Guillain-Barré Syndrome vs. MS

Every day, the immune system defends your body from would-be invaders like viruses and bacteria, as well as toxins, cancer, and pollutants. The immune system can sometimes misfire and attack the body's own tissues. Autoimmune disorders can affect different types of tissues, like your joints, or organ systems, like the digestive tract. 

Autoimmune disease can even target the nervous system, or the main control center for the entire body. Two rare but serious autoimmune diseases of the nervous system are multiple sclerosis, or MS, and Guillain-Barré syndrome. 

While the two can cause similar symptoms, they're actually quite different, explains Howard L. Weiner, MD, a Mass General Brigham neurologist who cares for patients at Brigham and Women's Hospital. Dr. Weiner is the co-director of the Center for Neurologic Diseases at Brigham, where his research lab studies MS and other diseases.

What is the nervous system? 

Every move you make, sensation you feel, and thought that crosses your mind is the result of signals sent through your nervous system. The nervous system includes the brain, the spinal cord, and a complex network of nerves stretching from the scalp on your head to the tips of your toes. 

There are two main parts:

1. The central nervous system: the brain and the spinal cord
2. The peripheral nervous system: the nerves branching off from the spinal cord to the rest of the body

The brain sends signals to the rest of the body via the spinal cord and through the peripheral nerves. In turn, the peripheral nerves send messages back to the brain. 

MS affects the central nervous system, while Guillain-Barré syndrome impacts the peripheral nervous system. But what does that mean regarding causes and treatment?

What is MS?

"MS affects the central nervous system and the white matter of the brain," Dr. Weiner says. White matter contains axons, or nerve fibers, surrounded by myelin. Myelin is a material that insulates and protects these nerve fibers. In MS, the immune system attacks and damages the myelin, which makes it harder for the brain to send signals to the rest of the body. As the myelin gets more damaged over time, MS symptoms can get worse. 

MS risk factors

MS can occur at any age but is most common in adults aged 20 to 40. Women are three times more likely to be affected. The exact cause is unknown, but risk factors can include: 

• Family history of MS
• Vitamin D deficiency
• Smoking

MS and the Epstein-Barr virus

"There are some studies that suggest the Epstein-Barr virus (EBV) can trigger MS. But almost everyone gets EBV infections. Not everybody gets MS. But there are very few MS patients that haven't had an EBV infection. It may be that the immune system's reaction against EBV then creates a reaction against the brain," says Dr. Weiner. 

According to the Centers for Disease Control and Prevention (CDC), the Epstein-Barr virus is one of the most common worldwide. It's a member of the herpes family of viruses and causes symptoms similar to the common cold. It can also cause a disease known as infectious mononucleosis, or "mono."

MS signs and symptoms

MS affects people differently and has different stages. In early MS, patients have attacks of symptoms and then experience periods of recovery and remission. In progressive MS, symptoms get steadily worse, there are no remission periods, and people may develop more disability.

Signs and symptoms of MS can include: 

• Fatigue or weakness
• Numbness or tingling
• Mobility issues like difficulty walking
• Muscle spasms or pain
• Double or blurred vision
• Difficulties remembering or focusing
• Depression

MS treatments

While there's no cure for MS, there are ways to prevent relapses and relieve symptoms. "The main treatments we have are for the active or relapsing forms, and they're drugs that dampen the abnormal immune system," says Dr. Weiner. 

Treatment options include:

• Medications to dampen an overactive immune system
• Stem cell therapy, which resets the immune system using a person's own cells
• Physical therapy and exercise to increase mobility
• Nutrition counseling to improve the diet and overall health
• Mental health counseling and treatment to relieve stress and anxiety 

MS Research at Mass General Brigham

Researchers from Mass General Brigham are looking into ways to combat the progressive form of the disease. 

"One of the things we discovered that I think is very exciting is a nasal spray that appears to treat progressive MS," Dr. Weiner says. Known as foralumab, the spray has shown promising results in managing MS symptoms and reducing inflammation.  Foralumab is now in a phase two, double-blind trial for MS patients. Dr. Weiner and his colleagues are also testing foralumab as a treatment for Alzheimer's, amyotrophic lateral sclerosis (ALS), Parkinson's, and could be used in the future for long COVID-19. 

Other innovative MS research at Mass General Brigham includes: 

• Advanced imaging technology: Scientists at Massachusetts General Hospital are using advanced scanners like the Connectome 2.0 and new MRI techniques to take detailed images of the brain. These new scans help them see how MS damages the brain and affects memory and movement. This could lead to better ways to treat MS. 
• MRI study on axon damage: Mass General Brigham researchers are studying axon damage in MS, which can affect thinking and movement. Their research plays a key role in finding better ways to monitor and treat MS.
• Wearable device study: Brigham and Women's Hospital researchers are testing a smart insole that monitors MS symptoms, such as gait and balance, right at home. This device could help doctors detect changes in symptoms earlier.
• Precision medicine and biomarkers: Researchers at Brigham and Women's Hospital are working on ways to better match MS treatments to each person. They are studying certain genes, proteins, and other markers in the body that could help doctors predict how the disease will progress and which treatments will work best. This research could help create more personalized care for people with MS.

"We're also researching the microbiome and how it affects MS," says Dr. Weiner. "The microbiome is made up of trillions of bacteria in your body, and they can affect the immune system and the brain."

What is Guillain-Barré syndrome? 

Guillain-Barré syndrome is a rare condition that develops after a person's immune system fights off an actual infection. According to the CDC, an estimated 3,000 to 6,000 people develop Guillain-Barré syndrome each year. 

It's thought that the bacteria or viruses have similar features to the body's healthy nerve cells. In some people, the immune system can't distinguish between the two. The exact way this happens is unknown, but it's thought the immune system starts producing antibodies, which are proteins to fight infections. In Guillain-Barré syndrome, those antibodies attack the body's cells instead, affecting the nerves in the peripheral nervous system. 

Guillain-Barré syndrome risk factors

Guillain-Barré syndrome is most common in adults over 50. According to the National Institute of Neurological Disorders and Stroke (NINDS), the infections that trigger Guillain-Barré syndrome can be viral or bacterial. The infections often occur in the respiratory or digestive tract and can include: 

• Campylobacter jejuni bacteria, which causes nausea, vomiting, and diarrhea
• Cytomegalovirus, a common virus related to the herpes family
• Zika, a virus spread by mosquitos in certain parts of the world
• Epstein-Barr virus
• COVID-19

Very rarely, surgery or certain vaccines can trigger Guillain-Barré syndrome. The CDC closely monitors reports of Guillain-Barré syndrome. In the case of the flu vaccine, the risk of developing severe complications from a flu infection is far higher than developing Guillain-Barré syndrome. 

Guillain-Barré syndrome signs and symptoms

Signs and symptoms of Guillain-Barré syndrome can include: 

• Weakness, often starting in the feet and spreading to affect the legs, arms, face, and even breathing muscles. 
• Tingling or prickling sensations in the feet and hands
• Vision difficulties
• Coordination problems
• Abnormal heart rate or blood pressure
• Problems with digestion and/or bladder control
• Temporary paralysis

Guillain-Barré syndrome treatments

While there's no cure for Guillain-Barré syndrome, there are treatment options that can relieve symptoms and shorten recovery time. These include: 

• Plasma exchange (PE): A health care provider draws a patient's blood and uses a machine to separate the liquid form of the blood (plasma) from the red blood cells. The provider then mixes the blood cells with a replacement fluid and returns the blood to the patient's body through an IV. According to the NINDS, PE may help treat Guillain-Barré syndrome by removing the antibodies damaging the nerves. 
• Intravenous immunoglobulin therapy (IVIg): A healthcare provider uses an IV or injection to deliver plasma containing immunoglobulin, a protein the immune system produces to fight infection, to a patient's bloodstream. According to the NINDS, IVIg therapy may help treat Guillain-Barré syndrome by reducing the number of harmful antibodies attacking the peripheral nerve cells. 
• Hospitalization: Some patients may need care in a hospital if they experience breathing difficulties, abnormal heart rates, or paralysis.  
• Physical rehabilitation and physical therapy: Depending on the severity of their symptoms, some patients may need help building strength or returning to their daily activities. 

The good news? "Most people recover. It's usually a monophasic illness, whereas MS is a chronic illness," explains Dr. Weiner. A monophasic illness means a person has a single episode of the condition that doesn't occur again.