Guillan-Barre Syndrome

Question 1

GBS

Answer 1

ascending paralysis with sensory impairment
acute, inflammatory demyelination of peripheral nerves and possible respiratory paralysis (AIDP)
can be medical emergency
General inflamm response eats myelin from peripheral N, antibodies against myelin

Question 2

Epidemiology

Answer 2

most common cause of rapidly evolving paralysis/sensory deficits
1/2 per 100,000
all age groups affected, young adult or 50-80 yo
M>F, caucasians

Question 3

Pathogenesis

Answer 3

exact cause unknown
autoimmune response
assoc with previous: resp infection or GI infection 30 days prior, flu, epstein-barr, cytomegalovirus, campylobacter, Sx

Question 4

Progression

Answer 4

distal symmetrical weakness with sensory impairment
ascending bottom–>top
many subtypes
can be life threatening 30% require mechanical ventilation

Question 5

Classic GBS

Answer 5

acute onset, an be <1 day
peak impairment in 4 weeks
2-4 week static period
gradual recovery in mo-yrs
10% relapse
can have some autonomic response

Question 6

Dx

Answer 6

CSF- lumbar puncture, look for increased albumin
EMG- slow N conduction
clinical exam- symptoms R/O lyme disease

Question 7

Acute management medical

Answer 7

restore and maintain airway
monitor and tx arrhythmias
plasmapheresis/ IVIg- 4-6 tx/wk- significant improve function

Question 8

Acute management PT

Answer 8

PROM-->AAROM
positioning/splinting
postural drainage/breathing exercises
pressure garments
watch for signs of PE

Question 9

Rehab

Answer 9

do thorough MMT and sensory exam for baseline
regain tolerance to vertical
breathing training
monitor vital signs for autonomic response
Tx pain
STR program
CV and endurance training
gait and functional retraining

Question 10

prognosis

Answer 10

poor outcome assoc with older age, protracted time before recovery begins, need for ventilation, EMG consistent with axonal degen
after 1 year, 67% show complete recovery, 20% significant disability
after 2 years, 8% not recovered