Guillain-Barré syndrome (GBS)

Guillain-Barré syndrome (GBS)

1. TOPIC: - GUILLAIN– BARRE SYNDROME ( GBS )   PRESENTED BY: PROF.VIJAYREDDY VANDALI DEPT OF MEDICAL-SURGICAL NURSING INDIA.

2. Myelinated Neurons

3. DEFINITION Guillain–Barré syndrome ( GBS ) 0r Landry's paralysis It is a disorder in which the body’s immune system attack part of the peripheral nervous system. It is an acute, progressive, autoimmune, inflammatory demyelination of polyneuropathy 0f the peripheral sensory and motor nerves and nerve roots.

4. INCIDENCE 1–2 cases per 1,00000 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. The syndrome is named after the French physicians Georges Guillain and Jean Alexandre Barré and strohl . who described it in 1916.

5. CLASSIFICATION Acute Inflammatory Demyelinating Polyneuropathy (AIDP) Most common. Auto immune response against schwann cell.

6. CLASSIFICATION 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 .

7. CLASSIFICATION 3) Acute Motor Axonal Neuropathy (AMAN) Also known as Chinese paralytic syndrome , Attacks motor nodes of Ranvier and is prevalent in China and Mexico.

8. CLASSIFICATION 4) Acute Motor Sensory Axonal Neuropathy (AMSAN) Similar to AMAN Affect the sensory with several axonal damage .

9. CLASSIFICATION 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 , and constipation unrelieved by laxatives or alternating with diarrhea.

10. Initial nonspecific symptoms of lethargy , fatigue, headache , and decreased initiative are followed by autonomic symptoms including orthostatic lightheadedness , blurring of vision, abdominal pain, diarrhea, dryness of eyes , and disturbed micturition .

11. CLASSIFICATION 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.

12. CLINICAL FEATURES The 1 st symptoms of Guillain–Barsré syndrome is… Pain. Progressive muscle weakness. Diminished reflexes of lower extremities. Prickly, tingling sensations. Low blood pressure. Paresthesis . Tenderness and muscle pain.

13. CLINICAL FEATURES Dysthesias & muscle spasms. Palpitation. Hearth rate change. Sweating abnormalities. Cardiac arrhythmia. Neuromuscular respiratory failure. Difficulty in eye movement, facial movement, speaking, chewing, or swallowing.

14. DIAGNOSTIC EVALUATION Medical history- Physical examination- Tests -

15. Nerve conduction studies (NCS)

16. CSF examination

17. Electromyography (EMG)

18. Electrocardiogram (ECG)

19. Pulmonary Function Test (PFT)

20. Criteria- Progressive weakness in leg & arm & areflexia . Features that strongly support diagnosis are progressive of symptoms over days to 4 week, relatively symmetry symptoms mild sensory symptoms /signs, cranial nerve involvement.

21. MEDICAL TREATMENT Plasmaphresis High dose immunoglobin therapy Mechanical ventilator Pain control Supportive care

22. Prognosis Start after the 4 th week from the onset. Approximately 80% of patient have a complete recovery.

23. NURSING MANAGEMENT Treatment is non specific and symptomatic. Observe continuously for adequacy of respiratory effort. Continuous ECG monitoring. Supportive nursing care measures indicated by the patients degree of paralysis. Residual efforts are rare, but prolonged flaccid paralysis lead to muscle atrophy requiring rehabilitation and physiotherapy.

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