Autonomic Dysfunction In Guillain Barr Syndrome Gbs

Overview

Guillain-Barré syndrome (GBS) is a rare condition where the body's immune system — the body's defence system — mistakenly attacks its own nerves. 'Autonomic dysfunction' means that this attack also affects the autonomic nervous system. This is the part of the nervous system that runs things you don't think about, like your heartbeat, blood pressure, sweating, digestion and going to the toilet. When these nerves are irritated, those automatic jobs can become uneven: your blood pressure may swing up and down, your heart may race or slow, and you may sweat more or less than usual. It sounds frightening, but it is a known part of GBS, and hospital teams are used to watching for it and managing it.

Autonomic problems are a recognised and fairly common part of GBS, particularly when the weakness is more severe or when someone needs intensive care. Not everyone with GBS gets them, and for many people the changes are mild. Your care team will know what to look for.

GBS can affect anyone at any age, but it is more often seen in adults. Autonomic problems are more likely in people with more severe weakness, in older adults, in people who already have heart or blood pressure conditions, and in those who are very unwell in an intensive care unit.

Symptoms

Common symptoms

• Feeling dizzy, light-headed or 'blacking out' when sitting or standing up, because blood pressure drops
• Blood pressure that swings — sometimes high, sometimes low — even without much warning
• A heartbeat that feels fast, fluttering, pounding or occasionally very slow
• Sweating much more than usual, or skin that is dry when you would expect to sweat
• Feeling hot or cold, or having clammy, blotchy skin
• Constipation, bloating, or a stomach that feels slow to empty
• Trouble passing urine, a weak stream, or feeling you cannot fully empty your bladder
• Changes in vision such as blurring when you change position

Symptoms in children

• Being fussy or unsettled in a way that is hard to explain, especially when moved or sat up
• Sweating, pale or blotchy skin, or feeling clammy to touch
• Tummy pain, constipation or trouble passing urine
• Dizziness or clinginess when sitting up or being lifted
• Heart rate changes that staff notice on the monitor rather than the child describing them
• Children may not be able to explain 'dizzy' — they may just look pale, tired or upset

Symptoms in older adults

• Falls or unsteadiness, especially when getting up from a chair or bed
• Fainting or near-fainting that may be put down to 'just age'
• Confusion or drowsiness when blood pressure drops
• Symptoms that are made worse by existing heart conditions or by medicines for blood pressure
• Constipation or bladder problems that are easy to blame on other causes
• Feeling more tired or weak than expected, which can hide a low blood pressure

Causes

Main causes

• GBS itself: the immune system attacks the covering or the body of nerves, and small nerve fibres that control automatic body functions can be caught up in this.
• Damage to the vagus nerve and other nerves that carry signals between the brain, heart, blood vessels and gut.
• The general stress of being very unwell, lying in bed for a long time, and changes in fluid levels in the body.
• Some treatments and medicines used in hospital can affect heart rate, blood pressure or the bladder, so teams adjust them carefully.

Risk factors

• More severe GBS, especially if you need help with breathing or care in an intensive care unit
• Older age
• Already having heart disease, high or low blood pressure, or diabetes
• Losing weight or eating and drinking poorly during illness
• Long periods of lying flat in bed
• Certain infections in the weeks before GBS started — GBS often follows an infection, though the exact trigger is not always found

When to see a doctor

See a doctor urgently if:

• You feel dizzy or faint when you sit or stand up, or you have already fainted
• Your heart feels fast, pounding or uneven, even if it settles
• You cannot pass urine, or your bladder feels full and painful
• You are constipated and your tummy is swollen or tender
• You notice you are sweating much more or much less than before
• You feel breathless, or you cough or choke when eating or drinking
• Your weakness is getting worse rather than staying steady or improving

Book a routine appointment if:

• You want to understand your blood pressure or heart rate readings
• You are worried about constipation, bladder habits or changes in sweating
• You feel dizzy in the mornings or after meals
• You are unsure whether a symptom is part of GBS or something else
• You would like advice about returning to activity, work or driving

Diagnosis

There is no single test for autonomic dysfunction in GBS. Doctors make the diagnosis by putting together your story, your examination, and close watching of your heart rate and blood pressure. In hospital this often means regular checks, sometimes with a heart tracing and a monitor. The aim is to spot changes early and keep you safe while your nerves recover.

Tests that may be done

• Blood pressure and heart rate checks, including lying down and then sitting or standing up
• An electrocardiogram (ECG) — a quick, painless tracing of the heart's rhythm
• Continuous heart monitoring in hospital if your team is concerned
• Blood tests to check salts, fluid levels, blood sugar and other causes of symptoms
• A bladder scan — a painless ultrasound to see whether your bladder is emptying properly
• Tests of nerve function, which your neurologist may arrange
• A tilt-table test in some cases — a special bed that tilts you to see how your blood pressure and heart rate respond

What to expect at your appointment

Most of these checks are quick and painless. You may be asked to lie still for a few minutes, then sit or stand while your blood pressure is taken again. Some people feel dizzy during these checks; tell the person doing the test straight away, as they can stop and help you. You may also be asked about your bowel and bladder habits, which can feel personal but helps your team keep you comfortable and safe.

Treatment

The main aim is to keep your heart, blood pressure, bowel and bladder steady while your nerves heal. That means close monitoring in hospital, adjusting fluids and activity, and treating the underlying GBS itself. Your team will choose the approach that fits your situation, and the plan may change from day to day.

Self-care at home

• Stand up slowly: sit on the edge of the bed for a minute first, then rise, and hold something steady
• Tell staff straight away if you feel dizzy, sick, sweaty or your vision goes grey — do not try to 'push through'
• Drink regularly unless your team has asked you to limit fluids
• Eat small, frequent meals if you feel full quickly or bloated
• Keep a simple diary of dizziness, heart flutters, sweating and toilet habits to show your team
• Avoid very hot baths or showers if heat makes you dizzy
• Ask about compression stockings or gentle leg movements if you are spending a lot of time in bed
• Take your time with eating and drinking, and sit upright for meals

Medical treatments

In hospital, treatment has two parts. First, the GBS itself is treated with approaches that help calm the immune system's attack on the nerves — your medical team will explain which option is right for you and why. Second, the autonomic symptoms are managed supportively. That can include careful monitoring of heart rate and blood pressure, adjusting how much fluid and salt you have, planning how you move and sit up, and using equipment such as compression stockings or a leg pump to help circulation. If your heart rhythm becomes a concern, or your bladder stops emptying, your team will bring in the right specialists. Medicines may be used for specific problems such as constipation, bladder emptying, or blood pressure and heart rate control, chosen and adjusted by your doctors — never start or change any medicine on your own.

When is surgery considered?

Surgery is not a treatment for autonomic dysfunction in GBS. Occasionally a small procedure may be needed to help drain the bladder if it is not emptying, but this is decided case by case by your medical team.

Living with this condition

Recovery from GBS takes time, and the autonomic symptoms usually improve gradually as the nerves heal. In the early weeks, life may feel very controlled by monitors, checks and routines. That is normal. As you get stronger, you can build back ordinary activities slowly — sitting up for longer, then standing, then walking short distances with help. Plan your day around rest, and do not be discouraged by good days and harder days following each other.

Lifestyle tips

• Build activity up slowly, with advice from your physiotherapy team
• Keep a note of your symptoms and bring it to appointments
• Stay hydrated and eat regular, balanced meals; ask for a dietitian if eating is difficult
• Avoid standing up quickly, very hot baths, and long periods standing still if these make you dizzy
• Keep your home safe — good lighting, clear walkways, a phone within reach
• Pace yourself and plan rest after activity
• Ask your team before driving again, and before returning to work or strenuous exercise

Diet and exercise

Eat regular meals with plenty of fibre — fruit, vegetables, wholegrains, beans and lentils — and drink enough fluid to keep your bowels moving, unless your team has told you to limit fluids. Smaller, more frequent meals can help if you feel full quickly. Gentle movement, such as ankle circles and leg lifts in bed, and later short walks, helps circulation and reduces dizziness. A physiotherapist can design a programme that matches your stage of recovery, and an occupational therapist can help you manage everyday tasks safely.

Mental health and emotional wellbeing

GBS can be frightening, and the swings in your body can make you feel out of control. Anxiety, low mood, poor sleep and frustration are common and understandable. Talking about it helps — with your team, family, or a counsellor. If you ever feel you cannot cope, or you have thoughts of harming yourself, please reach out for help straight away: contact your local emergency number or a crisis support line in your country, or tell a member of your care team immediately. You do not have to manage alone.

Prevention

GBS itself cannot be reliably prevented, and autonomic dysfunction is part of how GBS affects some people rather than something you could have avoided. What you can do is help catch problems early: report dizziness, heart flutters, sweating changes and toilet problems promptly, and follow your team's advice about moving, drinking and eating.

Vaccines

Vaccines are not a common cause of GBS, and GBS has been reported rarely after some infections and, very rarely, after some vaccines. If you have had GBS, talk to your doctor before any vaccination so the decision can be made together with your history in mind.

Screening programmes

There is no screening test for autonomic dysfunction in the general population. During GBS, your team screens for it by checking your heart rate, blood pressure, bowel and bladder function regularly.

Complications

If left untreated

• Falls and injuries from dizziness or fainting
• Dangerous changes in heart rhythm
• Very high or very low blood pressure
• Food or drink going down the wrong way, which can lead to chest infection
• A bladder that does not empty, which can cause infection or kidney strain
• Severe constipation and discomfort
• Longer time in hospital and slower rehabilitation

Long-term outlook

The great majority of people with GBS improve over time, and the autonomic problems usually settle as the nerves recover. Recovery is often slow — weeks to months, sometimes longer — and some people have lingering tiredness or odd sensations. Being monitored closely in hospital is exactly what keeps the riskiest moments safe. Many people return to their usual lives, and rehabilitation and support help you get there.

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