Guillain-Barre Syndrome refesr to an acute inflammatory demyelinating polyneuropathy. This means that the onset is sudden, there is inflammation which destroys the coverings (myelin) of multiple nerves (polyneuropathy). Demyelination takes places in the peripheral and cranial nerves. It should be noted that there are variants called axonal variants, e.g Miller-Fisher variant (which may present with ophthalmoplegia, ataxia, areflexia,little or no weakness, association with a specific antiganglioside antibody). This syndrome mainly affect the motor component of the nervous system.
The paralysis of the muscles may include bulbar musculature and respiratory muscles. This calls for emergency treatment in the intensive care unit (ICU) . Recovery takes place via axonal regeneration annd re-myelination.
GBS causes are not well understood but sufferers usually may have had an infection in the previous weeks. This autoimmune process may be triggered by different things called GBS precipitants. The preciptants may include:
- Epstein-Barr virus
- Mycoplasma pneumonia
- Campylobacter jejuni
Sometimes it may be precipitated by vaccines such as swine influenza or soome surgical procedures.
Before diagnosing someone of GBS, think of the following differentials possible:
- Acute spinal cord lesion
- Other acute neuropathies, e.g. due to porphyria, vasculitis, drugs, toxins, e.g. lead
- Myasthenia gravis
- Brainstem infarct
- Severe myopathy
- Hysteria, malingering
Signs and Symptoms
Symptoms of GBS are from distal to proximal
- Pain is variable on motor points in muscles and nerve trunks
- Glove and stocking pattern of sensory loss
Autonomic Function Disturbances:
- Labile blood pressure
- Cardiac arrhythmias
- Decreased tone and reflexes
- Progressive ascending limb weakness
- Paralysis of legs and arms
- Dysphagia (difficult swallowing)
- Slurred speech
- Respiratory muscle weakness or paralysis
- Shortness of breath (dyspnoea)
The condition may reach it's peak within hours or in less than or equal to a month. GBS victims may die due to paralysis of respiratory muscles.
- Mechanical Ventilation
- Injection with Immunoglobulins. A high-dose intravenous immunoglobulins (usually five daily infusions)
- Anticoagulants e.g lower molecular heparin as antithrombosis prophylaxis
- Parenteral feeding if swallowing is impaired
Physiotherapy Management During Acute Stage:
- Respiratory care
- Musculoskeletal:Joint protection, Maintenance Joint movement and soft tissue length
- Skin: positioning & circulatory exercises
- Circulation: Prevent DVT & Hypotension
- Psychological support: family and patient
Physiotherapy Management During Plateau Stage:
It is very important to assess the patient and determine treatment priorities.
- Chest care
- Joint range
- Muscle strength – central stability
- Sensory awareness & Balance re-education
- Activities of daily living
- Prescritpion of orthosis
- Forming motivational groups
5–10% of patients die, as a result of cardiac dysrhythmia, pulmonary embolism or sepsis.
Advanced patient age, fast onset of weakness, need for ventilation, preceding diarrhoeal illness, antiganglioside antibodies, and significant axonal degeneration presence on the electrophysiological parameters indicate poor prognosis.
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