After fighting a bad bout of covid in April this year, Nandita K (not her real name), a mother of two, believed she had put the worst behind her. In May, she resumed her job of online teaching at a city school. However, towards the end of the month, she started experiencing muscle weakness and would suffer from prolonged periods of ‘pricking sensation’ in her hands and feet. As with most post-covid patients, both she and her physician put it down to weakness due to the virus. But in a month, Nandita was finding it difficult to lift her one-year-old daughter. “Soon, any movement became an excruciatingly painful exercise. Aches and pains became a part of my life, and simple tasks like bending or lifting something became agonising. The pain would progress towards late evening and at night,” she adds. She finally consulted a neuro physician, who diagnosed her with early-stage GBS after ruling out other possibilities.
Multiple recent studies have indicated that there may be a link between covid and GBS. “Guillain-Barre Syndrome is associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection,” said the study of 42 patients, published in the Annals of Indian Academy of Neurology. In fact, studies worldwide have shown that 30 per cent of Covid patients developed neurological symptoms such as stroke, fatigue, Bell’s palsy and sensory problems.
So, what exactly is GBS? Dr Vinit Suri, Senior Consultant, Neurology, Indraprastha Apollo Hospitals, New Delhi, says, “Landry Guillain-Barre Strohl Syndrome or GBS is an immune-mediated disease affecting the nerves. A precedent viral infection or vaccination up to four weeks earlier induces antibodies that react against the myelin sheath or covering of the nerves leading to a rapid onset of weakness of the entire body.”
To put it simply, GBS is an autoimmune disease. It is generally triggered by an immune response to a recent viral or bacterial infection. It is caused due to inflammation of the nerves leading to weakness of limbs and sometimes, in severe cases, may cause respiratory problems if weakness extends to the nerves which control the chest muscles. “Once detected, GBS usually takes an ascending course from legs to trunk and cranial nerves and may affect the swallowing and breathing muscles. Sensory symptoms of distal tingling are seen in only a few patients at the onset of the illness,” says Suri. GBS can, in extreme cases, lead to excruciating muscle pain and even paralysis leading to one being unable to walk or be wheelchair-bound for life, as in the case with the Tokyo Paralympics medal-winner.
“People with GBS first experience weakness or tingling sensations in both legs this spreads to the arms and upper body. Symptoms may increase until one cannot use some muscles; in severe cases, the person can become paralysed. Symptoms can progress over hours, days, or weeks, and weakness typically peaks within the first two weeks after symptoms appear. Recovery may take as little as a few weeks or as long as a few years,” says Dr Ashish Gosar, Consultant Neurologist, Masina Hospital, Mumbai.
A rare disorder, GBS has been there long before masks became a reality in our world. On August 30, a wheelchair-bound Yogesh Kathuniya threw his discus 44.38m to bring home the silver medal at the Tokyo Paralympics. While the country celebrated, his mother—Meena Devi—remembered her then seven-year-old son being diagnosed at the PGIMER in Chandigarh in 2006 with Guillain-Barre Syndrome (GBS). Kathuniya may have been diagnosed with GBS when the world was a different place, but in the post-Covid era, the autoimmune disease has evolved to become a bigger threat.
Unfortunately, since the symptoms are similar to many other illnesses, it is not always possible to diagnose the disorder correctly and on time. Nandita says, “Till I consulted Dr Sunil Mallik, my regular physician thought it was just another ‘weakness-related post-Covid issue’. In fact, it took the neuro physician almost two weeks to conclude.” Once diagnosed, the equally painful recovery process began.
Dr Mallik says that though there is no particular ‘cure’ for GBS, it can be countered and managed by physical therapy, the most common treatment for those mildly affected. “In severe cases, one may need intubation and ventilation, or even blood transfusion,” he says, adding, “The disorder does not even have a particular ‘cause’. It can affect anyone at any age. But at the same time, it is extremely rare. It is estimated to affect about one person in 1,00,000 each year. In all my years of practice, I have only come across three cases.”
Diagnosing GBS is based on a patient’s symptoms and neurological examination. As the syndrome worsens, patients face difficulty with eye muscles and vision, suffer from abnormal heartbeat/heart rate or blood pressure, and have difficulty swallowing, speaking, or chewing. But the good news is that as much as 95 per cent of GBS patients show a complete recovery after therapeutic intervention. In most cases, GBS never recurs in later life.
Nandita was lucky enough that the disorder was diagnosed at a somewhat early stage. Then, with the help of muscle relaxants and physiotherapy, she began on her slow road to recovery. After months of therapy, Nandita is partly relieved of the pain and constant ‘pins and needles sensations. “After therapy, when I first lifted my daughter in my arms, I broke down. The journey to recovery has been painful, but Dr Mallik has assured me that I will soon be able to put all this behind me,” she says with a smile.