There has been a concerning increase in cases of Guillain-Barré Syndrome (GBS) in India. This rare but serious neurological disorder can cause paralysis and, in some cases, even death. One person dies in the hospital and doctors are baffled by the sudden spike in cases. Qvive, dedicated to researching health trends and issues, embarked on a mission to uncover the root cause behind this sudden surge in GBS cases. After a deep dive into the facts, qvive has discovered a concerning link between specific medicines and the onset of Guillain-Barré Syndrome in people in India.
These medicines, often used to treat various illnesses and conditions, have been found to have neurotoxic effects that can lead to the immune system attacking the nerves, resulting in GBS. It is essential for healthcare professionals and patients to be aware of these potential risks associated with certain medications.
When you go for a medication, it’s crucial to know about the potential risks. Although serious side effects are rare, they can occur. Some people may experience severe allergic reactions or other serious health effects that could be life-threatening.
What is Guillain-Barré Syndrome?
Guillain-Barré Syndrome (GBS) is a rare autoimmune disorder in which a person’s own immune system mounts an inflammatory response and causes damage to his or her peripheral nerves. This can affect the sensory, motor and autonomic nerves. Symptoms often come on rapidly and can include sensory disturbances in the extremities (hands, arms, feet and legs), muscle weakness and loss of reflexes. In some cases, this muscle weakness can lead to paralysis. In rare circumstances, patients can experience difficulty breathing that leads to respiratory difficulties, as well as sensory disturbance or paralysis of the facial muscles.
GBS after a flu shot is similar to Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), which also affects the peripheral nerves, but is distinguished by the gradual onset of symptoms and chronic nature of CIDP.
There are several variants of GBS, including acute inflammatory demyelinating polyneuropathy (AIDP), the most common GBS variant in the US. Other variants include Miller Fischer Syndrome (MFS), acute motor axonal neuropathy (AMAN), and acute motor-sensory axonal neuropathy (AMSAN).
Symptoms of Guillain-Barré syndrome
- Weakness: The weakness seen in GBS usually comes on quickly and worsens over hours or days. Often, feet are affected first, and weakness may move up the body to eventually impact the legs, arms, face, and breathing muscles. The person may first notice unexpected difficulty climbing stairs or walking. Less commonly, symptoms start in the face and move down to the legs and feet. Most people reach the greatest stage of weakness within the first two weeks after symptoms appear; by the third week 90% of affected people are at their weakest.
- Sensation changes: In GBS, the brain may receive abnormal sensory signals from the rest of the body due to the nerve damage associated with the condition. This results in unexplained, spontaneous sensations, called paresthesias, that the person may feel as tingling, a sense of insects crawling under the skin (called formications), and pain. Some people with GBS feel a deep muscular pain in the back and/or legs. Unexplained sensations often happen first, such as tingling in the feet or hands, or even pain (especially in children), often starting in the legs or back. Children will also begin to have difficulty walking and may refuse to walk. These sensations tend to disappear before the major, longer-term symptoms appear.
Other symptoms of Guillain-Barré syndrome may include:
- Difficulty with eye muscles and vision
- Difficulty swallowing, speaking, or chewing
- Pricking or pins and needles in the hands and feet
- Pain that can be severe, particularly at night
- Coordination problems and unsteadiness
- Abnormal heart rate or blood pressure
- Problems with digestion and/or bladder control
The body’s nerves have a central conducting core called the axon that carries an electric signal. The axon is surrounded by an insulating layer (or sheath) called myelin. The myelin sheath surrounding the axon speeds up the transmission of nerve signals and allows the transmission of signals over long distances. In the most common type of GBS, called acute inflammatory demyelinating polyradiculoneuropathy (AIDP), the immune system damages the myelin sheath. In two other types of GBS, called acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN), the immune system may damage the axons themselves. As a result, the nerves cannot transmit signals efficiently and the muscles begin to lose their ability to respond to the brain’s commands, which causes weakness and abnormal or no reflexes.
Miller Fisher syndrome is another type of GBS involving the cranial nerves, which extend from the brain to areas of the head and neck. The main symptoms are weakness or paralysis of the muscles that move the eyes, problems with balance and coordination, and abnormal or no reflexes. People with this disorder may have other common GBS symptoms like muscle weakness.
Global burden of vaccine-associated Guillain-Barré syndrome over 170 countries from 1967 to 2023
click here: https://www.nature.com/articles/s41598-024-74729-2
The Suspected Medicines in India
Several medicines commonly used in India have been suspected to be linked to the rise in GBS cases. One such medication is an over-the-counter painkiller that contains a high concentration of a certain active ingredient. This ingredient has been found to potentially trigger an immune response that leads to the development of GBS in some individuals.
Another medication commonly prescribed in India for the treatment of a particular chronic condition has also come under scrutiny. This drug has been associated with rare but serious side effects, including neurological complications such as GBS.
Key Medications with Potential Links to GBS in India:
Drugs with the Side Effect – Guillain-Barre syndrome
5-Asa , Cytarabine , D-penicillamine , Danazol , Enfuvirtide , Eslicarbazepine , Febuxostat , Gold , Hepatitis , Iopamidol , L-Dmp , Methotrexate , Nelarabine , Norfloxacin , Oxaliplatin , Paroxetine , Pregabalin , Stavudine , Sulfasalazine , Trans , Venlafaxine , Voriconazole
Certain Antibiotics:
- Fluoroquinolones: This class of antibiotics, widely prescribed for various bacterial infections, has been the subject of some studies linking them to a slightly increased risk of GBS.
https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics
Brand Names in India:
- Ofloxacin: Zenflox, Oflox, Oflomac, etc.[https://www.drugs.com/sfx/ofloxacin-side-effects.html]
- Ciprofloxacin: Ciprodac, Cifran, etc. [https://shmabstracts.org/abstract/guillainbarre-syndrome-a-rare-adverse-reaction-associated-with-ciprofloxacin/]
- Levofloxacin: L-Cin, Glaxo, Levobact, etc. [https://www.drugs.com/sfx/levofloxacin-side-effects.html]
- Moxifloxacin: Moxicip, Moxif, etc.[https://www.ncbi.nlm.nih.gov/books/NBK599511/]
- Nitrofurantoin: An antibiotic mainly used for urinary tract infections (UTIs), a few reports have suggested an association with GBS, although more studies are needed.
https://www.drugs.com/sfx/nitrofurantoin-side-effects.html
Brand Names in India: Nitrofur, Furanex, etc.
Certain Vaccines:
Post-vaccination GBS has been reported.
How is GBS related to the flu shot?
Since making the connection between GBS and the 1976 swine influenza vaccine, several studies have evaluated the relationship between GBS and the seasonal influenza vaccine. Although evidence has not been adequate to accept or reject a causal relationship between the vaccine and the condition, researchers have noted increased chances of contracting GBS both with the 1992-93 and 1993-94 seasonal influenza vaccines.
After several studies suggesting a link between GBS and the influenza vaccine, the Vaccine Injury Table was revised in March of 2017 to include the occurrence of GBS following the flu vaccine. According to the Vaccine Injury Table, symptoms of GBS after a flu shot should manifest 3-42 days following vaccination to bring an on-Table claim, although it is still possible to file a successful claim if symptoms do not strictly fall within this time period.
- Influenza Vaccines: Some studies in the past had shown a correlation with some types of influenza vaccinations.
Intussusception means the invagination of a segment of intestine into the next segment of intestine, resulting in bowel obstruction, diminished arterial blood supply, and blockage of the venous blood flow. This is characterized by a sudden onset of abdominal pain that may be manifested by anguished crying, irritability, vomiting, abdominal swelling, and/or passing of stools mixed with blood and mucus.
Some studies suggest that rotavirus vaccination possibly causes a small increase in the risk of intussusception, a type of bowel blockage.
Onset within 14 days after an infectious disease associated with intussusception, including viral disease (such as those secondary to non-enteric or enteric adenovirus, or other enteric viruses such as Enterovirus), enteric bacteria (such as Campylobacter jejuni), or enteric parasites (such as Ascaris lumbricoides), which may be demonstrated by clinical signs and symptoms and need not be confirmed by culture or serologic testing.
https://www.ecfr.gov/current/title-42/chapter-I/subchapter-J/part-100/section-100.3#p-100.3(a)
- COVID-19 Vaccines: Cases of GBS have been reported following COVID-19 vaccination.
https://www.cdc.gov/vaccine-safety/vaccines/covid-19.html
Certain Immunomodulators:
- Tumour Necrosis Factor (TNF) Inhibitors: These medications are commonly used to treat autoimmune conditions like rheumatoid arthritis. There have been rare case reports suggesting a potential association with GBS.
Brand names in India: Adalimumab (Humira biosimilars), Etanercept (Enbrel biosimilars), Infliximab.
- Immune checkpoint inhibitors: These are used to treat some cancers by targeting the immune system. Reports have shown a possible link to GBS.
Brand names in India: Ipilimumab, Nivolumab, Pembrolizumab
Inshort, some of the brand names of medications in India that have been linked to GBS include:
- Ciprofloxacin: An antibiotic used to treat bacterial infections.
- Tamiflu: An antiviral medication prescribed for influenza.
- Fluvir: Another antiviral drug commonly used for treating viral infections.
Ref: https://karger.com/crn/article/10/2/124/88692/Severe-Acute-Axonal-Neuropathy-Induced-by
https://pmc.ncbi.nlm.nih.gov/articles/PMC4375804
https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/fda-requires-warning-about-guillain-barre-syndrome-gbs-be-included-prescribing-information-shingrix
Other Medications:
- Although rare, some isolated case reports have indicated GBS related to other medications like some immunosuppressants, lipid-lowering medications (statins) or medications to treat seizures.
As the cases of Guillain-Barré Syndrome continue to rise in India, it is crucial for healthcare professionals and the general public to be aware of the potential risks associated with certain medications. By raising awareness about the symptoms of GBS, monitoring medication usage, and seeking timely medical intervention, we can work towards reducing the impact of this neurological disorder on individuals in India.
Remember, your health is priceless, and being informed is the first step towards prevention and treatment.
Source: Conway Homer PC, NIH, CDC, FDA, Wikipedia, WebMD, Medindia,
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