GUILLAIN-BARRÉ SYNDROME Linda Roybal & Sarah Jane Calub
DESCRIPTIONAcute autoimmune disease marked by inflammation of theperipheral nerves, affecting arms and legsInvolves destruction of the myelin sheath surroundinglargest, most myelinated sensory and motor fibers, resultingin disrupted proprioception and weakness.
ETIOLOGYNo clear causeNeither contagious nor hereditaryInappropriate immune responsePossible vaccine causal link
INCIDENCE &PREVALENCEGBS affects 2 per 100,000 annually (1,500 people/year)Nondiscriminatory: can affect persons of any gender, age, orethnic background
SIGNS AND SYMPTOMSNumbness and tingling in hands and feetDistal progression: muscle weakness, diminished reflexesand proprioception, decreased sensationFor some, progresses to trunk, face, and cranial nerves,resulting in difficulty swallowing, chewing, speaking, andfacial expressionsDeep, aching pain/hypersensitivity to touchRespiratory/cardiac dysfunction and failure
COURSE/PROGNOSIS80% experience complete recoveryRecovery may last from 2 months to 2 years3 distinct phases: Acute (4 wks) - initial rapid onset of symptoms Plateu (few days to few weeks) - symptoms neither worsen nor improve Recovery - gradual improvement
DIAGNOSIS Diagnostic testing for GBS includes Physical and neurological exam Lumbar puncture Computed Tomography (CT) scan
MEDICAL/SURGICALMANAGEMENTIntravenous immunoglobin therapy: prevents immunesystem from further attacking Schwann cells and myelin byblocking receptors on microphagesPlasmapheresis: filters blood plasma to removeantibodies and aids in replacing lost fluidsCorticosteroids: inhibit inflammation associated w/symptoms
IMPACT ON CLIENTLimited physical mobilityInability to engage in meaningful occupations because ofpain, extreme muscle weakness in arms and legs, and fatigueSensory functions impairedUsing cultural contexts to structure intervention activities
REFERENCESGuillain-Barré Syndrome Support Group (2009) A Quick Guide to Guillain-Barré Syndrome and CIDP. Guillain-Barré Support Group, Sleaford.Little evidence that supports a causal link between most vaccines and Guillain-Barre syndrome. (2009). Drugs & Therapy Perspectives, 25(11), 21-23.Lugg, J. (2010). Recognising and managing Guillain-Barre syndrome. Emergency Nurse, 18(3), 27-30.Lundy-Ekman, L. (2007). Neuroscience: fundamentals for rehabilitation (3rd ed.). St. Louis, Mo.: Saunders/Elsevier.