AUTOIMMUNE DISORDERS OF NERVOUS SYSTEMANILKUMAR BR
Autoimmune disorders of the nervous system can attack the central nervous system (CNS), Autoimmune disorders affecting both the central and peripheral nervous system.) which includes the brain and spinal cord, or the peripheral nervous system, consisting of nerves that connect the CNS with the limbs and organs.
The most common disorders are multiple sclerosis and myasthenia gravis.
Autoimmune nervous system disorders include:
Multiple sclerosis
Myasthenia gravis
Guillain-Barré syndrome. (GB Syndrome)
Guillain Barre syndrome - is a inflammatory Demyelinating polyneuropathy
- Causes damage to the peripheral nerves
- it has 4 sub types
AIDP, AMAN,AMSAN, MSF
- treatment
- Homoeopathy management
AUTOIMMUNE DISORDERS OF NERVOUS SYSTEMANILKUMAR BR
Autoimmune disorders of the nervous system can attack the central nervous system (CNS), Autoimmune disorders affecting both the central and peripheral nervous system.) which includes the brain and spinal cord, or the peripheral nervous system, consisting of nerves that connect the CNS with the limbs and organs.
The most common disorders are multiple sclerosis and myasthenia gravis.
Autoimmune nervous system disorders include:
Multiple sclerosis
Myasthenia gravis
Guillain-Barré syndrome. (GB Syndrome)
Guillain Barre syndrome - is a inflammatory Demyelinating polyneuropathy
- Causes damage to the peripheral nerves
- it has 4 sub types
AIDP, AMAN,AMSAN, MSF
- treatment
- Homoeopathy management
Acute onset infection
Monophasic immune mediated polyneuropathy
Rapid progressive motor paralysis
Affects people of all ages and is not hereditary
Post infectious disease
It can follow by systemic infections
Auto immune in nature
OTHER TERMS
Acute inflammatory demyelinating poly radiculopathy (AIDP)
Acute idiopathic poly radiculo neuritis
Acute idiopathic neuritis
French polio
Landry Guillain Barre Syndrome
TYPES - Acute inflammatory demyelinating poly radiculo neuropathy (AIDP)
Acute Motor Axonal neuropathy(AMDN)
Acute Motor &Sensory Axonal neuropathy(AMSAN)
Miller Fisher Syndrome(MFS)
Polyneuritis Cranialis
CLINICAL MANIFESTATIONS
Paresthesia is frequent followed by paralysis in the extremities
Hypotonia
Areflexia Autonomic dysfunctions include orthostatic hypotension
Hypertension
Abnormal vagal responses
Bowel and bladder dysfunction
Facial flushing
Diaphoresis
Syndrome of inappropriate anti diuretic hormoneProgression of Guillain barre syndrome
include lower brain stem that involves the
Facial Nerve
Abducens Nerve
Oculo Motor Nerve
Hypoglossal Nerve
Trigeminal Nerve
Vagus Nerve
Pain Is a common symptom and It becomes worse at Night.
TREATMENT
On set to two weeks: Plasma pheresis (40-50 ml/kg four times a week
After two weeks: intravenous administration of high dose immunoglobulin (Sandoglobulin)
Beyond three weeks: plasma exchange and immunoglobulin therapies
Chest Physiotherapy
Artificial ventilation-Maintain Gas Exchange
COMPLICATIONS
Cardiac arrhythmias
Respiratory failures
Dys autonomia
Pneumonia
Adult Respiratory Distress Syndrome
Septicemia
Death
A brief description about Demyelination topics by Dr Sabu Augustine for MBBS Students in Medical school.
References from textbooks and other presentations.
Pediatrics notes about "Acute flaccid paralysis". These notes were published in 2018.
You can download them from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Acute onset infection
Monophasic immune mediated polyneuropathy
Rapid progressive motor paralysis
Affects people of all ages and is not hereditary
Post infectious disease
It can follow by systemic infections
Auto immune in nature
OTHER TERMS
Acute inflammatory demyelinating poly radiculopathy (AIDP)
Acute idiopathic poly radiculo neuritis
Acute idiopathic neuritis
French polio
Landry Guillain Barre Syndrome
TYPES - Acute inflammatory demyelinating poly radiculo neuropathy (AIDP)
Acute Motor Axonal neuropathy(AMDN)
Acute Motor &Sensory Axonal neuropathy(AMSAN)
Miller Fisher Syndrome(MFS)
Polyneuritis Cranialis
CLINICAL MANIFESTATIONS
Paresthesia is frequent followed by paralysis in the extremities
Hypotonia
Areflexia Autonomic dysfunctions include orthostatic hypotension
Hypertension
Abnormal vagal responses
Bowel and bladder dysfunction
Facial flushing
Diaphoresis
Syndrome of inappropriate anti diuretic hormoneProgression of Guillain barre syndrome
include lower brain stem that involves the
Facial Nerve
Abducens Nerve
Oculo Motor Nerve
Hypoglossal Nerve
Trigeminal Nerve
Vagus Nerve
Pain Is a common symptom and It becomes worse at Night.
TREATMENT
On set to two weeks: Plasma pheresis (40-50 ml/kg four times a week
After two weeks: intravenous administration of high dose immunoglobulin (Sandoglobulin)
Beyond three weeks: plasma exchange and immunoglobulin therapies
Chest Physiotherapy
Artificial ventilation-Maintain Gas Exchange
COMPLICATIONS
Cardiac arrhythmias
Respiratory failures
Dys autonomia
Pneumonia
Adult Respiratory Distress Syndrome
Septicemia
Death
A brief description about Demyelination topics by Dr Sabu Augustine for MBBS Students in Medical school.
References from textbooks and other presentations.
Pediatrics notes about "Acute flaccid paralysis". These notes were published in 2018.
You can download them from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
4. Guillain-Barré syndrome (GBS)
• A collection of clinical syndromes that manifests as an acute inflammatory
polyradiculoneuropathy with resultant weakness and diminished reflexes.
• GBS is a rare disorder in which your body's immune system attacks your
nerves. Weakness and tingling in your hands and feet are usually the first
symptoms.
• These sensations can quickly spread, eventually paralyzing your whole
body. In its most severe form GBS is a medical emergency. Most people
with the condition must be hospitalized to receive treatment.
• Sensory, autonomic, and brainstem abnormalities may also be seen.
• GBS is the most common cause of acute motor paralysis in children.
4
5. Ethology/cause
• The exact cause of Guillain-Barre syndrome is unknown.
• Increasing data indicate that it is an autoimmune disease, often triggered:
5
• By Vaccination against the:
Flu
Rabies
Meningitis
• By a preceding viral or bacterial
infection with organisms such as:
Campylobacter jejuni
Cytomegalovirus
Epstein-Barr virus
Mycoplasma pneumoniae.
COVID-19, Zika virus
• Two-thirds of patients report symptoms of an infection in the six weeks
preceding. These include a COVID-19, respiratory or a gastrointestinal
infection or Zika virus.
6. Pathophysiology
• Two pathophysiological forms have been described:
Demyelinating form of GBS
Axonal forms of GBS
Demyelinating form of GBS :
• Segmental demyelination of peripheral nerves is due to immune mediated
involving both humoral and cell-mediated immune mechanisms
Axonal forms of GBS
• axonal degeneration may occur without demyelination or inflammation.
6
7. Pathophysiology (CONT’D)
• The mechanism of disease possibly involves an abnormal T-cell response
precipitated by an infection which activate CD4+ helper-inducer T cells.
• There is strong evidence that the cause is autoimmune. The immune system
produces an immune response to an infection which cross-reacts with the
nerves.
• It usually reacts with and damages the outer coating sheath of the nerve fibers,
called myelin. In more severely affected people, this damage also affects the
central conducting core of the nerve, called the axon.
• In some people the axon is itself the main target of the autoimmune response.
7
10. Types of GBS
• The clinical spectrum of GBS, which includes individual variation and
variable severity of presentation, comprises the following:
1. Acute inflammatory demyelinating polyradiculoneuropathy
(AIDP)
2. Acute motor axonal neuropathy (AMAN)
3. Acute motor and sensory axonal neuropathy (AMSAN)
4. Miller-Fisher syndrome (MFS)
5. Polyneuritis cranialis
10
11. 1.Acute inflammatory demyelinating
polyradiculoneuropathy (AIDP)
• Accounts for 80-90% of GBS cases ( Europe and North America)
• Characterized by an immune-mediated attack on myelin with infiltration of
lymphocytes and macrophages with segmental stripping of myelin.
• Motor and sensory fibres are usually affected simultaneously, producing
corresponding deficits.
• Electrophysiology shows:
1. Slow nerve conduction velocity
2. Prolonged F waves.
11
12. 2.Acute motor axonal neuropathy (AMAN)
• Most commonly seen in China and Japan (50-60% of cases), as
apposed toWestern countries (10-20% of cases).
• In this form, axonal degeneration occurs by immune attack within 1-2
weeks after infection.
• Specific antibodies to axonal membranes of motor fibres attack the nodes of
Ranvier.
• This, in turn, activates complement and intrusion of macrophages into
periaxonal space, resulting in destruction of axons.
12
13. 2.Acute motor axonal neuropathy (AMAN) {CONT’D}
• C jejuni is the most common preceding infection, and antiganglioside
antibodies are usually found in this type.
• Electrophysiology shows:
1. Reduction in muscle action potentials with relatively preserved
motor nerve conduction velocity
2. Normal sensory nerve action potentials and F waves
13
14. 3.Acute motor and sensory axonal neuropathy
(AMSAN)
• This type is rare and resembles AMAN except sensory nerves
are also affected.
• This type is associated with a severecourse and poor prognosis.
14
15. 4.Miller-Fisher syndrome (MFS)
• The involvement of Cranial nerves. is very distinct in this form of GBS.
• Ocular motor nerves (oculomotor, trochlear, and abducens) are affected and
produce a triad of ophthalmoplegia, ataxia, and areflexia.
• Electrophysiology is normal.
• The characteristic autoantibodies are against gangliosides GQ1b and GT1a.
• GQ1b plays a key role in the pathogenesis of MFS.
15
16. 5. Polyneuritis cranialis
• This is an acute onset of Multiple Cranial nerves.
o Elevated cerebrospinal fluid protein
o Slowed nerve conduction velocity
o Uncomplicated recovery.
16
17. Risk factors
undercooked poultry, common cause for campylobacter infection.
Influenza virus, Cytomegalovirus, Epstein-Barr virus, Zika virus,
COVID-19 virus
Males than females
Risk increases as age increases
Hepatitis A, B, C and E
HIV, the virus that causes AIDS
Mycoplasma pneumonia
Surgery
Trauma
COVID-19 Johnson & Johnson and AstraZeneca vaccine
17
18. Clinical Presentation
• Guillain-Barre syndrome often begins with tingling and weakness starting
in your feet and legs and spreading to your upper body and arms.
• Some people notice the first symptoms in the arms or face. As Guillain-
Barre syndrome progresses, muscle weakness can turn into paralysis.
Symptoms can progress over hours, days, or weeks.
18
19. Signs and symptoms of GBS may include:
A pins and needles sensation in your fingers, toes, ankles or wrists
Weakness in your legs that spreads to your upper body
Unsteady walking or inability to walk or climb stairs
Difficulty with facial movements, including speaking, chewing or swallowing
Double vision or inability to move the eyes
Severe pain that may feel achy, shooting or cramplike and may be worse at night
Difficulty with bladder control or bowel function
Rapid heart rate
Low or high blood pressure
Difficulty breathing
19
20. Diagnosis
• Guillain-Barre syndrome can be difficult to diagnose in its earliest stages.
• Its signs and symptoms are similar to those of other neurological disorders and may
vary from person to person.
• Physical Examination and medical history is our major diagnosis criteria.
Physical Examination
• Examine hands, feet or limb to check for numbness
• Recent history of GBS secondary to food poisoning or flu
• Check for reflexes
• Ask for duration and severity of symptoms
20
21. Diagnosis(CONT’D)
• The diagnosis of GBS is typically based on the presence of :
o Progressive ascending weakness
o Areflexia
• Findings on :
Lumbar puncture
Electrodiagnostic studies
MRI (occasionally)
• Can give support for the diagnosis.
• Abnormalities on these studies do not develop until days to weeks after onset
of symptoms.
21
22. Lumbar Puncture
• Typically, the LP findings are suggestive of demyelination (i.e., increased
protein >45 mg/dL within 3 weeks of onset) without evidence of active
infection (lack of CSF pleocytosis),
• The CSF findings may be normal within the first 48 hours of
symptoms
• Occasionally the protein may not rise for a week.
• Usually by 10 days of symptoms, elevated CSF protein findings will be
most prominent.
• Most patients have fewer than 10 leukocytes per milliliter, but
occasionally a mild elevation (i.e., 10-50 cells/mL) is seen.
• Greater than 50 mononuclear cells/mL of CSF makes the diagnosis of
GBS doubtful.
22
23. Electrodiagnostic Studies
• Within the first week of the onset of symptoms, electrodiagnostic studies
in at least two limbs reveal the following:
• A dispersed, impersistent, prolonged, or absent OF response (88%)
• Increased distal latencies (75%)
• Conduction block (58%) or temporal dispersion of compound muscle
action potential (CMAP)
• Reduced conduction velocity (50%) of motor and sensory nerves
• Criteria for axonal forms include:
• Lack of neurophysiologic evidence of demyelination
• Loss of amplitude of CMAP or sensory nerve action potentials to at least
less than 80% of lower limit of normal values for age
23
24. Electrodiagnostic Studies
Electromyography.
• Thin-needle electrodes are inserted into the muscles to study. The electrodes
measure nerve activity in the muscles.
Nerve conduction studies.
• Electrodes are taped to the skin above nerves. A small shock is passed
through the nerve to measure the speed of nerve signals.
24
25. MRI
Nearly 2 weeks after presentation of symptoms, lumbosacral MRI can
show enhancement of the nerve roots with gadolinium.
This imaging study has been described to be 83% sensitive for acute
GBS, with nerve root enhancement present in 95% of typical cases
25
26. differential diagnosis:
• Spinal cord lesions may be considered in the differential diagnosis:
• Transverse myelitis
• Vascular malformations
• Epidural abscess
• Cord infarctions
• Tumors
• Cord compression
• Enteroviral infections of the anterior horn cells
• Lumbosacral disk syndromes
• Poliomyelitis
• Trauma
• Hopkins syndrome
26
Spinal cord lesions may be considered in the differential diagnosis:
• Transverse myelitis • Vascular malformations
• Epidural abscess • Cord infarctions
• Tumors • Cord compression
• Enteroviral infections of the
anterior horn cells
• Lumbosacral disk
syndromes
• Poliomyelitis • Trauma
• Hopkins syndrome
27. Peripheral neuropathies from the following may produce a GBS-like
picture:
• Vincristine • Glue sniffing
• Heavy metals poisoning • Organophosphate pesticides
• HIV infection • Diphtheria
• Lyme disease • Inborn errors of metabolism
• Leigh disease • Tangier disease
• Porphyria
27
28. Treatment
In pediatrics, the most effective form of therapy is generally considered tobe:
• intravenous immunoglobulin (IVIG)
• Plasmapheresis
• Patients in early stages of this acute disease should be admitted to the
hospital for observation because the ascending paralysis can rapidly
involve respiratory muscles and cause respiratory failure and autonomic
instability
• Steroids are not effective for weakness but may help with pain.
• Supportive care, such as respiratory support, prevention of pressure sores,
nutritional support, pain management, prevention of deep vein thrombosis,
and treatment of secondary bacterial infections is important.
28
29. Intravenous immunoglobulin (IVIG)
• Severe or rapidly progressive muscle weakness is treated with intravenous
immunoglobulin (IVIG); common protocols include:
• IVIG 0.4 g/kg/day for 5 consecutive days or 1g/kg/day for 2 days.
• IVIG is a treatment made from donated blood that contains healthy
antibodies. These are given to help stop the harmful antibodies damaging
your nerves.
29
30. Plasmapheresis
• A plasma exchange, also called plasmapheresis, is sometimes used As an
alternative of IVIG.
This involves being attached to a machine that removes blood from a vein and
filters out the harmful antibodies that are attacking your nerves before returning
the blood to your body
• Most people need treatment over the course of around 5 days
• Plasma exchange shortens the disease course and hospital stay, and reduces
mortality risk and incidence of permanent paralysis.
• However, it may cause hypotension due to large fluid shifts, and IV access may
be difficult or cause complications.
• Plasma exchange removes any previously administered IVIG, negating its
benefits, and so should never be done during or soon after use of IVIG.
30
31. Other treatments
• While in hospital, you'll be closely monitored to check for any problems with
your lungs, heart or other body functions.
• You'll also be given treatment to relieve your symptoms and reduce the risk of
further problems. This may include:
• a breathing machine (ventilator) if you're having difficulty breathing
• a feeding tube if you have swallowing problem.
• painkillers if you're in pain
• being gently moved around on a regular basis to avoid bed sores and keep your
joints healthy
• a thin tube called a catheter in your urethra if you have difficulty peeing
• laxatives if you have constipation.
31
32. Complications of GBS
• The most common serious complications are:
1. Weakness of the respiratory muscles
2. Autonomic instability
32
Other important potential complications include:
• Pneumonia • Ileus
• Adult respiratory distress
syndrome
• constipation
• Septicemia • gastritis
• Pressure sores • dysesthesias
• Pulmonary embolus • Nephropathy
33. Prognosis
• In general, the outcome of GBS is more favourable in children than in adults
• the recovery period is long, often weeks to months
• Rarely, it can be fatal in 5-10% of patients with respiratory failure and cardiac
arrhythmia
• Recurrence of GBS occurs in approximately 5% of cases
• Overall mortality rate in childhood GBS is estimated to be less than 5%
• Deaths are usually caused by respiratory failure, often in association
with :
Cardiac arrhythmias
Dysautonomia
33
34. Clinical Summary
• Features required for diagnosis are:
(1) Progressive weakness of more than one extremity
(2) Hyporeflexia or areflexia
(3) Elevated cerebrospinal fluid protein (>45 mg/dL) after 1 week following onset
of symptoms
(4) Slow conduction velocity or prolonged F wave on electrophysiology testing.
34
35. • Features that rule out the diagnosis include:
(1) A current history of hexacarbon abuse
(2) Abnormal porphyria metabolism
(3) Recent diphtheria infection
(4) Evidence of polio, botulism, toxic neuropathy, tic paralysis, or
organophosphate poisoning.
35
Clinical Summary (Cont.)
36. REFERENCE
• Nelson textbook of pediatrics.
• MSD MANUAL.
• https://www.mayoclinic.org/diseases-conditions/guillain-barre-
syndrome/symptoms-causes/syc-20362793
36