THE University Hospital of the West Indies in St Andrew saw about five cases of Guillain-Barré syndrome (GBS) between October and November 2014. According to consultant neurologist Dr Francene Gayle, on average, she has seen one case of GBS per year since she has been at the health facility.

The consultant neurologist told the Jamaica Observer that the chikungunya virus that swept across the island late last year and has left several with lingering joint pains caused a spike in the number of GBS cases.

“I must tell you that, on average, since I have been back, I have been home three years, so on average, I see maybe one case of GBS per year at the University Hospital of the West Indies,” Dr Gayle disclosed. “But with CHIKV, between October and November, we saw about five cases of Guillain-Barré syndrome, so it resulted in a spike in the number of cases that we would normally see annually.”

GBS is a disorder in which the body’s immune system attacks part of the peripheral nervous system. The symptoms generally include weakness and tingling in the limbs before spreading, and eventually resulting in paralysis.

Speaking to Your Health Your Wealth in a recent interview, Dr Gayle said there are a few causes but the commonest cause is post-viral illness. The consultant neurologist explained that influenza as well as a particular bacteria known as campylobacter jejuni can bring on GBS.

She also spoke specifically to the Jamaican context. “In our Jamaican context, chikungunya virus is also associated with Guillain-Barré syndrome,” Dr Gayle said. “Viruses, on a whole, what they do is that your body mounts an attack against the infectious agent and, unfortunately, there are various proteins on the surface of the viruses that your immune system targets.

“These same proteins have similar proteins on the nerve linings and so the antibodies that are produced to fight these viral infections can actually be mediated against those proteins on the nerves within the body,” she continued. “And so the nerves get damaged as a bystander.”

She pointed out that it is not unique to any particular virus, but that in response to the attack on the virus, the nerves get damaged in the process.

The patient with chikungunya-associated GBS would present with similar symptoms as with any other GBS patient.

Since it is indistinguishable, Dr Gayle told Your Health Your Wealth that patients will say that they have weakness, which begins in their limbs.

“This is in general, whether it is CHIKV-mediated or influenza-associated GBS, it is the typical ascending paralysis involving four limbs with respiratory involvement or laryngeal involvement.”

But how is GBS diagnosed?

“Clinically, we suspect it in patients who have the diarrhoeal illness or the viral illness three weeks previously, and then, in addition to the classic ascending paralysis and the respiratory symptoms and swallowing difficulty, the examination of the patient would reveal what is called the quadriparesis,” Dr Gayle explained. “With a loss of power and additionally a loss of reflexes in the lower limbs, and they would usually as well have respiratory difficulties, shortness of breath, difficulty with their swallowing, that makes us suspicious that this is Guillain-Barré syndrome.”

The consultant neurologist said it is then confirmed by doing a lumbar puncture, which is where a sample of fluid is taken from the lower back and it is tested for various proteins.

“In Guillain-Barré syndrome, those CSS proteins are extremely high,” said Dr Gayle. “The GBS can also be confirmed by doing a nerve conduction test, because what happens when the myelin gets stripped off or peeled off, the nerves do not function.

“And so they don’t pass electrical information as quickly as they should,” the consultant neurologist continued. “So the nerve conduction test evaluates the speed at which the nerve transmits electrical information and in Guillain-Barré syndrome, conduction velocity or conduction speeds are remarkably reduced.”

She added that the reduction in the speed of transmission would be greater than 80 per cent.