Guillain-Barre syndrome

Question 1

underlying pathology- GBS

Answer 1

usually multifocal inflammation and demyelination throughout the PNS, with secondary axonal degeneration in the mist severely affected
autoimmune disease
usually develop a week or 2 after a throat or intestinal infection

Question 2

GBS

Answer 2

characterised by rapidly evolving symmetrical limb weakness, loss of tendon reflexes, absent or mild sensory signs, variable autonomic dysfunction

Question 3

diagnosis of GBS

Answer 3

clinical history/medical examination, blood tests, EMG (electromyogram), lumber puncture

Question 4

types of GBS- acute inflammatory demyelinating polyradiculoneuropathy

Answer 4

AIDP- the most common form. the most common sign is muscle weakness that starts in lower part of your body and spreads upward

Question 5

types of GBS- Miller Fisher syndrome (MFS)

Answer 5

paralysis starts in the eyes. It is associated with unsteady gait. MFS occurs in about 5% of people with GBS in the USA but is most common in Asia

Question 6

types of GBS- other

Answer 6

acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN)

Question 7

AIDP- initial symptoms

Answer 7

often begins with tingling and weakness starting in your feet and legs and spreading to your upper body and arms. this can progress into paralysis

Question 8

signs and symptoms of GBS

Answer 8

prickling, pins and needles sensations in your fingers/ toes/ ankles/ wrists, weakness in your legs that spreads to UL, unsteady walking or inability to walk/ climb stairs, difficulty with eye or facial movement (swallowing, speaking, chewing), severe pain that may feel achy or cramp- worse at night, difficulty with bladder and bowel function, rapid heart rate, low or high BP, difficulty breathing (intercostal muscles affected)

Question 9

common course of disease

Answer 9

disease is ascending, Nadir (maximum S and S) reached 2-4/52, plateau period lasts approx 4-6 weeks but can be up to a year, 15% require ventilation, recovery can start from week 4 or several months

Question 10

frequency

Answer 10

it affects about one in 40,000, 8% patient die (of respiratory failure, cardiac arrhythmias and pulmonary embolism), it can occur at any age from indancy onwards but is slightly more common in the old, more common in men

Question 11

medical treatment

Answer 11

steroids alone are ineffective, plasma exchange (plasmapheresis), gamma globulin (immunoglobulin)

Question 12

plasma exchange

Answer 12

plasma is separated from blood cells by a machine recognised as a cell separator. the cells collected are returned to the patient, although the plasma that includes the antibodies is useless and restored by other fluids
6-10 treatments within 2-10 weeks

Question 13

gamma globulin (immunoglobulin)

Answer 13

lessen the immune attacks on the cells, 400mg/kg/d IV for 5 days

Question 14

physio treatment

Answer 14

evidence to support individual treatments- strengthening muscles, functional rehabilitation of walking,
general neurological treatment

Question 15

acute phase care

Answer 15

respiratory care, passive movement, positioning, splinting, teach family members how to perform passive movement for their daughter/wife

Question 16

1st stage rehab

Answer 16

sitting practice, getting out of bed