GBS PRESENTATION

1. LEARNING ISSUESLEARNING ISSUES
؈ Worldwide, the annual incidence is about 0.6–4 occurrences per 100,000
people.
؈ Men are one and a half times more likely to be affected than women.
؈ The incidence increases with age; there are approximately 1 cases per
100,000 people aged below 30 years and about 4 cases per 100,000 in
those older than 75 years.
؈ The incidence of GBS during pregnancy is 1.7 cases per 100,000 of the
population.

2. ؈ GBS is a rare but serious autoimmune disorder that can affect any part of the nervous system outside
of the brain and spinal cord. Known as the peripheral nervous system.
؈ An autoimmune disease involves the immune system attacking and destroying certain groups of
healthy cells. In the case of GBS, the immune system attacks the myelin sheaths of peripheral nerves.
؈ Myelin sheaths are the coatings on the axons of nerves, and myelin is essential for the speedy carrying
of axonal nerve impulses. Axons are the long, thin extensions of nerve cells.
؈ As the myelin is damaged, nerves can no longer send certain information to the spinal cord and brain,
such as touch sensations. This causes the sensation of numbness. In addition, the brain and spinal cord
are no longer able to transmit signals back to the body, leading to muscle weakness.
؈ GBS begins with tingling sensations and weakness in the feet and legs. It then slowly spreads upward
until a large portion of the body is affected. The nerves connected to the lower extremities are the
longest in the body. This travel distance makes these nerves more prone to a break in nerve signals due
to GBS and its symptoms.
Introduction of GBSIntroduction of GBS

3. Etiology of GBSEtiology of GBS
؈ Exact causes is UNKNOWN.
؈ GBS is an known as an Auto Immune response to foreign antigens, such as infections agents (bacteria
etc.) that the body immune system mistakenly attacks gangliosides compound which are naturally
present in nerve tissues.
؈ The most common infection which precedes the development of GBS is Campylobacter Jejuni. One of
the most widespread causes of the human gastroenteritis.
؈ Its believed the influenza virus may also trigger and Auto Immune respond which causes the
Syndrome.
؈ Experts believe the foreign agent (bacterium/Virus) causes the body’s immune system to attack the
myelin sheath to the peripheral nerve. The myelin sheath is a cover that protect the nerve, a bit like
the plastic that covers electrical wires. The sheaths becomes damaged, causing nerve damage,
resulting in faulty sending of signals between nerve and muscles. This faulty wiring causes muscle
weakness, numbness, tingling and eventually paralysis.

4. Signs & Symptoms of GBS
؈ Muscle Weakness
؈ Numbness
؈ Loss of reflexes in arms & Legs
؈ Low blood pressure
؈ Uncoordinated movement
؈ Facial weakness
؈ Clumsiness & Falling
؈ Severe Pain in Lower back
؈ Sensation changes
؈ Tenderness or Muscle pain
؈ Blurred vision
؈ Respiratory problems

5. ؈ Older AGE (40-75)
؈ In Men more likely than Women
؈ Recent Gastrointestinal or Respiratory Infection by
Viruses or Bacteria
؈ Recent Vaccination (Esp. Influenza & Meningococcal)
؈ History of Lymphoma, Systemic Lupus
Erythromatous, HIV & AIDS
Risk Factors of GBSRisk Factors of GBS

6. Pathophysiology of GBSPathophysiology of GBS
GBS is considered to be an autoimmune disease triggered by a preceding bacteriology or viral
infection. Campylobacter Jejuni, Cytomegalovirus, Epstein-Barr Virus and Mycoplasma
pneumonia are commonly identified antecedent pathogens. They have specific antigens in
their capsule that they share with nerves. The immune system usually then respond to these
component in the capsule by producing antibodies that cross-react with the myelin in the
peripherals nervous system, causing demyelination and then damage the peripheral systems.
In GBS there is infiltration of the spinal roots and peripheral nerves via the lymphatic system,
causing stripping of the myelin. This will lead to a defect in the transmission of electrical
nerve impulses which will then lead to Flaccid paralysis.

7. Guillain-Barre syndrome is now known to occur in several
forms. The main types are:
؈ Acute inflammatory demyelinating polyradiculoneuropathy
(AIDP) The most common sign of AIDP is muscle weakness
that starts in the lower part of your body and spreads
upward.
؈ Miller Fisher syndrome (MFS), in which paralysis starts in the
eyes. MFS is also associated with unsteady gait.
؈ Acute motor axonal neuropathy (AMAN) characterized by
acute paralysis and loss of reflexes without sensory loss and
AMSAN is a severe acute illness differing from AMAN in that
it also affects sensory nerves and roots
Types of GBS

8. Diagnostic of GBS
The diagnosis of Guillain–Barre Syndrome depends on findings such as rapid
development of muscle paralysis, absent reflexes, absence of fever, and a likely cause:
• Clinically Assessment (Neurological Examination including diminished or loss of deep
tendon reflexes)
• Cerebral Spinal Fluid (CSF)
• Electrocardiogram (ECG)
• Blood Test
• Neurophysiology (Electromyography)

9. Management of GBS
؈ General Management of GBS to prevent complication include:
؈ Immunomodulatory Therapy (Eg: Intravenous Immunoglobin (IVIG), Plasmapheresis,
Plasma Exchange)
؈ Respiratory Support (Eg: Mechanical Ventilation)
؈ Heart Rate & Blood Pressure Management
؈ Anticoagulants
؈ Physical, Occupational & Speech Therapy

10. Complication of GBS
• Breathing difficulty
• Residual Numbness or other sensation
• Heart & Blood Pressure problems
• Severe Pain
• Bowel & Bladder functional problems
• Blood clots
• Pressure Sores
• Relapse GBS

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• Jason I,, Recognizing and managing Guillain-Barre Syndrome. Emergency nursing: October 2019; 18(3): 27-30
• http://www.thirdage.com/hc/c/guillain-barre-syndrome-risk-factors
• Osmosis Guillain-Barre Syndrome - causes, symptoms, diagnosis, treatment, pathology Available from
https://www.youtube.com/watch?v=rYNAzJqJKd8
• Dirlikov E, Major CG, Medina NA, Lugo-Robles R, Matos D, Muñoz-Jordan JL, Colon-Sanchez C, Garcia M, Olivero-
Segarra M, Malave G, Rodríguez-Vega GM. Clinical Features of Guillain-Barré Syndrome With vs Without Zika Virus
Infection, Puerto Rico, 2016. JAMA neurology. 2019 Oct 1;75(9):1089-97.