Why does the immune system attack the nerves?
Some microbes have molecules on their surface that resemble nerve sheath structures. The immune system produces antibodies against them, and they mistakenly bind to their own nerve fibers. The myelin sheath is damaged, and sometimes the axial cylinder itself is damaged - the conduction of the impulse is slowed down or interrupted. The long nerves are primarily affected, so symptoms begin in the feet and hands and spread upward. The disease is not contagious, and it is impossible to predict its development in advance.
- Precipitating infection 1–3 weeks before
- Intestinal infections, especially those caused by Campylobacter
- Respiratory viral infections
- Herpetic group viruses, cytomegalovirus
- Rarely - after surgery or vaccination
- Demyelinating and axonal variants of the course
Symptoms and their development
Tingling and numbness in the tips of the toes and hands usually appear first, followed by weakness: it is difficult to climb stairs, get out of a chair, and gait becomes unsteady. The weakness is symmetrical and spreads from bottom to top, increasing over the course of days, less often - up to four weeks. Upon examination, the doctor discovers the absence of tendon reflexes. Pain in the back and hips is often a concern. Sometimes the muscles of the face and eyes are involved, as well as autonomic regulation - pressure drops and heart rhythm disturbances appear.
- Numbness and tingling in the feet and hands
- Symmetrical increasing weakness from bottom to top
- Unsteadiness of gait, difficulty standing up
- Disappearance of tendon reflexes
- Pain in the lower back and thigh muscles
- Weakness of facial muscles, double vision
- Swallowing and breathing problems in severe cases
Diagnostics
The diagnosis is primarily clinical: the doctor relies on the nature and rate of increase in weakness, symmetry and loss of reflexes. It is confirmed by electroneuromyography, which shows a violation of nerve conduction, and by examination of the cerebrospinal fluid, where an increase in protein with a normal number of cells is typical. It is important that in the first days both studies may still be normal, and this is not a reason to delay treatment. Respiratory function must be assessed regularly because it may deteriorate unnoticed.
- Examination by a neurologist with assessment of reflexes and strength
- Electroneuromyography
- Lumbar puncture with cerebrospinal fluid examination
- Spirometry and assessment of inspiratory force over time
- ECG and pressure monitoring
- General and biochemical blood test
- MRI of the spine to rule out spinal cord compression
Treatment
Treatment is carried out in a hospital, and with a rapid increase in weakness - in the intensive care unit. Two equally effective methods are used: intravenous administration of immunoglobulin or plasmapheresis; the choice depends on the patient’s condition and the clinic’s capabilities. The earlier therapy is started, the better the outcome. Glucocorticoids are ineffective for this disease. Care is of great importance: prevention of thrombosis and bedsores, pain relief, nutritional support and, if necessary, artificial ventilation. All decisions are made by the doctor; treatment at home is unacceptable.
- Hospitalization and monitoring of breathing
- Intravenous immunoglobulin
- Plasmapheresis as an alternative
- Prevention of deep vein thrombosis
- Pain relief for neuropathic pain
- Artificial ventilation for respiratory failure
- Glucocorticoids are not used as primary therapy
Recovery and prognosis
After the increase in weakness has stopped, the condition remains on a plateau for some time, and then recovery begins, which goes from top to bottom and takes from several weeks to a year or more. Rehabilitation should begin already in the hospital: passive movements, breathing exercises, gradual verticalization. Then strength and balance training is added, and work with an occupational therapist and speech therapist if necessary. Most people return to independent living, although some may still have foot weakness, fatigue, or numbness. Repeated cases are rare.
- Early rehabilitation in hospital
- Breathing exercises and prevention of contractures
- Gradual increase in loads without overwork
- Orthoses for foot weakness
- Treatment of neuropathic pain and fatigue
- Observation by a neurologist after discharge