Guillian Barre Syndrome

Question 1

What is GBS?

Answer 1

• Unknown cause
• Autoimmune inflammatory disorder which demyelinates the PNS
• Lower motor neurone disorder
• Usually develops after a throat/intestinal infection
• Schwann Cells (which produce myelin in the PNS) are destroyed yet the axons remain in tact

Question 2

Symptoms of GBS

Answer 2

• Rapidly evolving symmetrical limb weakness
• Loss of tendon reflexes
• Absent or mild sensory signs
• Variable autonomic dysfunctions (parasympathetic nervous system)

Question 3

Diagnosis of GBS

Answer 3

• Usually from ruling out other diseases
• Blood tests
• Clinical history/examination
• Lumbar puncture

Question 4

Types of GBS (3)

Answer 4

• Acute Inflammatory Demyelinating Polyradiculoneuropathy - AIDP (most common): Weakness starts in the lower body and spread upwards.
• Miller Fisher Syndrome (MFS) - Paralysis starts in the eyes. Associated with an unsteady gait.
• Acute Motor Axonal Neuropathy (AMAN) and Acute Motor Sensory Axonal Neuropathy (AMSAN)

Question 5

AIDP symptoms

Answer 5

• Prickling, pins and needs sensations
• Weakness in the legs which spread upwards
• Unsteady walking
• Difficulty with eye or facial movements (including speaking, swallowing, chewing)
• Severe pain
• Difficulty breathing

Question 6

AIDP Prognosis

Answer 6

• Maximum signs and symptoms reached between 2-4 weeks
• Plateau period lasts around 4-6 weeks
• Recovery can start form week 4 over several months due to wylerian regeneration (PNS starting to regenerate)

Question 7

Medical Treatment of GBS

Answer 7

• Steroids alone are ineffective
• Plasma exchange (6-10 treatments)
• Gamma Globulin - lessens the immune attack on cells

Question 8

Acute phase of GBS (Ax)

Answer 8

• Positioning
• Splinting
• PROM
• Respiratory care

Question 9

Secondary problems in GBS

Answer 9

• Muscle atrophy
• DVT
• Joint contracture
• Pressure sores (hospital)