travel the longest distances they are most vulnerable to interruption. Therefore, muscle weakness and tingling sensations usually first appear in the hands and feet and progress upwards.
When Guillain-Barré is preceded by a viral or bacterial infection, it is possible that the virus has changed the nature of cells in the nervous system so that the immune system treats them as foreign cells. It is also possible that the virus makes the immune system itself less discriminating about what cells it recognizes as its own, allowing some of the immune cells, such as certain kinds of lymphocytes and macrophages, to attack the myelin. Sensitized T lymphocytes cooperate with B lymphocytes to produce antibodies against components of the myelin sheath and may contribute to destruction of the myelin. In two forms of GBS, axons are attacked by antibodies against the bacteria Campylobacter jejuni, which react with proteins of the peripheral nerves. Acute motor axonal neuropathy is particularly common in Chinese children. Scientists are investigating these and other possibilities to find why the immune system goes awry in Guillain-Barré syndrome and other autoimmune diseases. The cause and course of Guillain-Barré syndrome is an active area of neurological investigation, incorporating the cooperative efforts of neurological scientists, immunologists, and virologists.
How is Guillain-Barré syndrome diagnosed?
Guillain-Barré is called a syndrome rather than a disease because it is not clear that a specific disease-causing agent is involved. A syndrome is a medical condition characterized by a collection of symptoms (what the patient feels) and signs (what a doctor can observe or measure). The signs and symptoms of the syndrome can be quite varied, so doctors may, on rare occasions, find it difficult to diagnose Guillain-Barré in its earliest stages.
Several disorders have symptoms similar to those found in Guillain-Barré, so doctors examine and question patients carefully before making a diagnosis. Collectively, the signs and symptoms form a certain pattern that helps doctors differentiate Guillain-Barré from other disorders. For example, physicians will note whether the symptoms appear on both sides of the body (most common in Guillain-Barré) and the quickness with which the symptoms appear (in other disorders, muscle weakness may progress over months rather than days or weeks). In Guillain-Barré, reflexes such as knee jerks are usually lost. Because the signals traveling along the nerve are slower, a nerve conduction velocity (NCV) test can give a doctor clues to aid the diagnosis. In Guillain-Barré patients, the cerebrospinal fluid that bathes the spinal cord and brain contains more protein than usual. Therefore a physician may decide to perform a spinal tap, a procedure in which a needle is inserted into the patient's lower back and a small amount of cerebrospinal fluid from the spinal column is withdrawn for study.
How is Guillain-Barré treated?
There is no known cure for Guillain-Barré syndrome. However, there are therapies that lessen the severity of the illness and accelerate the recovery in most patients. There are also a number of ways to treat the complications of the disease.
Currently, plasma exchange (also called plasmapheresis) and high-dose immunoglobulin therapy are used. Both of them are equally effective, but immunoglobulin is easier to administer. Plasma exchange is a method by which whole blood is removed from the body and processed so that the red and white blood cells are separated from the plasma, or liquid portion of the blood. The blood cells are then returned to the patient without the plasma, which the body quickly replaces. Scientists still don't know exactly why plasma exchange works, but the technique seems to reduce the severity and duration of the Guillain-Barré episode. This may be because plasmapheresis can remove antibodies and other immune cell-derived factors that could contribute to nerve damage.
In high-dose immunoglobulin therapy, doctors give intravenous injections of the proteins that, in small quantities, the immune system uses naturally to attack invading organisms. Investigators have found that giving high doses of these immunoglobulins, derived from a pool of thousands of normal donors, to Guillain-Barré patients can lessen the immune attack on the nervous system. Investigators don't know why or how this works, although several hypotheses have been proposed.
The use of steroid hormones has also been tried as a way to reduce the severity of Guillain-Barré, but controlled clinical trials have demonstrated that this treatment not only is not effective but may even have a deleterious effect on the disease.
The most critical part of the treatment for this syndrome consists of keeping the patient's body functioning during recovery of the nervous system. This can sometimes require placing the patient on mechanical ventilatory assistance, a heart monitor, or other machines that assist body function. The need for this sophisticated machinery is one reason why Guillain-Barré syndrome patients are usually treated in hospitals, often in an intensive care ward. In the hospital, doctors can also look for and treat the many problems that can afflict any paralyzed patient - complications such as pneumonia or bed sores.
Often, even before recovery begins, caregivers may be instructed to manually move the patient's limbs to help keep the muscles flexible and strong and to prevent venous sludging (the buildup of red blood cells in veins, which could lead to reduced blood flow) in the limbs which could result in deep vein thrombosis. Later, as the patient begins to recover limb control, physical therapy begins. Carefully planned clinical trials of new and experimental therapies are the key to improving the treatment of patients with Guillain-Barré syndrome. Such clinical trials begin with the research of basic and clinical scientists who, working with clinicians, identify new approaches to treating patients with the disease.
What is the long-term outlook for those with Guillain-Barré syndrome?
Guillain-Barré syndrome can be a devastating disorder because of its sudden and unexpected onset. In addition, recovery is not necessarily quick. As noted above, patients usually reach the point of greatest weakness or paralysis days or weeks after the first symptoms occur. Symptoms then stabilize at this level for a period of days, weeks, or, sometimes, months. The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of those with Guillain-Barré still have a residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack.
Guillain-Barré syndrome patients face not only physical difficulties, but emotionally painful periods as well. It is often extremely difficult for patients to adjust to sudden paralysis and dependence on others for help with routine daily activities. Patients sometimes need psychological counseling to help them adapt.
What research is being done?
Scientists are concentrating on finding new treatments and refining existing ones. Scientists are also looking at the workings of the immune system to find which cells are responsible for beginning and carrying out the attack on the nervous system. The fact that so many cases of Guillain-Barré begin after a viral or bacterial infection suggests that certain characteristics of some viruses and bacteria may activate the immune system inappropriately. Investigators are searching for those characteristics. Certain proteins or peptides in viruses and bacteria may be the same as those found in myelin, and the generation of antibodies to neutralize the invading viruses or bacteria could trigger the attack on the myelin sheath. As noted previously, neurological scientists, immunologists, virologists, and pharmacologists are all working collaboratively to learn how to prevent this disorder and to make better therapies available when it strikes.
Where can I get more information?For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:
P.O. Box 5801
Bethesda, MD 20824
Information also is available from the following organizations:
GBS/CIDP Foundation International
The Holly Building 104 1/2 Forrest Ave.
Narberth, PA 19072
Tel: 610-667-0131 866-224-3301
"Guillain-Barré SyndromeFact Sheet", NINDS, Publication date November 19, 2015.
See a list of all NINDS Disorders
When Sarah Brison was 23 years old, she was at her physical prime. She played soccer, ate healthily and always took care of her body. That's why she was so confused when she woke up one morning in excruciating pain. It was so bad that she began to lose her sight. Sarah was having a heart attack.
Experts believe that Sarah's heart attack occurred because of her contraceptive pill. Sarah, who is now healthy and fully recovered, recounted the experience. She said:
"Everything went blurry then, within seconds, I lost my vision completely. I couldn't feel my limbs, had no control over my body and I was sweating uncontrollably. The pain was unbearable. It was like brain freeze except it was all over my chest, as if someone was pressing down on me with all of their weight. They say your hearing is the last sense to go before you die. Everything else had gone. I felt like my body was shutting down.''
After Sarah's boyfriend Billy Pamment, 23, called an ambulance the morning of her heart attack, she was wired to defibrillator pads and taken to St. George's Hospital in London. There, she was tranferred to the cardiology department for tests. The doctors were shocked to find blood clots on the vessels leading to Sarah's heart. Sarah said:
"I just kept asking the doctor how it could have happened. I was 23. Surely 23-year-olds didn't have heart attacks? I kept asking if I was going to die."SARAH BRISON
After tests came back, it was revealed that Sarah had a hole in her heart. While this condition typically causes no health problems for the 25 percent of the population who has it, a blood clot passed through the hole in Sarah's heart, which in turn caused her massive heart attack. Sarah said:
"The consultant told me the most likely reason was because I was on the Pill."SARAH BRISON
Sarah had been on birth control pills for seven years. However, she had recently switched from Cerazette to Marvelon before the heart attack. Sarah thought that the new pill might cause complications, but her doctor assured her that any negative side effects were highly unlikely. Sarah said:
"I had heard about it being linked with an increased risk of blood clots so I asked my doctor if it was safe. But my GP told me it would be highly unlikely anything would happen."SARAH BRISON
Now, after being discharged, Sarah still needs regular check-ups at the hospital and takes five drugs, including blood thinners, every day. She said:
"I carry an emergency spray in case I develop chest pains and am having counseling to help deal with the psychological impact of having a heart attack at such a young age. I may also need surgery to close the hole in my heart."SARAH BRISON
Sarah has now vowed to completely avoid birth control pills for the rest of her life. She's also urging her friends to seek different forms of birth control to avoid what happened to her. She said:
"Having a heart attack has changed my outlook on life. It's made me see what's important. I know the chances of this happening are rare so I guess I was just unlucky but people need to think seriously before taking the Pill because there are other, safer alternatives. I still have a long road ahead of me but if I can warn just one other girl about the dangers of the Pill, it'll be worth it."
Watch this video to learn about birth control options that serve as alternatives to the contraceptive pill:
(Reuters) -- About 30 makers of low-priced California wines including popular brands Charles Shaw and Sutter Home allow unacceptable levels of arsenic in their products, private attorneys said in a proposed class action filed in Los Angeles on Thursday.
The legal action represents a challenge to a segment of the industry that produces wines that consumers can buy for less than $10 a bottle, or in the case of Charles Shaw the so-called Two-Buck Chuck product that retailer Trader Joe's has popularized at $2.
A lawsuit filed on March 19, is claiming that many popular low cost wines contain a dangerous amount of inorganic arsenic. The wineries that are producing the wines have knowingly created them with 500% or more than the allowed safe amount of the chemical. The following site, has a copy of the complaint and other information pertaining to the lawsuit.
The following brands and types of wines are listed as containing the dangerous chemical:
Acronym, Gr8Rw Red Blend
Almaden, Heritage White Zinfandel, Heritage Moscato, Heritage Chardonnay, Mountain Burgundy, Mountain Rhine & Mountain Chablis
Arrow Creek: Coastal Cabernet Sauvignon
Bandit: Pinot Grigio, Chardonnay & Cabernet Sauvignon
Bay Bridge: Chardonnay
Beringer: White Merlot, White Zinfandel, Red Moscato & Refreshingly Sweet Moscato
Charles Shaw: White Zinfandel
Colores Del Sol: Malbec
Glen Ellen by Concannon: Glen Ellen Reserve Pinot Grigio & Glen Ellen Reserve Merlot
Concannon: Selected Vineyards Pinot Noir
Corbett Canyon: Pinot Grigio & Cabernet Sauvignon
Fetzer: Moscato & Pinot Grigio
Fisheye: Pinot Grigio
FlipFlop: Pinot Grigio, Moscato & Cabernet Sauvignon
Foxhorn: White Zinfandel
Franzia: Vintner Select White Grenache, Vintner Select White Zinfandel, Vintner Select White Merlot & Vintner Select Burgundy
Hawkstone: Cabernet Sauvignon
Hrm Rex Goliath: Moscato
Korbel: Sweet Rose Sparkling Wine & Extra Dry Sparkling Wine
Menage a Trois: Pinot Grigio, Moscato, White Blend, Chardonnay, Rose, Cabernet Sauvignon & California Red Wine
Mogen David: Concord & Blackberry Wine
Oak Leaf: White Zinfandel
Pomelo: Sauvignon Blanc
R Collection by Raymond: Chardonnay
Richards Wild Irish Rose: Red Wine
Seaglass: Sauvignon Blanc
Simply Naked: Moscato
Smoking Loon: Viognier
Sutter Home: Sauvignon Blanc, Gewurztraminer, Pink Moscato, Pinot Grigio, Chenin Blanc, Sweet Red, Riesling, White Merlot, Merlot, White Zinfandel & Zinfandel
Tribuno: Sweet Vermouth
Vendange: Merlot & White Zinfandel
Wine Cube: Moscato, Pink Moscato, Pinot Grigio, Chardonnay, Red Sangria, Sauvignon Blanc & Cabernet Sauvignon/Shiraz
The attorneys who brought the lawsuit said the majority of wineries in the state's $23 billion wine industry, the nation's largest, produce a safe product. But they said a lack of government regulation puts consumers at risk.
"There is more regulation in the caramel corn industry in the United States than in the wine industry, as surprising as that is," attorney Brian Kabatecktold a news conference.
"We are trying to bring the wine industry out into the sunshine," he said.
The lawsuit was filed in Los Angeles Superior Court and accuses about 30 California wineries of unjust enrichment, misrepresentation and engaging in unfair competition against wineries that follow safe practices.
The U.S. Environmental Protection Agency sets the maximum amount of arsenic in water at 10 parts per billion, but the lawsuit says laboratory tests conducted for the litigation have shown levels of inorganic arsenic, the most dangerous form of the substance, which can cause cancer and diabetes, at far higher levels.
The suit did not specify how much was being sought in damages.
Plaintiffs attorneys said they do not know exactly how the arsenic gets into some wines but said it may come from a clarifying agent or from inadequate filtration of pesticides used on grapes.
The Wine Institute, a trade association representing California wineries, said it believes the litigation is misleading.
"We are concerned that the irresponsible publicity campaign by the litigating party could scare the public into thinking that wine is not safe to consume, which is patently untrue," it said in a statement.
California Attorney General Kamala Harris has the power under state law to bring a complaint to protect consumers from what may be unsafe wines, and the attorneys who filed the suit expressed hope she would take such action.
A representative for Harris' office declined immediate comment. Representatives for Sutter Home and Trader Joe's could not immediately be reached for comment.
Discussion of arsenic effect on brain?
Is it worse to absorb arsenic when drinking wine or water, and why?
Here are some general biological mechanism of action and treatment protocol.
Biological mechanismThe high affinity of arsenic(III) oxides for thiols is usually assigned as the cause of the high toxicity. Thiols, usually in the form of cysteine residues, but also in cofactorssuch as lipoic acid and coenzyme A, are situated at the active sites of many important enzymes.
Arsenic disrupts ATP production through several mechanisms. At the level of the citric acid cycle, arsenic inhibits lipoic acid, which is a cofactor for pyruvate dehydrogenase. In addition, by competing with phosphate, arsenate uncouples oxidative phosphorylation, thus inhibiting energy-linked reduction of NAD+, mitochondrial respiration and ATP synthesis. Hydrogen peroxide production is also increased, which, it is speculated, has potential to form reactive oxygen species and oxidative stress. These metabolic interferences lead to death from multi-system organ failure. The organ failure is presumed to be from necrotic cell death, not apoptosis, since energy reserves have been too depleted for apoptosis to occur.
TreatmentTreatment of chronic arsenic poisoning is possible. British anti-lewisite (dimercaprol) is prescribed in doses of 5 mg/kg up to 300 mg every 4 hours for the first day, then every 6 hours for the second day, and finally every 8 hours for 8 additional days. However the USA's Agency for Toxic Substances and Disease Registry (ATSDR) states that the long-term effects of arsenic exposure cannot be predicted. Blood, urine, hair, and nails may be tested for arsenic; however, these tests cannot foresee possible health outcomes from the exposure. Excretion occurs in the urine and long-term exposure to arsenic has been linked to bladder and kidney cancer in addition to cancer of the liver, prostate, skin, lungs, and nasal cavity.
Could you give a physiological explanation to the following statement:
"the bottom of my feet turned ice cold. But they were burning on the inside"
"My body seemed to completely slow down. ... It was from my ankle all the way down to the bottom of my feet turned ice cold. But they were burning on the inside," Nancy Garlow said.
"On day seven I woke up and I was in so much pain everywhere. ... I felt like I was dying," added Dr. Susan Tannenbaum.
Two separate patients who were prescribed a popular class of antibiotic told WFTS the drug came with severe side effects.
For both women, the family of antibiotics known as fluoroquinolones resulted in pain and nerve damage.
Now here's the thing - in the fall of 2013, the U.S. Food and Drug Administration issued a warning about fluoroquinolones - that they carry a risk of permanent nerve damage.
"It's probably more common than it is uncommon," said Dr. Charles Bennett.
Levofloxacin, which is marketed under the brand name Levaquin in the U.S. and Tavanic in the EU, is often prescribed for pneumonia, urinary tract infections and infections of the abdomen.
According to Forbes, there have been 45,000 reported cases of side effects related to fluoroquinolones. 23.1 million patients filled prescriptions for oral flouroquinolones in 2011.
Fluoroquinolones in general have also been associated with cardiovascular, endocrine and renal symptoms. Though the National Institutes of Health says severe side effects are generally rare and that the benefits can outweigh the risks.
Bottom line: Most drugs carry a risk, but if you've been prescribed an oral or injected fluoroquinolone and you're concerned about side effects, be sure to talk to your doctor about switching. In the meantime, there are petitions filed with the FDA for more aggressive warnings about Levaquin and other fluoroquinolones.