Guillain-Barré

Syndrome (GBS)
Presented
by
NCHOZIEN PAMELA ZITOWOH
 OUTLINE
Introduction
 Defintion
Causes
Pathopysiology
Main clinical manifestation
Diagnosis
Treatment
Nursing management
Conclusion
 Introduction

• Guillain-Barré Syndrome (GBS) is a rare but serious neurological

disorder where the body’s immune system mistakenly attacks the
peripheral nerves.
• The syndrome can affect the nerves that control muscle
movement as well as those that transmit pain, temperature and
touch sensations. This can result in muscle weakness, loss of
sensation in the legs and/or arms, and problems swallowing or
breathing.
• It is a rare condition, and while it is more common in adults and in
males, people of all ages can be affected.
 Definition
• The World Health Organization (WHO) defines Guillain-Barré
Syndrome as an acute, inflammatory, demyelinating
polyneuropathy, which results in the rapid onset of muscle
weakness and paralysis.
• GBS is thought to be an autoimmune disorder where the body’s
immune system attacks peripheral nerves, typically triggered by
an infection
 Causes
The precise cause of Guillain-Barré Syndrome remains unclear,
though several triggers are commonly associated with the
disease:
Infections:
 Campylobacter jejuni (the most common bacterial trigger). which
causes gastroenteritis (including symptoms of nausea, vomiting
and diarrhoea), is one of the most common risk factors for GBS.
 Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Zika virus,
influenza, and COVID-19 have been identified as viral triggers.
 Mycoplasma pneumoniae and HIV are also associated.
 Vaccinations: Very rare cases of GBS have been linked to vaccines,
though the risk is much lower than the risks associated with the
infections the vaccines prevent.
 Surgery or trauma: Surgery or physical trauma may also act as
triggers.

Recent studies (2022) suggest molecular mimicry in GBS, where

the immune response against pathogens, such as Campylobacter
jejuni, mistakenly attacks the myelin in the peripheral nerves.
 Pathophysiology
GBS involves an autoimmune attack on
the peripheral nervous system. The main
mechanisms are:
Demyelination: The immune system
attacks the myelin sheath of peripheral
nerves, leading to delayed or blocked
nerve signals. This process is most
notable in acute inflammatory
demyelinating polyneuropathy (AIDP).
Axonal damage: Some forms of GBS,
such as acute motor axonal neuropathy
(AMAN), lead to damage of the axons
themselves, resulting in more severe
outcomes.
Molecular mimicry: Pathogens like Campylobacter jejuni
trigger an immune response that mistakenly recognizes nerve
tissue as foreign due to similarities in molecular structures.
Recent insights (2023) emphasize the importance of T-cell-
mediated autoimmune responses in the pathogenesis of GBS.
 Main Clinical Manifestations
The clinical features of GBS typically progress in a ascending pattern:
Muscle weakness: Starts in the feet and legs, progressing upward to
involve the arms, face, and respiratory muscles.
Paresthesia: Tingling or numbness, especially in the hands and feet.
Paralysis: In severe cases, paralysis can develop, potentially affecting
respiratory muscles, necessitating mechanical ventilation.
Pain: Sharp, aching pain or neuropathic pain in muscles and joints.
Autonomic dysfunction: Can involve blood pressure instability,
arrhythmias, and difficulty regulating body temperature.
 Facial
involvement:
Weakness of facial
muscles (e.g.,
difficulty closing
eyes).
 Difficulty
swallowing and
speaking: In severe
cases, affecting the
muscles for
swallowing and
speech.
 Diagnosis
The diagnosis of Guillain-Barré Syndrome is based on clinical features,
tests, and exclusion of other conditions:
 Clinical history and examination: Documentation of a recent
infection, especially gastrointestinal or respiratory illness.
 Lumbar puncture: Elevated protein levels in cerebrospinal fluid
(CSF) with normal white blood cell count is indicative of GBS. This is
known as albuminocytologic dissociation.
 Nerve conduction studies (NCS): These help to confirm the
diagnosis, showing slowed or blocked nerve signals due to
demyelination.
 Electromyography (EMG): To evaluate the extent of nerve damage.
 MRI: Can help rule out other conditions but is typically not diagnostic
for GBS.
 Treatment
The main treatments for GBS focus on modulating the immune
response and providing supportive care:
 Plasma exchange (plasmapheresis): Involves removing
harmful antibodies from the blood and is typically used for
patients who show rapid progression.

 Intravenous immunoglobulin (IVIg): High-dose IVIg can help

neutralize the harmful antibodies and reduce inflammation in the
peripheral nerves.
Supportive care:
 Mechanical ventilation: In severe cases where respiratory
muscles are affected.
 Pain management: Analgesics, including opioids and
anticonvulsants, for neuropathic pain.
 Physical therapy: To help prevent complications from
immobility, such as muscle atrophy and joint contractures.
 Anticoagulation therapy: To prevent deep vein thrombosis
(DVT) in immobile patients.
 Nursing Management
Nursing care for GBS involves monitoring, supportive care, and
rehabilitation:
 Monitoring: Regular assessments of respiratory function, motor
strength, and sensory responses. Close monitoring in an intensive care
unit (ICU) may be needed for respiratory support.
 Pain management: Administering appropriate medications to manage
neuropathic pain, such as gabapentin or pregabalin.
 Physical therapy: Early engagement with physical and occupational
therapists to prevent complications and facilitate gradual recovery.
 Prevention of complications: Ensuring proper positioning, preventing
pressure ulcers, and DVT prevention.
 Psychosocial support: Supporting patients and families emotionally, as
the process of recovery can be long and uncertain.
 Conclusion
Guillain-Barré Syndrome is a medical emergency requiring prompt
diagnosis and treatment. Early intervention with plasmapheresis or
IVIg is crucial to improving outcomes. While GBS often follows an
infection, the exact cause remains unclear, though immune system
malfunction is central. The prognosis for many patients is positive,
with early intervention leading to full or partial recovery in most
cases. However, some individuals may face long-term effects or even
permanent disability.
• References
1. Leonhard, S. E., Mandarakas, M. R., & van Doorn, P.
A. (2022). Guillain-Barré Syndrome: Pathogenesis, Diagnosis,
and Treatment. The Lancet, 399(10326), 2507-2519.
2. Yuki, N., & Hartung, H. P. (2023). Guillain-Barré
Syndrome. The New England Journal of Medicine, 389(2), 163-
173.
3. Hughes, R. A., & Cornblath, D. R. (2023). Guillain-
Barré Syndrome. The Lancet, 392(10143), 511-529.
4. Sengupta, A., & Borah, S. (2022). Recent Advances
in Guillain-Barré Syndrome. Journal of Clinical Neuroscience, 97,
8-15.
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