GUILLIAN-BARRE SYNDROME

                                                      GUILLIAN-BARRE SYNDROME

What is GBS?

 Guillain Barré Syndrome (GBS) is an autoimmune disease in which the peripheral nerves and nerve roots are damaged by the immune system’s antibodies and lymphocytes.The syndrome is named after the French neurologists Georges Guillain and Jean Alexandre Barré

Definition : 

It is a collection of clinical symptoms that manifests as an acute, frequently severe & fulminant polyradiculoneuropathy that is autoimmune in nature.

Pathophysiology :

Infectious organism containing amino acid that mimics the peripheral nerve myelin protien leads to cell mediatory inflammatory attack on peripheral nerve myelin as the immune system can not distinguish between the two leads to destruction of peripheral nerves targeting ganglioside GMB1 causing diminished nerve conduction.

Etiology & Risk factors :

• Idiopathic
• Viral Infection : Influenza, Zika virus, Epstein Barr Virus, Hepatits E virus etc
• Bacterial infections: Mycoplasma pneumoniae, Campylobacter jejuni etc
• Injury to spinal cord
• Head Injury

Types :

• Acute Inflammatory Demyeliunating Polyneuropathy [AIDP]: Inflammation & destruction of myelin sheaths of peripheral nerve cell activated by macrophages
• Acute Motor Axonal Neuropathy [AMAN]:  Binding of antibodies to ganglioside antigens on axon cell membrane followed by macrophage invasion, inflammation & axonal damage.
• Acute Motor & Sensory Axonal Neuropathy [AMSAN]: Bpoth motor & sensory nerve fibres are damaged due to macrophage invasion & inflammation causing axonal damage.
• Miller Fisher Syndrome [MFS]:  Demyelination of nerve roots 

Sign & Symptoms :

Motor System : 

• Motor paralysis with or without sensory disturbance
• Ascending type paralysis
• Rubbery legs
• Dysesthesias of limbs
• Lower limbs are affected more
• Burning & Numbness or tickelin feeling on lower limbs

Deep Tendon Reflexes :

• Attenuated or absent reflex

Cranial Nerves :

• Facial diparesis
• Bulbar weakness
• Ophtalmoplegia
• Pupillary paralysis
• Optic atrophy

Bladder :

• Loss of bladder tone & sensation is seen in early course of disease

Autoimmune Involvement :

• More prominent
• Labile BP
• Cardiac dysrhythmias
• Dyspnea due to intercoastal & diaphragmatic muscles are affected

Medical & Nursing Management :

• Plasmapheresis is the treatment of choice
• Corticosteroids to suppress immunity
• Analgesics to reduce pain
• Immunoglobulin Intravenously
• Oxgenation
• Turn & Reposition the patient
• Assess Vital signs, rate of accessory muscle involvement
• Assess communication ability
• Symptomatic Mgt

Distinctive facts:

• Ix- CSF analysis, Nerve Conduction Test, CT scan, MRI
• Most common type is AIDP
• GBS is also called as French Polio, Acute Idiopathic Polyneuritis
• Complications are DVT, bed Sore, Pneumonia
• Physiotherapy is mandatory

Prognosis:

Most of the patients recover fully but it takes many months of  intensive therapy. The mortality ranges from 2-12%. 15% patients suffer disability & 10% are unable to walk.