Guillain Barre Syndrome: Remedies, Ayurvedic Treatment

Article By Dr Raghuram Y.S. MD(Ay) 
Guillain-Barre Syndrome (GBS) is a rare disorder in which your body’s immune (protective) system attacks your nerves. Weakness and tingling in your extremities are usually its first symptoms. These sensations can spread quickly. Eventually your whole body may be paralyzed. On the other hand there is a rapid onset of muscle weakness which keeps progressing and later stabilizes. This happens due to the damage to the peripheral nervous system.

GBS an auto-immune disease

GBS is an autoimmune disease
GBS is defined as a poly-neuropathy. In this the body’s immune system mistakenly attacks the peripheral nerves (nerves outside the brain and spinal cord). When this happens, the insulation around the nerves (myelin) is destroyed. Sometimes this process is triggered by an infection.

In its most severe form, GBS is a medical emergency needing hospitalization to receive treatment
The exact cause of GBS is unknown. It is often preceded by an infection such as a respiratory infection or the stomach flu.

There is no known cure for GBS. Some treatments can ease the symptoms and thereby reduce the duration of the illness. Most people recover from GBS. Some experience lingering effects including weakness, numbness or fatigue.

Tips and home remedies

Tips and home remedies for Guillain Barre Syndrome

• Diet rich in minerals, vitamins A, C, E & B complex and food rich in fatty acids such as Omega 3s and Omega 6s
• Eat lot of beans, legumes, fish, lean-meat, plenty of fruits and vegetables
• Eat lot of fibre rich food
• Calculate your fat, carbohydrate and protein content of food. Take right quantities
• Avoid processed foods
• Take organic foods
• Eat whole grain cereals, brown rice, non-processed sugars
• Include mushrooms, beet, kale, avocado, grapefruit, soy beans and bell pepper in your diet (they boost your immunity)
• Green leafy vegetables like spinach boost immunity
• Yogurt, quinoa, cantaloupes, endives, kidney beans, shrimp, salmon and tuna are some known anti-inflammatory and immunity enhancing foods. Have more of them.
• Citrus fruits such as oranges, grapes and grapefruits are high in antioxidants which are essential to preserve strength of the body and to boost immunity
• Include cinnamon which has been proven for its worth in auto-immune diseases. It is antiviral, anti-bacterial and anti-tumour agent.
• Turmeric – It has potential anti-inflammatory agents like curcumin. Immune boosting properties of turmeric alleviate fatigue and neural problems associated with GBS. It also makes immune system healthy.

Modern view

About Guillain-Barre Syndrome – Disease details (Modern view):

GBS is an autoimmune disease in which the body’s defensive mechanism becomes offensive and attacks your nerves. It presents with weakness and tingling sensation in the extremities.

Presentation:

• Many patients experience changes in sensation (how we feel) or develop a pain in the muscles
• Later there is muscle weakness
• The muscle weakness typically begins in the feet and hands (lower and upper limbs)
• The symptoms can suddenly develop within half a day or gradually within a span of 2 weeks
• During acute phase GBS can be life-threatening. At least 25% of them develop weakness of the muscles responsible for breathing. Mechanical ventilation may be needed in such cases.
• In some, changes in the function of the autonomic nervous system can be seen. These people will have dangerous abnormalities in heart rate and blood pressure.

Other names:

• Guillain-Barre-Strohl syndrome
• Landry’s paralysis

Causes

• Infections (2/3 people) – Episodes of gastroenteritis or a respiratory tract infection
• Approximately 30% cases are provoked by Campylobacter jejuni bacteria (which cause diarrhoea)
• 10% cases can be attributed to Cytomegalovirus (CMV, HHV-5)
• Herpes viruses – Epstein-Barr virus / HHV-4 and Varicella zoster virus / HHV-3 (less certain)
• Mycoplasma pneumoniae bacterium (less certain)
• Dengue fever
• Previous Hepatitis-E virus infection
• Some cases of GBS may be triggered by influenza virus (influenza vaccine)

Signs and symptoms

The first and the most important symptoms of GBS are

• Numbness
• Tingling sensation
• Pain

They may be present singly or in combination
This is followed by –
Weakness:

• Weakness of the legs and arms affecting both sides of the body equally, the weakness worsens with time.
• The tingling and weakness starts in the feet and legs and spreads to your upper body and arms. In 10% of people the symptoms begin in arms or face.
• Weakness can take half a day or over 2 weeks time to reach maximum severity, later it becomes more or less steady
• Rarely (1 in 5 cases) the weakness continues to progress for a long period of 4 weeks
• Neck muscles may also be affected
• Difficulty with eye or facial movements (speaking, chewing, swallowing) – Many (50%) experience involvement of cranial nerves which supply the head and face. This will lead to weakness of face and eye muscles & difficulty in swallowing
• In about 8% weakness affects only the legs (paraplegia or paraparesis)
• Difficulty with bladder control and bowel clearance (involvement of muscles controlling urinary bladder and anus is unusual and not very common)

Other symptoms:

• Unsteady walking or inability to walk or climb stairs
• Rapid heart rate
• Low or high blood pressure
• Difficult breathing
• About 1/3 of people with GBS continue to be able to walk

Plateau phase – Once the weakness has stopped progressing, it persists at a stable level before improvement occurs. This phase can take between 2 days and 6 months (commonly 1 week)

As GBS progresses, the muscle weakness can evolve into paralysis

Pain related symptoms – affect more than 50% people and include –

• Back pain
• Painful tingling
• Pricking ‘pins and needles’ sensations in fingers, toes, ankles or wrists
• Severe pain (aching or cramp-like) often worsening at night
• Muscle pain
• Pain in the head and neck

Symptoms related to infection:

• If infection predisposes GBS – people may experience signs and symptoms of an infection in 3-6 weeks prior to the onset of the neurological symptoms including upper respiratory tract infection (sore throat, rhinitis etc) or diarrhoea

In ‘Miller Fisher’ variant subtype of GBS – weakness of the eye muscles (opthalmoplegia) is more pronounced. It may occur along with abnormalities in coordination (ataxia).

Level of consciousness is normally unaffected in GBS

Neurological examination –

• Reduced power or absent of tendon reflexes (hyporelfexia or areflexia respectively)
• Sometimes (rare) we can see normal reflexes before developing areflexia and some may have exaggerated reflexes

Respiratory failure:

• About a quarter of people with GBS develop weakness of the breathing muscles leading to respiratory failure (inability to breathe adequately to maintain healthy levels of oxygen and / or carbon dioxide in the blood)
• Pneumonia, severe infections, blood clots in the lungs and bleeding in digestive tract also can take place. This will seriously pose a threat to life. Most of these people might require artificial ventilation.

Autonomic dysfunction:

• In about 2/3 of people suffering with GBS, the autonomic or involuntary nervous system is involved. This system controls body functions such as heart rate and blood pressure. About 20% of these people experience severe BP fluctuations and irregularities in heartbeat. Many times, heart beat stops and will require pacemaker-based treatment.
• Associated problems – Perspiration (excessive sweating) and changes in reactivity of pupils

Types of GB Syndrome

• Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) – Muscle weakness starts in the lower part of the body and spreads upwards (common in US)
• Miller Fisher Syndrome (MFS) – Paralysis starts with the eyes, associated with unsteady gait (more common in Asia)
• Acute motor axonal neuropathy (AMAN) and Acute Motor-Sensory Axonal Neuropathy (AMSAN) – frequent in China, Japan and Mexico

Mechanism:

• Immune attack on the nerve cells of the peripheral nervous system and their supporting structures leads to activation of a group of blood proteins called complement.
• Following this the white blood cells (T lymphocytes and macrophages) damage and destroy the myelin sheath of nerves – protective insulation over the nerves (in demyelinating variant). In the axonal variant is mediated by attack on cell membrane covering the axon by IgG antibodies and complement.
• Various antibodies thus directed at nerve cells cause nerve dysfunction
• The production of these antibodies after an infection is probably the result of molecular mimicry. Here the immune system is reacting to microbial substances but the resultant antibodies also react with substances occurring naturally in the body
• These antibodies have been shown to bind to gangliosides, a group of substances found in peripheral nerves, cross react with them and trigger the reactions
• This further leads to weakness, pain, numbness and tingling in muscles leading to GBS

Diagnosis

Usually done on clinical findings (symptoms) such as –
Rapid development of muscle paralysis
Absent reflexes
Absence of fever

• Cerebrospinal fluid analysis (CSF analysis) / Spinal tap / Lumbar puncture – In GBS – protein levels are elevated in CSF with low numbers of white blood cells (albumin-cytological dissociation). This distinguishes it from a number of other conditions such as lymphoma and poliomyelitis where both the protein and cell count are elevated
• Nerve conduction studies
• Electromyography
• Testing for anti-ganglioside antibodies
• Blood test for

Potassium levels (to exclude possibility of another cause for weakness such as low level of potassium in blood)
Sodium levels (abnormally low level of sodium in blood is often encountered in GBS)

• MRI of spinal cord – To distinguish between GBS and other conditions causing limb weakness such as spinal cord compression (MRI scan shows enhancement of nerve roots in GBS)

Complications

• Breathing difficulties
• Residual numbness or other sensations
• Heart problems (irregular heart rhythms – cardiac arrhythmias) and Blood pressure fluctuations
• Pain – nerve pains which may be eased with medications
• Bowel and bladder problems (sluggish bowel functions, urinary retention)
• Blood clots – People with GBS who cannot walk are at risk of developing clots, they must take blood thinners and wear support stockings until they are able to walk independently
• Pressure sores (bed sores due to being immobile) – frequent re-positioning should be advised
• Relapse – Up to 5% of people with GBS experience relapse.
• Death – can occur rarely from complications such as respiratory distress syndrome and heart attack

Prognosis

• Prompt treatment with intravenous immuno-globulins or plasmapheresis together with supportive care will lead to a good recovery in majority of patients with severe weakness.
• Death (in about 5% cases) – As a result of a number of complications including severe infections, blood clots and cardiac arrest
• Poor outcome in those above 40 years of age
• After 2 weeks when the symptoms are severe
• Worst prognosis in those who have experienced diarrhoea before the onset of GBS
• Some patients may experience ongoing difficulty with walking, painful symptoms
• Some patients require long-term breathing support
• On nerve conduction study, the presence of conduction block predicts poorer outcome at 6 months
• In those who have received intravenous immunoglobulins, a small increase in IgG in the blood (2 weeks after administration) is associated with poorer mobility outcomes at 6 months than those whose IgG level increased substantially
• If the disease progresses beyond 4 weeks (or there are multiple fluctuations in severity – more than 2 in 8 weeks) the diagnosis may be chronic inflammatory demyelinating polyneuropathy
• The health related quality of life (HRQL) after an attack of GBS can be significantly impaired. About 1/5^th people are unable to walk unaided after 6 months. They may experience chronic pain, fatigue and difficulty with work, education, hobbies and social activities
• HQRL significantly improves in the first year

Scale indicating prognosis of GBS –
0 – completely healthy
1 – Very minor symptoms but the patient is able to run
2 – able to walk but unable to run
3 – Requires a stick or other support to walk
4 – Confined to bed or chair
5 – Requiring long-term respiratory support
6 – Death

Ayurvedic concepts, treatment

Exact correlation of any condition explained in Ayurveda cannot be made precisely with Guillain-Barre Syndrome. Below mentioned are a few conditions which I have tried to categories under GBS due to proximity of their clinical presentation.

Mamsagata Vata / Medogata Vata
गुर्वङ्गं तुध्यतेऽत्यर्थं दण्डमुष्टिहतं यथा।
सरुक् श्रमितमत्यर्थं मा.समेदोगतेऽनिले॥{च.चि}

When the morbid Vata afflicts Mamsa (muscles / flesh) and / or Meda (fat tissue) the below said symptoms are seen:

• Gurvangam – Heaviness of the body
• Ati toda – Pricking / tingling in the body (muscles)
• Dandamushti hatam yatha – Feeling as if someone has hit with a closed fist or a stick
• Saruk – Pains
• Shramitam – Weakness

Myelin sheath is a fatty white substance that surrounds the axon of some nerve cells, forming an electrically insulating layer. It is essential for the proper functioning of nervous system. This is damaged in GBS. This can be compared to Medogata Vata i.e. the vitiated Vata owing to its property of dryness and roughness destroys the fat (myelin in this context). This will impact the conductivity of nerve signals at their synapse with muscle fibres. The muscles get weak and lead to GBS. This can be considered as Mamsagata Vata.

Kaphavrita Vyana
स्तम्भो दण्डकश्चापि शूलशोथौ कफावृते॥{मा.नि}
गुरुता सर्वगात्राणां सर्वसन्ध्यस्थिजा रुजः।
व्याने कफावृते लिङ्गं गतिसङ्गस्तथाऽधिकः॥{च.चि}

When the functioning of Vyana Vata is blocked or enveloped by morbid Kapha the person suffers from –

• Stambha – Tightness all over the body
• Dandaka – Stiffness all over the body, body becomes like a stick
• Shoola – Pain
• Shotha – Swelling / inflammation
• Guruta sarvagaatraanaam – Heaviness of the whole body
• Sarva sandhi asthi ruja – Pain in all the joints and bones
• Adhika gatisangha – Severe restriction of movements

Kaphavrita Prana
दौर्बल्यं सदनं तन्द्रा वैरस्यं च कफावृते॥{मा.नि}

When the functioning of Prana Vata is blocked or enveloped by morbid Kapha the person suffers from –

• Daurbalyam – Weakness
• Sadanam – tiredness / fatigue
• Tandra – Stupor
• Vairasyam – manifestation of opposite and variable tastes in the mouth (ex. sweet appears as sour)

Sarvanga Vata
सर्वाङ्गकुपिते वाते गात्रस्फुरणभञ्जने॥
वेदनाभिःपरीतश्च स्फुटन्तीवास्य सन्धयः।{च.चि}

When Vata is vitiated all over the body it causes the below said symptoms:

• Gaatrasphurana – Pulsating pain all over the body
• Gatrabhanjana – Breaking pain all over the body
• Sandhi vedana – Pain in all the joints
• Sandhi sphota – Blasting pain in all the joints

Majority of the symptoms in the above said conditions mimic the symptoms of GBS

Ayurvedic treatment principles of Guillain-Barre Syndrome:
GBS should be treated on the lines of treatment of:

Vata Vyadhi –

• Vata disorders in general, because it is Vata which is controlling the whole body and the morbidity of Vata can afflict the functions of each and every cell, tissue and organ in the body. In GBS, the primary manifestation is weakness, numbness, tingling – all of which are caused by vitiated Vata.
• The complications explained in GBS can be correlated with the organs and tissues being afflicted by maximum vitiation of Vata. When Vata is vitiated to peaks it tends to deplete all the tissues in the body, pitta and kapha doshas, the immunity and life span of an individual.
• Thus control of Vata is the key in treatment of GBS. Vata shaman (pacifying the Vata) and Vatanulomana (propelling the morbid vata in a downward direction) by the administration of effective medications and treatment will lead to the effective cure of GBS.

In conditions like Sarvanga Vata (Vata vitiated in the whole body) and all Vata disorders, we should treat Vata effectively. The same principle shall be implemented in GBS too –

Treating Vayu Dosha

• Sneha – Administration of medicated oils / ghee, Massage, oil pouring etc
• Sweda – Steaming / sudation / sweating therapy
• Mridu shodanam – Evacuation treatment (mild cleansing treatments like Virechana etc)
• Svadu bhojana – Consuming sweet foods
• Amla bhojana – consuming sour foods
• Lavana bhojana – consuming salty foods
• Ushna bhojana – Hot and fresh foods
• Abhyangam – Massage with herbal oils
• Mardana – Tapping the body with closed fists after application of vata alleviating oils
• Seka – Pouring of medicated oils over the body in streams
• Paishtika Madhya – Alcohol or fermented products prepared with flours
• Goudika Madhya – Alcohol or fermented products prepared with jaggery
• Snigdhoshna Vasti – Medicated enemas with oils and ghee, given luke warm
• Deepana pachana sneha – Oils and ghee processed with deepana (appetizer) and pachana (digestant) drugs

Avoiding Vata prakopaka ahara vihara

Avoiding food and life style activities which aggravate Vata include –

Vata Prakopaka Karanani (Causative factors responsible for Vata vitiation): 

• Vyayama – Excessive exercises
• Apatarpana – Fasting in excess
• Prapatana – Fall, injury
• Bhanga – Fractures
• Kshaya – Depletion of tissues
• Jaagarat – Excessive vigil (awakening all night)
• Veganam cha vidharanat – Suppression of natural body urges (reflexes)
• Ati shuchi – Excessive administration of cleansing procedures (Panchakarma)
• Shaityadi – Excessive consumption of cold foods and activities
• Traasaat – Fear
• Ruksha – Excessive consumption of dry foods
• Kshobha – Irritation
• Kashaya – Excessive consumption of astringent foods
• Tikta – Excessive consumption of bitter foods
• Katu – Excessive consumption of pungent foods
• Vari-ghanagame – cloudy and rainy season
• Parinate anne – After the digestion of food
• Aparahne – Evening

Vataghna herbs

Useful Vataghna herbs in GBS (Herbs alleviating Vata) – =

• Devadaru – Cedrus deodara
• Kushta – Saussurea lappa
• Bala – Sida cordifolia
• Atibala – Abutilon indicum
• Shallaki – Boswellia settata
• Agnimantha – Clerodendrum phlomidis
• Guduchi – Tinospora cordifolia
• Eranda – Ricinus communis
• Shatavari – Asparagus racemosus
• Punarnava – Boerhavia diffusa
• Dashamula – Roots of 10 drugs

Gatavata Avastha (Mamsagata Vata and Medogata Vata) –

• Gatavata is a condition wherein the vitiated Vata gets lodged in some tissue and disturbs the qualitative and quantitative integrity of that particular dhatu (tissue) or organ leading to either depletion or destruction (partial or whole) of the target tissue / organ.
• Here Vata getting lodged in Mamsa (muscle / flesh) and Meda (fat) tissues causes GBS like symptoms. Therefore GBS shall be treated on the lines of Mamsagata Vata and Medogata Vata
• In these conditions treatments and medicines so as to pacify vata (Vatashamana) or remove vata (Vatanulomana) should be considered. Apart from this Balya (strengthening) and Brumhana (bulk promoting) medicines along with Rasayana (tissue rejuvenators, anti-ageing agents) should be given to increase the cellular immunity and aid their recovery (in terms of quality and quantity)
• The below said are the best in tackling Mamsagata Vata and Medogata Vata –

Virechana – Therapeutic purgation
Niruha vasti – Medicated decoction enemas
Shamana chikitsa – Palliative treatments and medicines

Vata Avarana (Kaphavrita Prana and Kaphavrita Vyana) –
Avarana of Vata is a condition in which the normal functioning of Vata is obstructed when Vata or its subtypes get blocked or enveloped by any elements of the body (including Pitta, Kapha, Food, Stools etc) or its own sub types. This leads to serious illness.

In Kaphavrita Prana and Kaphavrita Vyana conditions which resemble GBS, we first have to deal with the obstructing or enveloping element i.e. Kapha. After removing the obstruction, the victims i.e. Prana Vata and Vyana Vata are treated.

When Vata is obstructed by Kapha the below said measures should be followed:
कफावृते यवान्नानि जाङ्गला मृगपक्षिणः।
स्वेदास्तीक्ष्णा निरूहाश्च वमनं सविरेचनं।
जीर्णं सर्पिस्तथा तैलं तिलसर्षपजं हितम्॥{च.चि}

• Teekshna swedana – Intense sudation / fomentation / sweating treatment
• Niruha vasti – Medicated decoction enemas
• Vamana – Therapeutic emesis
• Virechana – Therapeutic purgation
• Yavanna – food prepared with Yava (barley)
• Jangala mamsa – Flesh / meat of animals and birds living in dry lands
• Jeerna sarpi – old ghee
• Tila Tailam – Sesame oil
• Sarshapa Tailam – Mustard oil

यापन वस्तयः प्रायो मधुराः सानुवासनाः।
प्रसमीक्ष्य बलाधिक्यं मृदु वा स्रंसनं हितम्।{च.चि}

The below mentioned are best in tackling the Avarana conditions

• Yapana Vasti – Nourishing enemas
• Madhura Anuvasana Vasti – Enemas with oils and ghee processed with drugs having sweet taste
• Mrudu sramsanam – Mild laxatives (after judging the strength of the patient)

Other treatment strategies

Other strategies to be adopted in the treatment:
Brumhana –

Brumhana means bulk promoters. Medicines which improve the muscle bulk also strengthen the muscles. They also provide nutrition and nourishment to the tissues. These medicines can be used both during treatment and also during follow up. Read more about Brihmana therapy

Below said are the best Brumhana drugs –

• Ksheerini – Ipomoea digitata
• Rajakshavaka – Euphorbia hirta
• Ashwagandha – Withania somnifera
• Kakoli – Roscoea procera
• Ksheerakakoli – Lilium polphyllum
• Vaatyaayini – Sida cordifolia
• Bhadraudani – Sida rhombifolia
• Bhaaradvaaji – Thespesia lampas
• Payasya – Pueraria tuberose
• Rushyagandha – Argyreia speciosa

Others:

• Navanna – New paddy / rice
• Shali – Rice
• Masha – Black grams
• Godhuma – Wheat
• Ikshu vikara – Sugarcane and its derivatives (jaggery, sugar etc)
• Anupa mamsa – Flesh of animals living in marshy areas
• Audaka mamsa – Flesh of animals living in water
• Dadhi – curds
• Dugdha – milk
• Ghrita – Ghee
• Vrishya dravya – Aphrodisiacs
• Rasayana dravya – Rejuvenators

Ashwagandha is the best drug in dealing with neuro-muscular disorders.

In Kaphavarana conditions, it should be implemented only during the follow up i.e. after destroying the Kapha envelope over the Vata.

Balya –
Balya means strengthening. The drugs which increase the vitality and strength of the body are called Balya Dravyas. Increase in vitality and strength also depicts an increase in immunity. Bala is said to be the function of Oja (essence of body tissues in the body). Balya drugs also maintain this oja in the body while enhancing the immunity. Tissue strength and immunity are less in GBS.

Below mentioned are the best Balya drugs –

• Brahmi – Aindri – Bacopa monnieri
• Rushabhi – Mucuna pruriens / Fagonia cretica / Mucuna monosperma
• Atirasa (Shatavari) – Asparagus racemosa
• Rushyaprokta – Argyreia petaloides
• Payasya – Roscoea procera
• Ashwagandha – Withania somnifera
• Sthiraa – Uraria picta
• Rohini – Picrorrhiza kurroa
• Bala – Sida cordifolia
• Atibala – Abutilon indicum

Santarpana –
Santarpana means nourishing or refreshing. The below said are best in Santarpana –

• Mamsarasa – Meat soup
• Paya – milk
• Ghrita – Ghee
• Snana – Refreshing bath / shower
• Vasti – Enema
• Abhyanga – Massage
• Tarpana – Refreshing drinks

Jeevaneeya drugs –
Jeevaneeya means to promote longevity. Jeevaneeya drugs also provide an anti-inflammatory and anti-oxidant effect on the body. Thus they are highly beneficial in GBS

Below mentioned are the best Jeevaneeya drugs –

• Jeevaka – Crepidium acuminatum / Malaxis acuminate
• Rishabhaka – Manilkara hexandra / Malaxis muscifera
• Meda – Polygonatum verticillatum
• Mahameda – Polygonatum cirhifolium
• Kakoli – Roscoea purpurea
• Ksheerakakoli – Lilium polyphyllum
• Mudgaparni – Phaseolus trilobus / Vigna trilobata
• Mashaparni – Teramnus labialis
• Jivanti – Leptadenia reticulate
• Madhuka – Glycyrrhiza glabra

Vayasthapana –
Vayasthapana dravyas means longevity promoters or anti-ageing drugs.

Below mentioned are the best Vayasthapana drugs –

• Guduchi – Tinospora cordifolia
• Haritaki – Terminalia chebula
• Amalaki – Emblica officinalis
• Rasna – Alpinia galangal
• Shweta (Shweta aparajita) – Clitoria ternatea
• Jivanti – Leptadenia reticulate
• Atirasa/Shatavari – Asparagus racemosa
• Mandukaparni – Centella asiatica
• Sthira – Desmodium gangeticum
• Punarnava – Boerhavia diffusa

Rasayana –
Rasayana includes all those drugs, medicines, treatments and activities which enhance the quality of all the tissues in the body and improve the immunity.

The below said are the best Rasayana’s in GBS–

• Amalaki – Emblica officinalis
• Haritaki – Terminalia chebula
• Vidanga – Embelia ribes
• Pippali – Piper longum
• Shatavari – Asparagus racemosa
• Shilajit
• Brahmi – Bacopa monnieri
• Bibhitaki – Terminalia bellirica
• Guduchi – Tinospora cordifolia
• Yashtimadhu – Glycyrrhiza glabra
• Mandukaparni – Centella asiatica
• Shankapushpi – Convolvulus pluricaulis
• Vidari – Pueraria tuberosa
• Jivanti – Leptadenia reticulata
• Punarnava – Boerhavia diffusa
• Sthiraa – Desmodium gangeticum

Vajikarana –
Vajikarana means aphrodisiacs. Some of the Vajikara dravyas are also highly effective in GBS. They are –

• Ashwagandha – Withania somnifera
• Kapikachchu – Mucuna pruriens
• Shatavari – Asparagus racemosus
• Masha – black gram
• Ksheera – milk
• Ghrita – Ghee etc

Other herbs useful in GBS –

• Shunti – Ginger – Zingiber officinale
• Kupilu – Strychnos nux vomica
• Gokshura – Tribulus terrestris
• Manjishta – Rubia cordifolia
• Nirgundi – Vitex negundo
• Musta – Cyperus rotundus
• Haridra – Turmeric / Curcuma longa

External treatments

Ayurvedic treatment for GBS –
Bahya Chikitsa (External treatments):

• Abhyanga – Massage with medicated oils
• Taila dhara – Stream pouring of medicated oils over the body
• Taila Shiro dhara – Stream pouring of medicated oils over the head
• Shiro vasti – Pooling of medicated oil / ghee within a compartment constructed over the head

Best oils for Abhyanga, Dhara and Shiro vasti in GBS –

• Ksheerabala Taila
• Tila Tailam – sesame oil
• Balashwagandhadi Tailam
• Ashwagandha ghritam
• Mahamasha Tailam
• Chandanabala Lakshadi Tailam
• Mahanarayana Tailam etc

Ksheera dhara – Stream pouring of milk processed with medicinal drugs over the head and body

Shashtika Shali Pinda Sweda –

• Shashtika Shali (rice which is grown in 60 days time) processed in milk processed with decoction of Bala mula and Dashamula is tied in clothes and boluses(pottali) are prepared. They are dipped in the same herbal milk and rubbed over the body following Abhyanga.
• This strengthens the muscles and soft tissues, alleviates Vata, and removes pain, numbness, tingling pain and weakness of muscles and body. This is highly effective in GBS.

Swedana – Steaming with decoction / milk prepared with Dashamula, Bala mula etc. Read more about Svedana – sweating therapy

Internal treatments

Abhyantara Chikitsa (Internal treatments):
Snehapana –

Consumption of oils / ghee processed with medicinal drugs is used orally in metered doses on a daily basis.

The below mentioned medicament’s are used for Snehapana –

• Mahamasha Tailam
• Ksheerabala Tailam
• Gandharvahastadi Eranda Tailam (for purgation)
• Nimbamritadi Eranda Tailam (for purgation)
• Saraswatha Ghritam
• Panchagavya Ghritam
• Brahmi Ghritam
• Kalyanaka Ghritam
• Guggulutiktakam Ghritam
• Ashwagandhadi Ghritam

Virechana – Therapeutic purgation

Nasya – Nasal instillation of medicated ghee or oils is called Nasya. Bruhmana Nasya (oil / ghee prepared using strengthening medicines) is preferred in GBS.

The below said medicaments are used for Nasya:

• Ksheerabala Tailam,
• Ksheerabala tailam 101,
• Dhanwantaram Tailam 101,
• Mahamasha Tailam

Vasti – Enemas

Kashaya Vasti – Decoction enemas

• Erandamooladi Kashaya Vasti
• Mustadi Yapana Vasti
• Raja Yapana Vasti

Sneha Vasti – Enemas with medicated oils / ghee

• Ashwagandhadi Ghritam
• Brihat Chagalyadi Ghritam
• Guggulutiktakam Ghritam
• Mahamasha Tailam
• Ksheerabala Tailam etc

Ksheera Vasti – Enemas using milk processed with medicinal drugs

Ayurvedic medicines

Best Ayurvedic medicines for GBS:

Kashayam (Herbal decoctions):

• Maharasnadi Kashayam
• Gandharvahastadi Kashayam
• Ashtavargam Kashayam
• Drakshadi Kashayam
• Sahacharadi Kashayam
• Punarnavadi Kashayam
• Dashamula Kashayam
• Pathyakshadhatryadi Kashayam
• Prasarinyadi Kashayam etc

Asava / Arishtam (Herbal fermented liquids):

• Dashamularishtam
• Balarishtam
• Saraswatharishtam
• Ashwagandharishtam
• Punarnavasavam
• Draksharishtam

Vati / Gulika (Tablets):

• Yogaraja Guggulu
• Mahayogaraja Guggulu
• Rasnadi Guggulu
• Simhanada Guggulu
• Trayodashanga Guggulu
• Panchatikta ghrita guggulu
• Chandraprabha vati
• Shallaki
• Sutashekara rasa
• Brihatvatachintamani Rasa
• Mahavata-vidhwans Rasa
• Trailokya chintamani Rasa
• Chaturbhuja Rasa
• Vatakulantaka Rasa
• Vatagajankush Rasa
• Sameera pannaga rasa
• Brahmi Bati
• Smritisagar Rasaa
• Tapyadi loha

Best Rasayana’s / Lehyas (Rejuvenators and confections) in GBS:

• Ashwagandha Rasayanam
• Ajashwagandha Rasayanam
• Ajamamsa Rasayanam
• Drakshadi Rasayanam / Drakshadi Leham
• Kushmanda Rasayanam
• Chyavanaprasham
• Dashamula Haritaki
• Vanari kalpa

Others (Churna, Satwa, Bhasma etc):

• Guduchi satva
• Rajata bhasma
• Yashada Bhasma
• Swarna Bhasma
• Swarna Makshika Bhasma
• Mukta pishti
• Ashwagandha churna
• Shatavari churna
• Kapikachchu churna

Modern Treatment

Immunotherapy –

• Plasma exchange / Plasmapheresis – The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then put back into your body, which manufactures more plasma to make up for what was removed. This filters the antibodies out of the bloodstream and attempts to reduce body’s attack on the nervous system. It speeds recovery when used within 4 weeks of the onset of symptoms
• Intravenous immunoglobulins (IVIg) – neutralizes harmful antibodies and inflammation. Works best when started within 2 weeks of the onset of symptoms. This is preferred and used first because it is easy to administer and is safe. Occasionally it can cause liver inflammation or kidney failure.

For respiratory failure –

• Intubation of the windpipe and breathing support through mechanical ventilation, generally on an intensive care unit

For pain –

• Pain medications will help ease pain associated with GBS. It is difficult to make exact recommendations regarding choice of pain medication because the studies to compare the best resorts are on.

Rehabilitation:

• This is oriented towards improving activities of daily living (ADL’s)
• Following acute phase, around 40% of patients with GBS need intensive rehabilitation with the help of a multidisciplinary team
• This approach is likely to improve long-term symptoms

The team of intensive rehabilitation may include –

• Physical therapists – Physiotherapy includes improving strength, endurance and gait training and aims at increasing mobility, maintenance of posture and alignment and joint functions
• Occupational therapists – They help to improve everyday function and domestic and community tasks as well as driving and work
• Social workers
• Psychologists – They may provide counselling and support. Psychological interventions may be needed for anxiety, fear and depression. Speech-language pathology input may be required in those with speech and swallowing problems and also to support communication in those who require ongoing breathing support.
• Allied health professionals
• Nurses
• Nutritionists – Nutritional support may be provided by the team and dieticians.

The team usually works under the supervision of a neurologist or rehabilitation physician directing treatment goals

Home modifications, gait aids, orthotics and splints may be provided

When to see a doctor?
Call doctor if you have –

• Mild tingling in your toes or fingers that doesn’t seem to be spreading or getting worse

Feel it an emergency if you have –

• Tingling that started in your feet or toes and is moving up your body
• Tingling or weakness that’s spreading rapidly
• Difficulty catching your breath or shortness of breath when lying flat
• Choking on saliva

History

• Jean-Baptiste oCtave Landry (French physician) first described GBS in 1859
• Georges Guillain, Jean Alexandre Barre and Andre Strohl diagnosed 2 soldiers with the illness and described the key diagnostic abnormality – albumin-cytological dissociation – of increased spinal fluid protein concentration but a normal cell count in 1916
• Miller Fisher (Canadian neurologist) described the variant of GBS which bears his name in 1956
• Edwin Bickerstaff (British neurologist) described the brain-stem encephalitis type of GBS in 1951 (with Philip Cloake)
• The axonal sub type was first described in the 1990’s
• Diagnostic criteria were developed in the late 1970’s and were refined in 1990
• The case definition was revised by the Brighton Collaboration for vaccine safety in 2009
• Plasma exchange was first used in 1978 and its benefits confirmed in 1985
• Intravenous immunoglobulins were introduced in 1988 and its non-inferiority compared to plasma exchange was demonstrated in the early 1990’s

Epidemiology

• GB syndrome is rare (1-2 cases per 100,000 people every year)
• New episodes per year (Western countries) – 0.89 – 1.89 cases / 100,000 people
• Children and young adults are less likely affected than the elderly
• Risk increases by 20% for every decade of life
• Men are more likely to develop GBS than women. Relative risk for men is 1.78 compared to women
• Distribution of sub types:

In Europe and US, 60-80% people with GBS have the demyelinating sub type (AIDP). AMAN affects only a small number (6-7%)

In Asia and Central and South America AMAN is significantly higher (30-65%)

Miller Fisher variant – more common in Southeast Asia

Usually we just neglect symptoms like weakness or we may be too busy to notice it. But many a times weakness may develop at the backdrop of some harmful diseases like GB syndrome. The disease is rare but don’t forget to see your doctor if your weakness lasts for long time and is progressive and if it is not attended by any medicines, changes in diet and lifestyle activities. Remember, Ayurveda provides excellent medicines and remedies towards GBS.
Click to consult Article by Dr Raghuram Y.S. MD (Ay)