The Growing Concern of Guillain-Barre Syndrome Outbreak in India and the Role of Physical Therapists

The global incidence of GBS is estimated at 1–2 cases per 100,000 people annually
Physical therapists play a pivotal role in the multidisciplinary approach to managing Guillain-Barre Syndrome.
Physical therapists play a pivotal role in the multidisciplinary approach to managing Guillain-Barre Syndrome. (Canva)
Published on: 
Dr. Mohammed Amjad Khan (PT), M.I.A.P, CDN, CKT
Senior Physical therapist,
Physio plans Rehabilitation Centre,
Medina Al Munawwarah, Saudi Arabia.

Introduction

Guillain-Barré Syndrome (GBS) is a rare but serious autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nervous system, leading to symptoms such as muscle weakness, tingling sensations, and, in severe cases, paralysis [1]. It often follows infections, such as respiratory or gastrointestinal illnesses, with the immune response targeting the body’s nerves [1]. While the exact cause remains unclear, GBS can progress rapidly and requires urgent medical attention [2].

The global incidence of GBS is estimated at 1–2 cases per 100,000 people annually [3]. While nationwide data for India is limited, regional studies provide some insights. A retrospective study from northwest India analyzed 65 GBS patients, reporting a higher occurrence (36.92%) among young adults aged 18 to 29 [4]. Additionally, research indicates that the incidence of acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) subtypes in India is nearly equal, with AMAN being more prevalent among younger patients [5]. however, regional factors—such as infections like dengue and chikungunya contribute to seasonal variations [6,7], emphasizing the need for tailored management strategies, particularly in resource-limited settings.

Managing GBS requires a multidisciplinary approach, especially during the acute phase [8]. Hospitalization is critical for close monitoring, as about 20-30% of patients may need mechanical ventilation due to respiratory muscle weakness [9]. The primary treatments include immunotherapies such as intravenous immunoglobulin (IVIG) and plasmapheresis, which can significantly reduce disease severity when initiated early [10,11]. Additionally, supportive care during the acute phase focuses on pain management, addressing autonomic dysfunction, and preventing complications like thrombosis [12].

Rehabilitation plays a crucial role in the recovery phase, aiming to restore functional independence, minimize residual disability, and improve overall quality of life [13]. Key components of rehabilitation include physical therapy, occupational therapy, and psychological support, all of which help patients regain strength and cope with the emotional challenges of recovery [13]. Early rehabilitation has been shown to improve both physical and psychological outcomes, with a focus on gradually increasing mobility and strength through personalized programs [14]. Although most individuals recover fully, approximately 20% may experience long-term disability, highlighting the importance of timely intervention and ongoing follow-up [15].

Understanding Guillain-Barré Syndrome

GBS is characterized by rapid-onset muscle weakness and, in severe cases, paralysis [1]. While it can affect individuals of any age, it is more commonly seen in adults, particularly males [16]. Symptoms often begin with tingling sensations or weakness in the legs, which can progress to the arms and upper body [1]. In some cases, GBS can cause respiratory failure, necessitating immediate medical attention [2].

Bacterial and viral infections are among the most common triggers for GBS. Campylobacter jejuni infection is one of the most frequently identified causes, followed by other pathogens such as Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and influenza [17]. These infections can prompt an immune response that mistakenly attacks the peripheral nervous system.

The condition is divided into several subtypes, including:

  1. Acute Inflammatory Demyelinating Polyneuropathy (AIDP): This is the most common subtype, characterized by damage to the myelin sheath surrounding the nerves.

  2. Miller Fisher Syndrome (MFS): This variant presents with eye muscle weakness, coordination problems, and ataxia.

  3. Acute Motor Axonal Neuropathy (AMAN) and Acute Motor-Sensory Axonal Neuropathy (AMSAN): These subtypes primarily affect the axons of motor and sensory nerves, leading to more severe weakness and sensory loss.

Timely diagnosis and intervention are essential for reducing complications and improving outcomes in GBS patients [18]. Early treatment with therapies like intravenous immunoglobulin (IVIG) or plasmapheresis can significantly impact recovery and reduce the severity of the condition [16,19].

Recent Trends of GBS in India

Recent trends in Guillain-Barré Syndrome (GBS) in India highlight a concerning surge in cases, particularly in Pune, with over 100 reported instances [20]. This increase is suspected to be linked to a confluence of factors, including seasonal infections, bacterial triggers like Campylobacter jejuni and Norovirus, and potentially contaminated water sources [21]. Health authorities have intensified surveillance efforts, conducting widespread testing to pinpoint the outbreak's origins [22].

This cluster's first suspected GBS case was hospitalized on January 9th, 2025 [22]. A suspected GBS-related death occurred on January 26, 2025, in Pune, following a history of cold, cough, and breathing difficulties in a patient who had recently travelled to Solapur [23]. With 16 patients currently on ventilator support [23], Authorities are actively investigating potential environmental factors, including contaminated water sources, in response to the recent surge in Guillain-Barré Syndrome (GBS) cases in Pune, Maharashtra. The State Public Health Laboratory has identified bacterial contamination in eight water sources across Pune and Pimpri-Chinchwad, including public tanks and private wells in affected regions.[24]. The rise in cases has prompted government intervention, including surveys and monitoring, focusing on urban areas [25].

Challenges in Managing GBS

The management of GBS faces several challenges:

 Delayed Diagnosis: Limited access to advanced diagnostic tools, particularly in rural areas, can delay treatment [26].

  • High Cost of Treatment: Therapies such as plasmapheresis and intravenous immunoglobulin (IVIG) are expensive and may not be accessible to all patients [27].

  • Rehabilitation Gaps: A lack of comprehensive rehabilitation facilities can hinder long-term recovery for GBS patients [28].

As the patient stabilizes, physical therapy shifts to active engagement to restore functionality.
As the patient stabilizes, physical therapy shifts to active engagement to restore functionality. (Canva)

The Role of Physical Therapists in GBS Management

Physical therapists play a pivotal role in the multidisciplinary approach to managing GBS. Their responsibilities span across the acute, subacute, and chronic phases of the disease [29,30]. A three-phase approach to physical therapy is recommended for the effective management of GBS as the condition progresses through its various stages [30].

1. Acute Phase: Supportive Care

During the initial phase of GBS, patients may experience severe muscle weakness or paralysis, requiring intensive care. The primary focus for physical therapists during this stage includes:

  • Preventing Complications: Techniques such as passive range-of-motion (ROM) exercises help prevent joint stiffness and muscle contractures.

  • Maintaining Respiratory Function: Breathing exercises and positioning strategies are essential to prevent pulmonary complications in patients with respiratory muscle weakness.

  • Positioning and Skin Care: Proper positioning reduces the risk of pressure sores and maintains comfort.

2. Subacute Phase: Gradual Recovery

As the patient stabilizes, physical therapy shifts to active engagement to restore functionality:

  • Muscle Strengthening: Graded exercises tailored to the patient’s tolerance help rebuild strength without causing overexertion.

  • Mobility Training: Therapists assist patients in relearning basic movements such as sitting, standing, and walking.

  • Balance and Coordination: Activities that enhance proprioception and coordination are crucial during this phase.

3. Chronic Phase: Long-Term Rehabilitation

For patients experiencing residual symptoms, long-term rehabilitation is essential to optimize their quality of life:

  • Functional Training: Focused exercises enable patients to regain independence in daily activities.

  • Assistive Devices: Physical therapists recommend and train patients to use assistive devices such as orthotics, walkers, or wheelchairs.

  • Psychological Support: Encouraging a positive outlook and managing mental health challenges, such as anxiety or depression, are integral to recovery.

This comprehensive role of physical therapists is crucial throughout the recovery process, ensuring that patients with GBS regain their independence and quality of life [30].

The Need for Awareness and Advocacy

The increasing incidence of Guillain-Barre Syndrome (GBS) in India presents a significant public health concern. To effectively address this issue, it is crucial to raise awareness and advocate for proactive healthcare strategies. Public health campaigns should be designed to educate the public about GBS, focusing on recognizing its early signs and symptoms. By emphasizing the significance of early detection, these campaigns can encourage individuals to seek prompt medical attention, which is vital for improving patient outcomes.

In addition to public awareness, there is an urgent need for specialized training programs for healthcare professionals across various disciplines. While neurologists and general practitioners are essential in diagnosing and managing GBS, physical therapists, occupational therapists, and other allied healthcare providers are integral to the rehabilitation process. Providing these professionals with comprehensive education on the complexities of GBS—covering its clinical progression, treatment options, and rehabilitation strategies—can greatly enhance the quality of care.

By strengthening both public awareness and the training of healthcare professionals, India can better manage the rising incidence of GBS, ultimately improving patient outcomes and mitigating the long-term impact of the disease.

Conclusion

The rising prevalence of Guillain-Barré Syndrome (GBS) outbreaks in India underscores the urgent need for a well-coordinated, multidisciplinary approach to managing this complex and challenging condition. From early diagnosis and treatment to the crucial rehabilitation phase, each stage plays a vital role in ensuring optimal patient outcomes. Physical therapists, in particular, are central to the recovery process, providing essential care that aids in restoring mobility, strength, and overall quality of life. Their involvement spans from acute management—helping to prevent complications such as joint contractures and respiratory issues—to long-term rehabilitation, where they support patients in regaining independence and managing the physical and psychological challenges that accompany recovery.

Addressing the growing concern of GBS in India requires a multifaceted strategy. This includes raising public awareness about the signs and symptoms of the disease and improving access to healthcare resources. Timely medical intervention is crucial to minimizing the severity of GBS, and public health campaigns can play a pivotal role in encouraging individuals to seek early medical attention. Furthermore, providing specialized training for healthcare professionals, particularly those involved in rehabilitation, will improve the overall quality of care and promote a more effective, comprehensive approach to managing the disease.

By focusing on prevention, early diagnosis, and rehabilitation, the healthcare system can not only improve survival rates but also significantly reduce the long-term disability burden associated with GBS. Through collaborative efforts across public health, medical professionals, and the community, India can meet the challenges posed by GBS and provide better care and support for its affected population.

References:

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Physical therapists play a pivotal role in the multidisciplinary approach to managing Guillain-Barre Syndrome.
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