GBS

Question 1

What is GBS-guaillain Barre Syndrome?

Answer 1

Acute inflammatory demyelinating polyneuropathy whereby it attacks the myelin sheath and interrupts the nerve conduction.

Question 2

What causes GBS?

Answer 2

Suspected to be infections and systemic illnesses. They do not directly cause GBS but the antigens that are present look similar to the lipids in the myelin sheath (molecular mimicry) hence the immune system is unable to differentiate between the two and attacks the myelin sheath.

Viral infections:
HIV
Cytomegalovirus, Epstein Barr virus( common)
Harmophilus influenzae

Bacterial:
Campylobacter jejuni
Mycoplasma

Post flu vaccine

Systemic:
hodgkin’s disease
SLE
paraproteinemia
Cancer
Sarcoidosis

Question 3

What are the clinical features of GBS?

Answer 3

1)Progressive symmetric ascending muscle weakness; paralysis, respiratory failure
-diaphragm affected

2) reduced or absent deep tendon reflex ( motor neuron)

3) sensory symptoms: paresthesia ( burning, prickling feeling) of the hand, feet and pain related to the demyelination of the sensory fibres

4) CN III-VII and IX-XII may be affected
-diplopia, dysarthria, dysphagia, opthalmoplegia ( paralysis of the muscles within or ard the eye) , facial droop, autonomic dysfunction

5) dysautonomia -BP lability, tachy brady, arrythmias, bowel bladder involvement, pupillary changes

Question 4

What are the diagnostic tests to be done for a GBS? (5)

Answer 4

● History taking and physical examination
● Tests for infectious disorders – FBC, antibody titres to EBV & CMV, C. Jejuni infection, hepatitis, HIV
● Electrodiagnostic test – demyelination – absent F waves, slow nerve conduction velocities (normal initially)
● CSF analysis – albuminocytologic dissociation = increased protein but normal WBC (may be normal up to 1
week & 10% of patients)
● Anti-GQ1b antibodies - for Miller Fisher syndrome

Question 5

What are the treatment available for GBS? (5)

Answer 5

● Intensive supportive care
● ventilator support / close monitoring of blood pressure, heart rate, respiration rate is part of the
treatment plan for some patients who progress in their disease,.
● Intravenous immunoglobulin can be given. 0.4g/Kg once a day for 5 consecutive days. Check IgA
antibodies.
● Plasmapharesis – plasma exchange to remove damaging antibodies
● Gabapentin/Carbamazepine – Neuropathic pain

Question 6

Signs of impending respi failure

Answer 6

Progressive Quadriparesis Bulbar involvement Weak cough
Dyspnea Tachypnea Orthopnea Accessory muscle use
Tachycardia Diaphoresis
Vital capacity testing (bedside) Arterial oxygen saturation Arterial blood gas: PaCO2 Chest radiographs
Signs of impending respiratory failure
Quadriplegia, Inability to lift head off the bed Dysphagia, weak voice, bifacial weakness Trouble expelling secretions “wet” voice
Respiratory complaints
Respiratory fatigue
Inability to speak in full sentences or count to 20 Nocturnal desaturations, prefers to sit up
Using neck and abdominal muscles
Signs of distress
Restlessness Staccato speech
Monitoring
Vital capacity <15mL/kg to 20ml/kg, falling, drop by 30% Desaturation (late sign)
Hypercapnia = hypoventilation (late sign)
Atelectasis, pneumonia

Question 7

Nursing care for GBS

Answer 7

● Nursing care
● Discharge planning
● Physical and psychosocial well-being
● Prevent complications during the early stages of the disease
● Assist in the recovery of function during the rehabilitation stages
● Patient education
○ Illness and disease process, and the anticipated course