Guillain-Barré syndrome

(GBS)
Prepared by
Dr. Madiha Anees PT
Asst. Prof/VP RCRS
MS-PT, BS-PT
Content

 Introduction
 Incidence
 Classification
 Pathophysiology
 Causes
 Risk factors
 Symptoms
 Diagnosis
 Managment
Introduction

 Guillain Barre Syndrome (GBS) or Landry's paralysis is a serious disorder that occurs
when the body’s defense (immune) system mistakenly attacks part of the peripheral
nervous system.
 It is an acute, progressive, autoimmune, inflammatory demyelination of polyneuropathy of
the peripheral sensory and motor nerves and nerve roots.
 The syndrome is named after the French physicians Georges Guillain and Jean Alexandre
Barré and strohl. who described it in 1916.
INCIDENCE

 1–2 cases per 100,000 people annually

 Men are one and a half times more likely to be affected than women
 It is the most common cause of acute non- trauma-related paralysis in the world.
Classification

 There are 6 different subtypes of GBS and they are:

 Acute Inflammatory demyelinating polyneuropathy
 Miller Fisher syndrome
 Acute motor axonal neuropathy
 Acute motor sensory axonal neuropathy
 Acute panautonomic neuropathy
 Bickerstaff’s brainstem encephalitis
1) Acute Inflammatory Demyelinating
Polyneuropathy (AIDP)
 Most common
 Auto immune response against schwann
cell.
2) Miller Fisher Syndrome (MFS)

 Rare variant
 Manifest as a descending paralysis.
 Usually affects the eye muscles first and
presents with the triad of ophthalmoplegia,
ataxia, and areflexia.
3) Acute Motor Axonal Neuropathy (AMAN)

 Also known as Chinese paralytic

syndrome.
 Attacks motor nodes of Ranvier and is
prevalent in China and Mexico.
4) Acute Motor Sensory Axonal Neuropathy
(AMSAN)
 Similar to AMAN
 Affect the sensory with several axonal damage.
5) Acute Panautonomic Neuropathy

 Is the most rare variant of GBS, sometimes accompanied by encephalopathy.

 Frequently occurring symptoms include
 Impaired sweating
 Lack of tear formation
 Photophobia
 Dryness of nasal and oral mucosa
 Itching and peeling of skin
 Nausea
 Dysphagia
 Constipation unrelieved by laxatives or alternating with diarrhea.
Contt.

  Initial nonspecific symptoms of

 Lethargy
 Fatigue
 Headache
 decreased initiative
 followed by autonomic symptoms including
 Orthostatic lightheadedness
 Blurring of vision
 Abdominal pain
 Diarrhea
 Dryness of eyes
 Disturbed micturition.
6) Bickerstaff's brainstem encephalitis (BBE)

 It is characterized by acute onset of

 Ophthalmoplegia
 Ataxia
 Disturbance of consciousness
 Hyperreflexia.
 Large, irregular hyper intense lesions located mainly in the brainstem, especially in the
pons, midbrain and medulla, are described in the literature.
Pathophysiology

 GBS is a rare and severe disease.

 It occurs after an acute infectious procedure.
 Normally it is acute form of paralysis in lower body area that moves towards upper limb
and face.
 Gradually patient loses all his/her reflexes and goes through a complete body paralysis.
 GBS is a life threatening disorder and needs timely treatment and supportive care.
Contt..

 GBS is considered to be an autoimmune disease triggered by a preceding bacterial or viral

infection.
 Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus and Mycoplasma pneumoniae are
commonly identified antecedent pathogens.
 They have specific antigens in their capsule that they share with nerves.
 The immune system usually then response to these components in the capsule by producing
antibodies that cross-react wit the myelin in the peripheral nervous system, causing
demyelination and then damage to the peripheral nervous system.
 In GBS there is infiltration of the spinal roots and peripheral nerves via the lymphatic system,
causing stripping of the myelin.
 This will lead to a defect in the transmission of electrical nerve impulses which will then lead to
flaccid paralysis.
Causes

 Nobody knows precisely what the exact cause is.

 It is due to an immune response to foreign antigens, such as infectious agents (bacteria,
etc.) that the body's immune system mistargets - attacks good tissue by mistake.
 Experts believe our immune system mistakenly attacks gangliosides - compounds which
are naturally present in nerve tissues.
 The most common infection which precedes the development of GBS is Campylobacter
jejuni - one of the most widespread causes of human gastroenteritis.
 Even so, in over half of all cases no previous infection was present; in other words, there
was nothing to which the doctor could link the syndrome.
 It is believed that influenza virus may also trigger an autoimmune response which causes
the syndrome.
Contt…

 Experts believe the foreign agent (bacterium/virus) causes the body's immune system to
attack the myelin sheath of the peripheral nerves.
 The sheath becomes damaged, causing nerve damage, resulting in faulty sending of signals
between nerves and muscles.
 This faulty wiring causes muscle weakness, numbness and tingling, and eventually
paralysis.
Risk factors

 Age (15-35) and (60-75)

 In men more likely than woman
 Recent gastrointestinal or respiratory infection by viruses or bacteria
 Recent vaccination (especially influenza and meningococcal)
 Recent surgery
 History of lymphoma, Systemic lupus erythromatosus, or HIV and AIDS
Signs and Symptoms

 Pain
 Progressive Muscle weakness
 Numbness
 Loss of reflexes in arms and legs
 Low blood pressure
 Uncoordinated movement
 Facial weakness
 Clumsiness and falling
 Severe pain in the lower back
 Sensation changes
 Tenderness or muscle pain
 Blurred vision
 Respiratory problems
DIAGNOSTIC EVALUATION

 Medical history
 Physical examination
 Tests -
 Nerve conduction studies (NCS)
 CSF examination
 Electromyography (EMG)
 Electrocardiogram (ECG)
 Pulmonary Function Test (PFT)
Medical management

 Treatment is non specific and symptomatic.

 Observe continuously for adequacy of respiratory effort. 
 Patients with GBS will be hospitalized initially (medical emergency).
 It is important to monitor the individual's respiration carefully.
 If breathing problems are severe he/she may be placed in an ICU and put on a ventilator.
 According to the National Health Service, the two main initial treatment options for GBS
are intravenous immunoglobulin, which is safer and easier to give, or plasmapheres
(plasma exchange).
 After the acute phase of the syndrome, the patient may need rehabilitation to regain
functions that were lost.
 Treatment concentrates on improving activities for daily living, such as brushing teeth,
washing, getting dressed and performing some other everyday tasks.
Physiotherapeutic problems

 Acute Respiratory failure due to paralysis of diaphram and secretions

 Decreased A/E due to paralysis of diaphram and secretions
 Decreased chest expansion due to decreased A/E
 Increased secretions due to pneumonia, poor cough attempt and weakness of respiratory
muscles
 Post acute Decreased Fx w.r.t. ADL due to muscle weakness
 Poor proximal and distal control due to weakness
 Decreased Fx due to immobility
Associated problems

 Muscle atrophy due to weakness and inactivity

 Poor sensation due to nerve damage
 Contractures due to immobility
 Decreased exercise tolerance due to inactivity
 Decreased circulation due to inactivity
 Secondary lung infection due to secretions
 Pressure sores and DVT due to immobility
 Weakness due to inactivity
Short term Goals

 Improve/maintain respiratory function

 Prevention of pressure sores and DVT
 Prevention of muscle atrophy
 Improve/maintain muscle strength
 Improve/maintain function
Long term Goals

 Maintain exercise tolerance

 Maintain function
Wheelchair handling
 Support groups
 Retrain proximal control
 Maintain muscle strength
 Retraining of gait
That’s All Folks…..