Guillain-Barre Flashcards
What’s the technical name for guillain barre? how does it affect the nervous system?
Acute inflammatory demyelinating polyneuropathy (AIDP)
- Autoimmune disease that attacks the myelin around the axon slowing or impeding the conduction of nerve impulses
- Lesions occur throughout peripheral nervous system from spinal nerve roots to distal end of motor, sensory, and autonomic fibers
What are some possible causes of GB?
- May be related to bacterial or viral infection - Campylobacter Jejuni; 2/3 pts report respiratory or GI sx in the 3wk before the onset of GBS sx
- No significant research showing a link between GBS and vaccinations (flu, hepatitis, tetanus)
- Stressful events and surgeries may also trigger the disease
- Link with disease to Zika virus
What are S and S of GB?
- Characterized by ascending symmetrical motor and sensory impairments and autonomic symptoms
- Motor - Distal more than proximal – LE’s usually before UE’s; Can affect cranial nerves; May affect respiratory muscles creating need for intubation – 25% of all cases
- Sensory - Absence of DTR’s; Paresthesias (numbness and tingling)
- Autonomic - Urinary retention; Blood pressure instability; Cardiac arrythymias; Slowing on gastrointestinal motility
- Other - Fatigue; Pain of limbs or back with movement
What are the criteria required for diagnosis of GB?
- Bilateral symptoms
- Progressive weakness in more than 1 extremity
- Loss of DTR’s
Sx to support:
- Weakness develops rapidly and progression stops by week 4
- Symmetric weakness
- Mild sensory symptoms
- Facial weakness
- Autonomic changes
- Absence of fever
What does an EMG show in GB?
shows nerve conduction velocity slowed or blocked
What does a lumbar puncture reveal with GB?
cerebrospinal fluid shows increased protein levels after 1 week and continue to increase and normal WBC count
what is the progression of GB symptoms?
- peak within 4 wks (90% progression ends by 4 weeks; 25% require mechanical ventilation, mean hospital stay is 7 days)
- plateau
- gradual recovery over 1-2 yrs (77% completely recover in 1 year, 20% have LT impairments [10% of which are severely disabled], 3% mortality)
what usually contributes to mortality in GB?
respiratory distress, PE, cardiac arrest
What are the subtypes of GB?
- Acute inflammatory demyelinating polyneuropathy – AIDP (most common form 85-90% of cases)
- Acute motor axonal neuropathy – AMAN; Motor changes more prominent, respiratory involvement, more typical in younger patients
- Acute sensory axonal neuropathy – ASAN; Sensory changes more prominent, more typical in adult patients
- Miller Fisher syndrome; Present with ataxia, areflexia, and paralysis of extraocular muscles
- Acute autonomic neuropathy; Rarest subtype, autonomic symptoms, especially cardiac and visual, recovery is slow
What are complications of GB?
- Anxiety and Depression
- Respiratory distress
- Contractures
- Skin breakdown
- DVT’s and embolisms
- Pneumonia
- Aspiration
What is medical treatment of GB?
- Plasma exchange - First line of therapy; Removes plasma from blood and filters it to remove or dilute circulating antibodies; 2-4 sessions performed within 7 days of symptom onset
- Intravenous immunoglobulin (IVIg) - Protein the immune system normally uses to attack foreign organisms; 1x/day for 5 days within 2 weeks of symptom onset ; Should be considered for nonambulatory patients
- RCT’s have shown no benefits to combining IVIg and plasma exchange
- Corticosteroids are NOT beneficial and may actually delay recovery
What are negative prognostic indicators for GB?
- Older age at onset
- More severe and rapid onset of symptoms
- Disease progression past 4 weeks
- Need for artificial respiration (mechanical ventilation)
What symptom of GB lasts the longest?
severe fatigue
- other symptoms resolve first
- supervised exercise is recommended
- early therapy positively correlated to recovery potential and improved physical outcomes
- strength exercises should be done in acute phase
What does acute therapy look like for GB?
1 focus is toward prevention of complications associated with immobilization
- Maintain joint ROM
- Monitor muscle strength closely
- Proper skin care
- Coughing and deep breathing
- Gentle massage
- Orthotics or splinting devices
- Educate pt. and family:
- Passive ROM
- Turning schedule/position changes
- Disease progression and treatment
- Talk about fears and frustrations
What are precautions for therapy during the acute phase of GB?
- *Take extreme care to not over fatigue patients**
- May impede recovery by increasing weakness and pain
- Do not use high resistance exercises
- Gradually increase activity
- Monitor day to day
- Exercise programs have been shown to be effective for improvement of fatigue
