Guillain barré syndrome


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Guillain barré syndrome

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Guillain barré syndrome

  1. 1. Guillain-Barré Syndrome Dpt. Aamir Memon 26.08.2013
  2. 2. Guillain-Barré Syndrome (acute idiopathic polyneuropathy) Definition: Guillain-Barré syndrome (GBS) is a condition involving acute inflammation and destruction of the myelin layer of peripheral nerves.  It usually starts in the extremities and moves toward the trunk, but some variants of this syndrome affect only cranial nerves or have other patterns. → Guillain-Barré syndrome is a peripheral nervous system disease characterized by the sudden onset of muscle paralysis or paresis. → Guillain-Barré results from an autoimmune attack against the myelin surrounding the peripheral nerves. With destruction of the myelin, the axons can be damaged. → Symptoms of Guillain-Barré disappear as the autoimmune attack ceases and the axons regenerate. If destruction of the cell body occurred during the attack, some degree of disability may remain. → Although the cause of Guillain-Barré is unknown, the disease usually occurs 1 to 4 weeks after a viral infection or immunization.  The muscles of the lower extremities are usually affected first, with paralysis advancing up the body.  Respiratory muscles may be affected, leading to respiratory collapse.  Cardiovascular function may be impaired because of interruption of autonomic nerve function.  It is an inflammatory, demyelinating disease whose etiology is not completely understood but probably immunologic in origin.  It affects people of any age, sex, or race and is characterized by extreme weakness and numbness or tingling in the extremities and a loss of movement or feeling in the upper body and face progressing to paralysis.  There is an association with infections, vaccinations, and surgery.  Most clients have good recovery but it may take months.  GBS was first described in 1916, but our understanding of how this disease comes about has not progressed a great deal since then.  Many patients have an infection of the respiratory or gastrointestinal tract several days before developing GBS symptoms.  It is believed that this preceding infection stimulates an immune system attack mistakenly directed against the myelin sheaths of peripheral nerves. Demographics: → GBS can affect anyone any time, but most affected people are 15-35 or 50-75 years old. → Men with GBS slightly outnumber women. → Although it is not a particularly common problem, affecting about 1 in every 100,000 people (about 3,000 people in the United States each year), it is the most frequently seen form of acute neuromuscular paralysis since the eradication of polio in the Western Hemisphere.
  3. 3. Etiology: → Research indicates that a common cause of food poisoning, the bacterium Campylobacter jejuni, may trigger many cases of GBS in the United States. Other pathogens that have been linked to GBS include Haemophilus influenzae, Mycoplasma pneumoniae, Borrelia burgdorferi, cytomegalovirus, Epstein-Barr virus, and HIV. → Some GBS patients don’t experience a preceding infection. This disorder has also been seen in conjunction with immune system changes brought about by pregnancy, surgery, and administration of certain vaccines, specifically the swine flu vaccine that was distributed in 1976. → Regardless of what initiates the disease process, the end result is that the myelin sheaths on peripheral nerves are attacked and destroyed by macrophages and lymphocytes.  The damage progresses proximally and may also affect cranial nerves.  This can be life threatening if the nerves that control breathing are damaged; many GBS patients spend time on a ventilator before they recover. → GBS is now recognized as several different subtypes of demyelinating diseases. The most common form in the United States is acute inflammatory demyelinating polyneuropathy; this accounts for 90% of GBS diagnoses. Other types include these:  Acute motor axonal neuropathy affects motor neurons only.  It is most common in children and has a good prognosis.  Acute motor-sensory axonal neuropathy affects motor and sensory function.  It is most common in adults and has a poorer recovery rate than other forms of GBS.  Miller-Fisher syndrome is a rare variant of GBS that involves only the cranial nerves.  It leads to poor control of the eyes and other facial muscles. → The cause of Guillain–Barré syndrome is unknown, but in about 50% of cases, the onset follows the infections: Causes Why Viral infection, bacterial infection, common cold, mononucleosis, hepatitis, gastrointestinal (GI) infection, Pathogens in these infections, such as C. jejuni in GI infection, are thought to alter the immune system, causing T-lymphocytes to be sensitized inoculations to myelin and to trigger demyelination
  4. 4. Signs and Symptoms → GBS is notorious for being unpredictable, but it has a few features that distinguish it from other peripheral nerve disorders. → Onset is typically fast and severe; a patient may go from being fully functional to being hospitalized within a matter of hours or a couple of days. → GBS is usually symmetrical, affecting both legs equally. → Also, myelin damage progresses proximally, moving up toward the trunk rather than distally; this pattern is unique among peripheral nerve problems. → When GBS first appears, it often involves weakness or tingling in the affected limbs. → Reflexes become dull or disappear altogether. → Loss of sensation progresses proximally, although pain frequently develops in the hips and pelvis. → If the GBS affects cranial nerves of the face, facial weakness, pain, and difficulty with speech and swallowing may develop. → As the disease progresses, the nerves that supply respiratory muscles are affected, and problems with breathing develop. → GBS symptoms usually peak 2 or 3 weeks after onset, and they may linger for several weeks before they begin to subside. → The amount of damage that accrues while the nerves are inflamed depends on what treatments were introduced when and on how soon the patient can begin to use the affected muscles after the paralysis resolves. → Weakness usually begins in the legs, then spreads to involve the arms and face. → Respiratory muscles may be involved. → Life-threatening complications can occur such as tachycardia, arrhythmias, and pulmonary dysfunction The signs and symptoms and rationales associated with Guillain–Barré syndrome: Signs and symptoms Why Numbness Nerve impulses slow down or cease Tingling in fingers or toes Nerve impulses slow down or cease Mild difficulty in walking With denervation, muscles atrophy Complete paralysis of the extremities With denervation, muscles atrophy Diagnosis Guillain–Barré syndrome is difficult to diagnose because of the varied symptoms, but if symptoms occur uniformly across the body and progress rapidly, the diagnosis is made much easier. → Lumbar puncture may be performed to look for elevated proteins in cerebrospinal fluid which is common. → Nerve conduction test may be recommended to confirm that nerve transmission to the extremities is impaired.
  5. 5. Treatment → Because GBS is an idiopathic disease, no specific cure has been developed. → Two treatment options have been successfully used to shorten recovery time: 1. Plasmapheresis (blood cleansing).  This removes autoimmune antibodies and reduces attacks against myelin.  This procedure is most effective within 2 weeks of onset. 2. Injections of high concentrations of IV immunoglobulin (donated antibodies).  Inhibit the patient’s antibody and cytokine activity, thus limiting the autoimmune attack against myelin sheaths on peripheral nerves.  These options can shorten the recovery process by up to 50%. → About one-third of patients require the use of a ventilator until the respiratory nerves regain full function. → Anticoagulants may be used against the danger of blood clots in immobilized legs. → Pain management is problematic because powerful pain medications can depress the nervous system; massage and other nondrug options are often recommended for this purpose. → Once the acute inflammation has passed, occupational and physical therapy is used to help the patient regain as much muscle function as possible. MODALITY RECOMMENDATIONS FOR GBS MODALITY RECOMMENDATION Deep Tissue Massage Indicated while subacute. Work in areas with full sensation to improve proprioception. Encourage active movement with release work during a long recovery. Lymphatic drainage Supportive. Polarity S: Indicated. R/D: Locally contraindicated while acute; otherwise indicated. PNF/MET/stretching Supportive. Reflexology Indicated; all glands, brain, head, spine, solar plexus points. Shiatsu Indicated. Treat immune system via TH/SP/K; nervous system via BL, SI. Swedish massage Contraindicated while acute; otherwise indicated to help restore function. Caution for areas of reduced sensation. Trigger point therapy Locally contraindicated while acute; indicated when subacute with caution for areas of reduced sensation.
  6. 6. Prognosis → The good news is most people who develop GBS have a full or nearly full recovery, although the process may take 18 months or longer. → Many people live with permanent loss of some neurological function (foot drop or numbness in an area, for instance), but these are not considered disabling problems. → A small number of patients (5%–15%) have permanent serious disability as a result of the disease. → About 10% of GBS patients have a relapse later in life. → About 5% to 7% of GBS patients die, usually of respiratory failure, pulmonary embolism, or cardiac arrest. Complications → Respiratory or cardiovascular collapse may cause death. → Weakness of some muscles may persist.