I am a 57 year old teacher. November 2019 I was diagnosed with GBS following Chickenpox and spent 8 days in ICU. I left hospital on 24 January 2020. I am still struggling with fatigue and loss of muscle mass in my legs. I have pain, swelling and numbness in my toes and it feel like I am walking on a cushion under the ball of my feet. Are these symptoms related to GBS and how can I overcome my fatigue.
Hi Ingrid: The symptoms you describe are all quite common in patients who have had severe GBS. The nerve damage that developed during the acute attack can take a long time to heal and, unfortunately, is sometimes permanent. Although it seems a long time to you, in fact it can take more than a year to achieve maximum recovery so I would expect continued improvement for a while yet. There are a number of different treatments available for the pain so talk to your doctor about that. Fatigue is one of the commonest and most debilitating of the GBS after-effects and I will leave that for Dr. Suzie Mudge, a neurophysiotherapist who is a member of our Medical Advisory Board and an expert on fatigue management, to address (see below). Gareth.
The fatigue is related to your GBS in two ways. Firstly, when you lose muscle mass, you have less strength and remaining muscle fibres can get overworked leading to muscle fatigue because the muscle can’t maintain repetitive force because its energy is depleted. This kind of fatigue recovers quite quickly so after a few minutes rest, the muscle can work again. This type of fatigue improves with strength and endurance training.
The other type of fatigue is more generalised and is very common after GBS and can be quite persistent even some time after recovery. There is evidence in other neurological conditions that this type of fatigue can be improved with regular physical activity and there is a small amount of research that makes us think the same might be true after GBS.
In terms of guidance for starting or increasing exercise after GBS, a cautious approach is needed so that you don’t make fatigue worse. Choose an activity that you like doing (e.g. walking). Start gradually and increase as you can by watching your symptoms. When you increase your activity, just increase one aspect at a time: frequency (per week), intensity (how hard you are working), time (duration of each exercise session). If possible, this should be done under the supervision of a neurophysiotherapist who can provide guidance to prevent over doing it. Dr. Suzie Mudge.