tag:theconversation.com,2011:/us/topics/guillain-barre-syndrome-24439/articlesguillain barre syndrome – The Conversation2016-06-03T09:28:27Ztag:theconversation.com,2011:article/603962016-06-03T09:28:27Z2016-06-03T09:28:27ZShould Zika really stop you going to the Rio Olympics? Here are the facts<figure><img src="https://images.theconversation.com/files/124997/original/image-20160602-23270-cxexrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cidade maravilhosa.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=Rio&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=328110866">Aleksandar Todorovic/Shutterstock.com</a></span></figcaption></figure><p>Over 200 academics from around the world have now signed <a href="http://rioolympicslater.org/">an open letter</a> to the Director-General of the World Health Organisation (WHO) calling for the Olympics and Paralympics in Rio de Janeiro to be postponed or moved to another venue, owing to the threat posed by the ongoing Zika virus pandemic. The evidence concerning Zika virus so far, however, does not justify this course of action. The <a href="http://rioolympicslater.org/">RioOlympicsLater.org</a> authors misunderstand the nature of Zika virus, its history since its discovery in 1947, and also the relative risk posed by Zika virus versus other risks affecting any large event in a tropical country. </p>
<p>The letter begins by referring to the movement of the <a href="http://www.fifa.com/news/y=2003/m=5/news=sars-fifa-executive-decides-relocate-fifa-women-world-cup-2003-87152.html">2003 Women’s World Cup</a> from China to the USA owing to the outbreak of SARS, and the disruption of the <a href="http://www.nytimes.com/2014/11/12/sports/soccer/morocco-wont-host-africa-cup-of-nations-because-of-ebola-fears.html?_r=0">African Cup of Nations</a> schedule during the Ebola epidemic. Neither of these is, however, a valid comparison. </p>
<p>Both <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3083.2003.01302.x/abstract;jsessionid=5EC933F85FDD4A286A7376B1DEE53824.f02t03">SARS</a> and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870382/">Ebola</a> were high-mortality diseases. Also, SARS was a completely new pathogen. Mortality in Zika is very low, and where deaths occur they are often due to complications of <a href="http://www.nhs.uk/Conditions/Guillain-Barre-syndrome/Pages/Introduction.aspx">Guillain-Barre Syndrome</a> rather than a direct result of the virus’s usual symptoms.</p>
<p>The real concern with Zika is <a href="https://theconversation.com/explainer-what-is-microcephaly-and-what-is-its-relationship-to-zika-virus-54049">microcephaly</a> and other damaging effects on foetuses via infection in pregnant women. But the authors’ statement that “Zika virus harms health in ways that science has not observed before” is not correct. <a href="http://www.ncbi.nlm.nih.gov/pubmed/27180225">Recent experiments</a> on laboratory mice, on brain <a href="http://www.ncbi.nlm.nih.gov/pubmed/27118425">organoids</a> (small balls of nervous cells that have <a href="https://www.technologyreview.com/s/535006/brain-organoids/">some of the structure and properties of developing brains</a>) and in brain tissue culture, as well as <a href="http://www.ncbi.nlm.nih.gov/pubmed/27028667">detailed observation</a> of the signs and symptoms of Zika-associated microcephaly in foetuses and infants, show that Zika <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878297/">can be categorised with other TORCH-syndrome pathogens</a>. </p>
<p>TORCH is an acronym for “TOxoplasma, Rubella, Cytomegalovirus, Herpes”, <a href="http://rarediseases.org/rare-diseases/torch-syndrome/">all agents which cause similar defects in foetuses</a> when the mothers are exposed in pregnancy. Zika is the only TORCH-like pathogen that is spread by mosquito bites, but based on what we have seen so far, there is no reason to think that Zika is particularly virulent. If one insists on drawing comparisons with other diseases, Zika is not the new Ebola, but the new <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316306/">rubella</a>. </p>
<p>The letter also claims that “most of South Asia and Africa” are “as yet unaffected places”. That is not true either. Many <a href="http://jgv.microbiologyresearch.org/content/journal/jgv/10.1099/jgv.0.000381#tab2">studies</a>, going back to the 1940s, have shown that humans, and often also monkeys, in several African and Asian countries have antibodies to the Zika virus, and we have direct evidence of Zika circulating in both <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321795/">West Africa</a> and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866850/">South East Asia</a> within the last ten years. These studies need to be repeated to determine the current levels, but it is very likely that many parts of the tropical world have already seen Zika virus in the past and there will probably be considerable herd immunity to the local Zika variant in the human population. </p>
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<img alt="" src="https://images.theconversation.com/files/124999/original/image-20160602-23291-35owpc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/124999/original/image-20160602-23291-35owpc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124999/original/image-20160602-23291-35owpc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124999/original/image-20160602-23291-35owpc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124999/original/image-20160602-23291-35owpc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124999/original/image-20160602-23291-35owpc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124999/original/image-20160602-23291-35owpc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The rubella virus.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-208188670/stock-photo-rubella-german-measles.html?src=fLi9iCGaqf9D3L15SdAqTQ-1-0">decade3d - anatomy online/Shutterstock.com</a></span>
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<p>Will that previous exposure be protective against more exotic strains of Zika? The likely answer is “yes”. The Brazilian and African varieties of Zika are about 12-13% different in terms of the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289602/">genetic variants accumulated</a> since their last common ancestor. The <a href="http://www.ncbi.nlm.nih.gov/pubmed/25545072">corresponding figure</a> for yellow fever virus, another member of the flavivirus family that includes Zika, is just under 22%. Yet a single <a href="http://www.nhs.uk/Conditions/yellow-fever/Pages/prevention.aspx">yellow fever vaccination</a> will protect against all variants of yellow fever and for a long period of time, so it would be very unusual if exposure to African or South-East Asian Zika did not similarly generate immunity against Brazilian Zika.</p>
<p>Brazil has many of the typical diseases found in the tropical world, including <a href="http://www.who.int/malaria/travellers/en/">malaria</a> and <a href="http://www.nhs.uk/Conditions/dengue/Pages/Introduction.aspx">dengue</a> as well as <a href="http://www.avert.org/professionals/hiv-around-world/latin-america/brazil">levels of HIV</a> about <a href="http://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/uk">three times higher</a> than the UK. These are things that travellers and athletes need to prepare for. All are clinically more serious than Zika, but none has been proposed as a reason to cancel the event.</p>
<p>There is no major event that is ever 100% safe, and that especially applies to major events in tropical countries. When Zika is seen as it should be, as an insect-borne rubella-like agent, the proper perspective for prevention becomes evident. </p>
<p>Pregnant women, those planning pregnancy and those predisposed to Guillain-Barre syndrome perhaps would be best advised to stay away. Other groups simply need to monitor their health carefully during their visit, use insect repellent and avoid risky sexual behaviour – and thereby also reduce their risk of catching HIV in the process. </p>
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<img alt="" src="https://images.theconversation.com/files/125002/original/image-20160602-23270-1x1gkji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125002/original/image-20160602-23270-1x1gkji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125002/original/image-20160602-23270-1x1gkji.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125002/original/image-20160602-23270-1x1gkji.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125002/original/image-20160602-23270-1x1gkji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125002/original/image-20160602-23270-1x1gkji.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125002/original/image-20160602-23270-1x1gkji.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Go, but take the precautions.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=NSfsObRvTSMfWCGAbjYbaA-1-11&clicksrc=download_btn_inline&id=295527683&size=medium_jpg&submit_jpg=">lazyllama / Shutterstock.com</a></span>
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<p>The <a href="https://www.gov.uk/foreign-travel-advice/brazil/health">travel advice</a> for the topics has not changed much because of Zika, unless you are pregnant or starting a pregnancy soon. The one new important point is that all travellers should <a href="http://apps.who.int/iris/bitstream/10665/204421/1/WHO_ZIKV_MOC_16.1_eng.pdf">abstain from unprotected sex for 60 days</a> following their return, since a Zika infection often does not have symptoms. Everyone who has been in a Zika area needs to assume that they may have been infected. </p>
<p>More importantly, all travellers with a fever or rash, or both, during or after their trip need to go to their doctor. But the first test will be for malaria rather than Zika, because the really important and dangerous tropical diseases must take priority. If these principles are observed, there is no reason why the Olympics cannot take place.</p><img src="https://counter.theconversation.com/content/60396/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Derek Gatherer is affiliated with the WHO Expert Committee On Biological Standardization as a participant in their project "WHO collaborative study to assess the suitability of an interim standard for antibodies to Ebola virus"</span></em></p>Academics have sent an open letter to the World Health Organisation calling for the Olympics to be postponed or moved because of the Zika threat. They’re overreacting.Derek Gatherer, Lecturer, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/575692016-04-18T20:11:16Z2016-04-18T20:11:16ZExplainer: what autoimmune disorder is newly linked to Zika?<figure><img src="https://images.theconversation.com/files/119032/original/image-20160418-23618-4loztg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Acute disseminated encephalomylitis can lead to coma. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>The <a href="https://theconversation.com/explainer-where-did-zika-virus-come-from-and-why-is-it-a-problem-in-brazil-53425">ongoing Zika virus outbreak</a> in South America has brought media and research attention to several rare neurological disorders.</p>
<p>Early reports suggested links between <a href="https://theconversation.com/explainer-what-is-microcephaly-and-what-is-its-relationship-to-zika-virus-54049">Zika infection and microcephaly</a> (abnormal smallness of the head) in newborn infants. These were quickly followed by reports of increased rates of auto-immune disorder <a href="https://theconversation.com/explainer-what-is-guillain-barre-syndrome-and-is-it-caused-by-the-zika-virus-53884">Guillain-Barre syndrome</a> in Zika-infected adults. The most recent reports propose a connection between <a href="http://www.reuters.com/article/us-health-zika-brain-idUSKCN0X70VP">Zika infection and acute disseminated encephalomyelitis (ADEM)</a>. </p>
<p>These three rare conditions all cause damage to the nervous system, which includes the brain, spinal cord and nerves. Our nervous system functions to send signals throughout the body to co-ordinate movement, sense our environment and regulate body function.</p>
<h2>What is acute disseminated encephalomyelitis (ADEM)?</h2>
<p><a href="http://www.ninds.nih.gov/disorders/acute_encephalomyelitis/acute_encephalomyelitis.htm">ADEM</a> is a rare <a href="https://theconversation.com/explainer-what-are-autoimmune-diseases-22577">autoimmune disease</a> that causes lesions in the brain and spinal cord. Disease is usually triggered by a previous infection or vaccination, although why this occurs is not well understood. For example, one in 1,000 people infected with measles goes on to develop ADEM. Rates of disease have decreased in developed countries, due to reduced rates of infection.</p>
<p><a href="https://theconversation.com/explainer-how-does-the-immune-system-work-27163">Immune cells</a> normally protect our body against disease, by killing invading viruses and bacteria. In ADEM, these immune cells attack our nerves within the brain and spinal cord and cause damage. Damage destroys the insulating coating on our nerve cells, called myelin, and interferes with signalling in the nervous system. </p>
<p>Early symptoms include fever, low energy, headache nausea and vomiting. Within several days, symptoms escalate and can range from low energy to coma, with weakness along one side of the body or in the legs (hemiparesis/paraparesis). Symptoms can also include loss of control of body movements (ataxia) and other movement disorders. Anti-inflammatory drugs are usually used to try to reduce damage.</p>
<p>Symptoms can start to improve quickly (within days) and people usually fully recover within six months. Most people experience no long-term symptoms. However, some individuals do “relapse”, meaning they go on to experience another round of symptoms. </p>
<p>If patients continue to having recurring symptoms, they may be diagnosed with <a href="https://theconversation.com/explainer-multiple-sclerosis-32662">multiple sclerosis</a>. Multiple sclerosis causes similar damage and symptoms to ADEM and is a life-long disease. It is currently unclear whether ADEM leads to multiple sclerosis in some people or whether ADEM is simply confused for the first episode of multiple sclerosis.</p>
<h2>How do you show Zika causes neurological disease?</h2>
<p>Last week, the Centers for Disease Control and Prevention (CDC) <a href="http://www.cdc.gov/media/releases/2016/s0413-zika-microcephaly.html">concluded</a> that Zika infection causes microcephaly. Microcephaly is a birth defect that causes abnormally small head size in infants and is associated with brain defects. </p>
<p>CDC researchers have also provided evidence for a <a href="http://www.cbc.ca/news/canada/british-columbia/zika-virus-guillain-barre-syndrome-cdc-1.3538726">strong link</a> between Zika infection and Guillain-Barre syndrome. Guillain-Barre syndrome, which causes temporary paralysis and can lead to death, has increased in 12 countries currently experiencing a Zika virus outbreak.</p>
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<img alt="" src="https://images.theconversation.com/files/119035/original/image-20160418-23601-vhv6hm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/119035/original/image-20160418-23601-vhv6hm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119035/original/image-20160418-23601-vhv6hm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119035/original/image-20160418-23601-vhv6hm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119035/original/image-20160418-23601-vhv6hm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119035/original/image-20160418-23601-vhv6hm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119035/original/image-20160418-23601-vhv6hm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"><em>Aedes aegypti</em> – the mosquito responsible for spreading the Zika virus.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/60569585@N06/5568919509/in/photolist-9u7aKB-LJpmH-8iKcfb-e4U79v-LJpmP-8voVuN-eMet3o-d4AtbL-bxG24p-746aaJ-e4U7a8-o3SGYM-9u7gVB-Fnkms-9UiBXf-81RGYL-4k9XxA-cVenub-7aDdQ7-JmmMr-JmmMx-d4YEz9-8hapcj-8gXkmN-8gU5uZ-oqyjAA-9DTCXp-8h7aqP-9DTCU2-98Qr6b-9DWvEE-9DTCSH-93W66w-9DTCMP-9DWvuY-EVXC6r-9DTCR6-d4YEwu-93T2e4-4mNPZ2-fxTewX-oapKcG-d4YEBA-DvupqC-CAqaU2-CAioz7-8h7avx-7FYhqp-4wDUEr-5evtxG">jentavery/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Demonstrating Zika infection actually causes disease requires extensive study and consideration of a range of data. This was done in the recent <a href="http://www.nejm.org/doi/full/10.1056/NEJMsr1604338">publication</a> connecting Zika infection and microcephaly. These conclusions required data showing individuals who develop disease are infected with Zika, as well as population data showing that rates of disease increased in Zika-affected areas and ruling out other possible causes.</p>
<p>The conclusions were also supported by laboratory data demonstrating that Zika virus can <a href="http://www.the-scientist.com/?articles.view/articleNo/45796/title/Zika-Seeks--Destroys-Developing-Neurons/">infect and kill nerve cells</a>. These functional studies in the lab provide a logical connection between Zika virus and neurological disease.</p>
<h2>Is ADEM linked to Zika virus infection?</h2>
<p>A possible link between Zika infection and ADEM has been proposed based on recent <a href="http://www.reuters.com/article/us-health-zika-brain-idUSKCN0X70VP">study findings</a> from Brazil. In 151 patients with confirmed arbovirus infection (a group of viruses that includes Zika), six developed neurological symptoms. </p>
<p>All six patients were infected by Zika virus and four developed Guillain-Barre syndrome. The remaining two developed ADEM. ADEM is well known to develop after infection by a range of viruses, so it’s entirely possible Zika virus will be added to this list. However, it should be noted that even among people infected with Zika virus, a very small number will develop ADEM. </p>
<p>While a link between Zika infection and ADEM is cause for concern, it remains to be formally proven. It may take months or years of study to confirm whether Zika actually causes ADEM. The hope is that through continued study we can better understand both Zika infection and ADEM disease and develop better ways of treating both.</p><img src="https://counter.theconversation.com/content/57569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Maltby receives funding from the NHMRC Centre of Excellence in Severe Asthma (<a href="http://www.severeasthma.org.au">www.severeasthma.org.au</a>) and the Hunter Medical Research Institute (<a href="http://www.hmri.org.au">www.hmri.org.au</a>). He is affiliated with The University of Newcastle and the HMRI. </span></em></p>Recent reports propose a connection between Zika infection and acute disseminated encephalomyelitis (ADEM).Steven Maltby, Post-doctoral Fellow in Immunology & Genetics / Research Academic for Centre of Excellence in Severe Asthma, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/538842016-02-03T19:05:40Z2016-02-03T19:05:40ZExplainer: what is Guillain-Barré syndrome and is it caused by the Zika virus?<figure><img src="https://images.theconversation.com/files/109922/original/image-20160202-32251-ati9zn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Zika virus is suspected of causing this rare autoimmune disorder. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/corneveaux/4944172309/">Jason Corneveaux/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The recent outbreak of Zika virus in South America has been a cause of concern. This is not because Zika itself is a serious condition, but because it is believed to be linked to birth defects when expectant mothers are infected, and to a rare but severe and progressive neurological disorder called Guillain-Barré syndrome.</p>
<p>The syndrome is triggered by an infection and can cause temporary or long-term paralysis. It is quite rare, occurring in approximately one in 100,000 people per year.</p>
<p>Guillain-Barré syndrome is not new. This is the 100-year anniversary of its description. The French researchers Giullain, Barré (and Strohl) first diagnosed Guillain-Barré syndrome in Paris.</p>
<p>A link between Zika and Guillain-Barré syndrome was <a href="http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20720">first proposed</a> in 2014 in French Polynesia. With the World Health Organisation reporting the “<a href="http://who.int/dg/speeches/2016/zika-situation/en/">explosive spread</a>” of Zika virus, there are concerns that Guillain-Barré syndrome levels may also increase.</p>
<p>In January 2016, El Salvador reported an <a href="http://www.who.int/csr/don/21-january-2016-gbs-el-salvador/en/">increase in Guillain-Barré cases</a> (46 in one month, which is around three times the average number of cases). This increase overlaps with high numbers of Zika infections (3,836 cases in one to two months).</p>
<p>It is important to note that it still has not been demonstrated that Zika infection actually causes Guillain-Barré syndrome. Further, even if all cases of Guillain-Barré syndrome reported in El Salvador were caused by Zika infection, only about one in 100 infected people develop Guillain-Barré syndrome. This ignores all of the cases due to other causes.</p>
<h2>Causes</h2>
<p>The exact cause of Guillain-Barré syndrome is still unclear, but it generally develops after a lung or gut infection and appears to be an <a href="https://theconversation.com/explainer-what-are-autoimmune-diseases-22577">autoimmune disease</a>. This means that symptoms are caused by our own <a href="https://theconversation.com/explainer-what-is-the-immune-system-19240">immune system</a> attacking our body.</p>
<p>The initial infection can be caused by either bacteria or viruses, and a large number of infections have been linked to Guillain-Barré syndrome. The most commonly associated infections are the bacteria <a href="https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/campylobacter">Campylobacter jejuni</a>, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cytomegalovirus-cmv">cytomegalovirus</a> and <a href="http://www.cdc.gov/epstein-barr/about-ebv.html">Epstein-Barr virus</a>.</p>
<p>When we get an infection, our immune system will <a href="https://theconversation.com/explainer-how-does-the-immune-system-learn-37285">learn to fight off</a> the invader. It does this by developing antibodies, which are molecules that can attach to the surface of the bacteria or virus. These antibodies attach to a specific pattern or shape on the surface of the bacteria or virus. When they are attached they act as a target that our immune cells will attack and kill.</p>
<p>In Guillain-Barré syndrome, our immune system makes a mistake – sometimes a similar pattern or shape to the one on the bacteria or virus is also on the surface of our nerve cells. When the antibodies attach to the surface of our nerve cells, they still act as a target. As a result, our immune cells then attack our own nerve cells.</p>
<h2>Symptoms</h2>
<p>The type and severity of symptoms vary greatly between individuals. This probably depends on the location and extent of nerve damage caused. They can range from mild numbness and weakness, to death.</p>
<p>Guillain-Barré syndrome causes rapid and progressive weakness in the arms and legs. This starts with mild symptoms, such as numbness in the hands and feet. It then spreads up the limbs and progresses to severe weakness and paralysis. </p>
<p>Symptoms generally reach full severity within four weeks. Around two-thirds of patients experience symptoms so severe they can no longer walk. </p>
<p>A high number of patients also experience pain, including backaches, muscle pain and headaches. </p>
<p>Of most concern, around 30% of patients develop respiratory problems that require life support. Up to 20% of these patients <a href="http://www.aafp.org/afp/2004/0515/p2405.html">will die</a>. A large proportion also experience problems with autonomic nervous system function (the part of the nervous system that controls organ function), which can cause heart problems. </p>
<p>Estimates of deaths caused by Guillain-Barré syndrome vary widely and rates depend on the quality of medical care. Around <a href="http://www.aafp.org/afp/2004/0515/p2405.html">5%</a> of all Guillain-Barré patients die from the condition.</p>
<p>Most patients fully recover from the disease, although a proportion (around <a href="http://www.aafp.org/afp/2004/0515/p2405.html">one-third</a> after one year) continue to experience serious problems including permanent paralysis, long-term pain and fatigue. </p>
<h2>Treatment</h2>
<p>Patients often require hospitalisation to monitor symptoms and life support if severe paralysis develops. </p>
<p>While there is currently no cure for Guillain-Barré syndrome, two treatment options can reduce disease severity and speed up recovery. One is “plasma exchange”, where the liquid portion of the patient’s blood is replaced with donor plasma. Our antibodies are contained within this plasma, so this exchange effectively removes them from our blood.</p>
<p>The second is “intravenous immunoglobulin”, where large amounts of donor antibodies (also called immunoglobulins) are injected into the bloodstream. This process effectively dilutes out the bad antibodies that were causing damage, and reduces their effect. Both aim to reduce the effect of our antibodies and limit nerve damage.</p>
<p>Treatment is often complemented with supportive procedures to decrease symptoms. These include pain relief, physiotherapy to limit muscle loss and the negative effects of being bed-bound, and life support in the case of severe symptoms.</p><img src="https://counter.theconversation.com/content/53884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Maltby receives funding from the NHMRC Centre of Excellence in Severe Asthma and the Hunter Medical Research Institute (HMRI). He is affiliated with The University of Newcastle and the HMRI. </span></em></p>Guillain-Barré syndrome is not new. This year is the 100-year anniversary of its description.Steven Maltby, Post-doctoral Fellow in Immunology & Genetics / Research Academic for CRE in Severe Asthma, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.