Guillain barre syndrome in children.pptx

guillian barre syndrome

1. Guillain barre syndrome

2. What is gbs ? Guillain-Barré syndrome (GBS) is a rare autoimmune disorder that attacks the peripheral nervous system. The peripheral nervous system is a network of nerves outside the brain and spinal cord that carries messages between the brain and the muscles, allowing you to move, feel sensations, and control other bodily functions. Here's a breakdown of GBS: Causes: The exact cause of GBS is unknown, but it's often triggered by a recent infection, such as: Campylobacter (food poisoning) Cytomegalovirus (CMV) Epstein-Barr virus (EBV) Influenza (flu) Zika virus

3. Sindrom Guillain-Barré (GBS) adalah kelainan autoimun langka yang menyerang sistem saraf tepi . Sistem saraf tepi adalah jaringan saraf di luar otak dan sumsum tulang belakang yang membawa pesan antara otak dan otot , memungkinkan Anda bergerak , merasakan sensasi , dan mengontrol fungsi tubuh lainnya . Berikut rincian GBS: Penyebab : Penyebab pasti GBS tidak diketahui , namun sering kali dipicu oleh infeksi yang baru terjadi , seperti : Campylobacter ( keracunan makanan ) Sitomegalovirus (CMV) Virus Epstein-Barr (EBV) Influenza (flu) virus Zika

4. Selain itu , berdasarkan asal percabangannya , sistem saraf tepi juga dapat dibedakan menjadi : Saraf kranial , yaitu 12 pasang saraf yang berasal dari otak untuk mengumpulkan informasi antara otak dan bagian tubuh lainnya . Tugas dari saraf kranial adalah untuk mengontrol fungsi motorik dan sensorik tubuh .  Saraf spinal, yaitu 31 pasang saraf yang berasal dari medula spinalis ( sumsum tulang belakang ) dan berfungsi sebagai penghantar impuls dari dan ke otak serta sebagai pengatur gerak refleks .

5. Berdasarkan cara kerjanya , sistem saraf tepi dapat dibedakan menjadi dua jenis , yaitu : Sistem saraf somatik : Sistem saraf yang bertugas menyampaikan informasi dari saraf motorik dan sensorik pada mata , telinga , kulit , dan otot menuju sistem saraf pusat dan membawa instruksi dari otak untuk menghasilkan suatu respons . Sistem saraf ini mengontrol semua gerakan yang disadari . Sistem saraf otonom : Sistem saraf yang mengendalikan kerja kelenjar atau organ dalam tubuh secara tidak sadar . Sistem saraf otonom terdiri dari dua cabang , yaitu sistem simpatik untuk mengatur respons tubuh saat terjadi ancaman atau stres (flight or fight) dan sistem parasimpatik untuk mengatur organ dalam tubuh agar dapat bekerja secara optimal dan rileks (rest and digest).

6. Based on how its works : Somatic nervous system : This nervous system controls all conscious movements. Autonomic nervous system : The nervous system that controls the work of glands or organs in the body unconsciously.

7. IS GBS an autoimun ? Guillain-Barré syndrome (GBS) is not exactly an immune system mimicry disease. While the immune system plays a key role in GBS, it's not mimicking something else. Here's a breakdown for clarity: Mimicry in the Immune System: Molecular mimicry is a phenomenon where a foreign molecule (often from a pathogen) closely resembles a molecule in the body. This can confuse the immune system, leading it to attack healthy tissues along with the foreign molecule. GBS and the Immune System: In GBS, the immune system mistakenly attacks the myelin sheath or the nerves themselves in the peripheral nervous system. The cause for this mistaken attack is not entirely clear, but it's often triggered by a recent infection. The immune system isn't mimicking something else; it's reacting abnormally to a perceived threat.

8. Diagnostic : Sensitifitas ( kepekaan ) Spesifisitas ( kecermatan ) Sensitivity refers to a test's ability to designate an individual with disease as positive. The specificity of a test is its ability to designate an individual who does not have a disease as negative.

9. IS GBS an autoimun ? Here's an analogy: Imagine a security guard protecting a building. In molecular mimicry, the guard mistakes a harmless visitor dressed like a robber for a real robber and attacks them. In GBS, the security guard (immune system) overreacts to a situation and mistakenly attacks the building's security system (nerves) itself, causing problems.

10. How to diagnose GBS? patient's medical history, neurological examination, and specific tests. Patient medical history : Muscle weakness, numbness, tingling, or pain Progression of symptoms (typically rapid worsening over days or weeks) Recent illnesses or infections (GBS often follows an infection) A physical examination will assess: Muscle weakness and reflexes (typically reduced or absent) Sensory changes (numbness, tingling) Facial weakness or drooping eyelids

11. anamnesis: Kelemahan otot , mati rasa, kesemutan , atau nyeri Perkembangan gejala yang cepat ( biasanya memburuk dengan cepat selama berhari-hari atau berminggu-minggu ) Penyakit atau infeksi yang baru saja terjadi (GBS sering kali terjadi setelah infeksi ) Pemeriksaan fisik Kelemahan otot dan refleks ( biasanya berkurang atau tidak ada ) Perubahan sensorik ( mati rasa, kesemutan ) Kelemahan wajah atau kelopak mata terkulai

12. How to diagnose GBS? Diagnostic test in GBS : Lumbar puncture (spinal tap):In GBS, the protein level in the CSF may be elevated, while the number of white blood cells may be normal * **Electromyography (EMG) and Nerve Conduction Studies (NCS):** EMG: Measures the electrical activity of muscles at rest and during contraction. In GBS, EMG may show signs of nerve damage **NCS:** Measures how quickly electrical signals travel through nerves. In GBS, NCS often shows slowed nerve conduction velocity or conduction block, indicating nerve dysfunction.

13. How to diagnose GBS in limited sources? Detailed Medical History and Focused Examination Examination : A thorough neurological exam will assess: Muscle strength and reflexes (weakness and absent reflexes are suggestive) Sensory changes (numbness, tingling) Facial weakness or drooping eyelids Alternative Diagnostic Strategies Blood tests: Though not specific for GBS, they can help rule out other conditions with similar symptoms (e.g., infections, electrolyte imbalances). Imaging: X-rays or ultrasounds are unlikely to diagnose GBS but might be used to rule out other causes of weakness or pain (e.g., fractures, tumors).

14. Perbedaan LMN dan UMN UMN damage: Disrupts the communication pathway between the brain and muscles. This leads to: Spasticity: Increased muscle tone, resulting in stiffness and resistance to movement. Weakness: Reduced muscle strength due to the impaired signal from the brain. Hyperreflexia: Exaggerated reflexes. Loss of dexterity and coordination: Difficulty with fine motor skills. LMN damage: Disrupts the direct connection between the spinal cord and muscles. This leads to: Flaccidity: Decreased muscle tone, causing muscles to feel limp and weak. Muscle atrophy: Wasting away of muscles due to lack of stimulation. Hyporeflexia: Diminished or absent reflexes. Fasciculations: Involuntary muscle twitching.

15. Perbedaan LMN dan UMN

16. Outcome for this patient The outcomes of Guillain-Barré syndrome (GBS) can vary depending on the severity of the condition and the individual's overall health. Here's a breakdown of what to expect: Recovery: Most people with GBS eventually improve, but recovery can be slow and take weeks, months, or even years.

17. Sequele for GBS Sequelae (Long-term effects): Unfortunately, some people experience long-term effects (sequelae) from GBS. These can include: Muscle weakness: This is the most common sequela, and it can range from mild to severe. Some people may require ongoing physical therapy or assistive devices like canes or walkers. Fatigue: Many GBS survivors experience persistent fatigue, even after regaining some strength. Pain: Chronic pain can be a significant issue for some people with GBS. Balance problems: Difficulty with maintaining balance and coordination can increase the risk of falls. Sensory problems: Numbness, tingling, or burning sensations may persist in some cases. Autonomic dysfunction: This can affect functions like blood pressure regulation, bladder control, and digestion. Depression and anxiety: The emotional impact of GBS and its long-term effects can be significant.

18. PERBEDAAN GBS DAN AFP Similarities: Both GBS and AFP cause weakness and paralysis, often affecting the legs first and progressing upwards. Both can be triggered by a recent infection

19. PERBEDAAN GBS DAN AFP Additional Points: GBS is an autoimmune disease, while AFP can have various causes. Sensory involvement and autonomic dysfunction are more suggestive of GBS. CSF analysis and EMG/NCS are crucial tools for distinguishing between GBS and AFP. Early diagnosis and treatment are essential for both GBS and AFP to improve outcomes and prevent complications. Here are some additional tips for differential diagnosis: Consider the patient's age and vaccination history. Poliovirus is a concern in unvaccinated individuals, while GBS can occur at any age. Look for other symptoms that might suggest a specific cause of AFP, such as fever, respiratory illness, or exposure to toxins.

20. Apa itu LOE (Level of evidence) LOE stands for Level of Evidence in the Oxford Centre for Evidence-Based Medicine (OCEBM) framework . It's a system used to rate the quality and strength of scientific evidence in medical research . The LOE ranking helps healthcare professionals and researchers assess the reliability of a study and the conclusions drawn from it.

21. Apa itu LOE (Level of evidence) Here's a breakdown of the Oxford LOE system: Level 1: Randomized controlled trials (RCTs) - Considered the highest level of evidence. RCTs involve randomly assigning participants to either an intervention group (receiving a new treatment) or a control group (receiving a standard treatment or placebo). This randomization helps control for confounding factors and provides the strongest evidence for the effectiveness of an intervention. Level 2: Double-blind RCTs - These are RCTs where neither the participants nor the researchers know who is in the intervention or control group until the study is complete. This double-blinding helps to reduce bias in the study results. Level 3: Cohort studies - These studies involve following groups of people over time and comparing outcomes between groups who received an intervention and those who didn't. Cohort studies can be good for exploring potential associations between factors and health outcomes, but they can't definitively prove cause and effect. Level 4: Case-control studies - These studies compare a group of people with a particular condition (cases) to a group of people without the condition (controls). They can help identify potential risk factors for a disease, but they can't establish cause and effect. Level 5: Case series or expert opinion - Considered the lowest level of evidence. Case series are reports of a small number of individuals with a particular condition. Expert opinion, while valuable, is not based on rigorous research.

22. Level 1a:RCTs with the highest quality methodology and minimal risk of bias.These studies have the most robust design and are considered the most reliable form of evidence within Level 1. Level 1b:RCTs with some methodological limitations but still considered high-quality evidence.These limitations might involve aspects like blinding (where participants don't know if they're receiving the intervention or control), allocation concealment (ensuring treatment assignment is hidden from researchers until the study is underway), or other aspects of study design.

23. Level 1a: Ini adalah uji coba terkontrol secara acak (RCT) dengan metodologi kualitas tertinggi dan risiko bias minimal. Penelitian ini memiliki desain paling kuat dan dianggap sebagai bentuk bukti paling terpercaya dalam Level 1. Level 1b: Ini adalah uji coba terkontrol secara acak (RCT) dengan beberapa keterbatasan metodologi tetapi masih dianggap sebagai bukti berkualitas tinggi . Keterbatasan ini mungkin melibatkan aspek-aspek seperti blinding ( peserta tidak tahu apakah mereka menerima intervensi atau kontrol ), allocation concealment ( memastikan penetapan pengobatan disembunyikan dari peneliti sampai penelitian sedang berlangsung ), atau aspek lain dari desain penelitian .

24. Apa itu LOE (Level of evidence) The LOE is just one factor to consider when evaluating medical research. Other factors, such as the study design, sample size, and quality of reporting, are also important. Not all research questions require the highest level of evidence (Level 1). For example, case series might be helpful for understanding a new and rare disease. The LOE system is constantly evolving as new research methods are developed. Understanding LOE helps you: Critically evaluate medical research and news articles. Make informed decisions about your health care. Stay up-to-date on the latest medical evidence.

25. Feature GBS TM Myasthenia Gravis (MG) Periodic Paralysis (PP) Myositis Affected Area Peripheral nerves Spinal cord Neuromuscular junction Muscle cells Muscle tissue Cause Autoimmune Varied (infection, autoimmune, idiopathic) Autoimmune Genetic, metabolic disorders Autoimmune, infection, medications Weakness Ascending (starts in legs, progresses upwards), often symmetrical Varies (legs, arms, all extremities), may be asymmetrical Specific muscle groups (eyes, face, swallowing muscles) Episodic weakness, attacks triggered by factors like eating, potassium shift Proximal muscles (shoulders, hips) often affected Sensory Symptoms Numbness, tingling, prickling (common) Numbness, tingling, burning pain (below lesion level) Less common No sensory symptoms Pain, tenderness in affected muscles Reflexes Diminished or absent (hyporeflexia) Variable (normal, reduced, absent) Normal Normal Normal or hyperreflexia Progression Rapid over days/weeks, plateaus/worsens briefly before improvement Rapid or gradual, depends on cause Fluctuates throughout the day, worsens with activity, improves with rest Episodic attacks lasting hours to days Gradual or sudden onset, may be chronic Autonomic Dysfunction Rare Possible No No No Bladder/Bowel Dysfunction Rare Common No No No CSF Analysis Elevated protein, normal white blood cell count Elevated white blood cell count, increased protein levels Normal Normal Normal EMG/NCS Abnormalities consistent with demyelination Variable, may be normal initially Abnormal neuromuscular transmission Normal between attacks, abnormal during attacks Myopathic changes

26. Wong baker scale The Wong-Baker Faces Pain Rating Scale is a helpful tool for children to communicate their pain level, but it doesn't directly dictate when to administer pain medication. Here's a breakdown: Wong-Baker Scores and Pain Levels: 0 (Smiling): No hurt 2 (Partially Smiling): Hurts a little bit 4 (Neutral): Hurts a little more 6 (Slight Frown): Hurts even more 8 (Frowning): Hurts a whole lot 10 (Crying): Hurts worst Pain Management Decisions:

27. Wong baker scale The decision to administer pain medication should be based on a holistic assessment, considering factors like: Child's age and ability to communicate: Younger children might not be able to accurately express their pain level using the Wong-Baker scale. Severity of pain: A score of 8 or 10 likely indicates significant pain requiring medication. Child's behavior: Is the child withdrawn, irritable, or unable to participate in normal activities due to pain? Cause of pain: The underlying cause of pain might influence the medication choice and dosage. General Guidelines (Not a substitute for medical advice): Scores of 0-2: Comfort measures like distraction, positioning, or applying heat/cold packs might be sufficient. Scores of 4-6 : Consider non-prescription pain relievers like acetaminophen or ibuprofen, following age-appropriate dosage guidelines. Scores of 8-10 : Consult a healthcare professional for stronger pain medication or alternative pain management strategies.

28. Salah satu penyebab nya cough bagaimana ke gbs Afp Kenapa kena gbs dibawah dulu ga extremitas atas APA KAITANNYA HISTORY OF ANIMAL BITES DAN GBS TIPE GBS, PALING BYK TIPE APA, PALING PARAH TIPE APA, APAKAH SEMUA TIPE SAMA TATA LAKSANANYA? ADA TERAPI LAIN SELAIN IV IG? dyselectrolemia apa ? Hasil emg pengertiannya

29. Ad vitam : This refers to survival, or how long a patient is expected to live. Ad functionam : This refers to functional ability , meaning the patient's capacity to perform daily activities and maintain independence. Ad sanationam : This refers to complete recovery , indicating whether the disease can be fully cured.

30. Psc 17 The PSC-17 consists of 17 questions that parents or caregivers can answer about the child's behavior over the past month. The questions cover a range of areas, including: Internalizing problems: feeling sad, worried, or down on themselves. Externalizing problems: aggressive, disobedient, or disruptive Attention problems: These are problems with focus, concentration, or hyperactivity.

31. pedsQL Pediatric Quality of Life Inventory. It's a set of age-specific questionnaires designed to measure health-related quality of life (HRQOL) in children and adolescents with acute or chronic health conditions.

32. Issue sub pin polio Freeze dry asi

33. Whats is AFP Acute muscle weakness is a major neurological emergency in pediatrics It is defined by muscle weakness or acute flaccid paralysis, with clinical onset in less than five days, according to the World Health Organization (WHO) definition

34. Dd pasien weakness berdasarkan keluhan utama Acute muscle weakness is a major neurological emergency in pediatrics. It is defined by muscle weakness or acute flaccid paralysis, with clinical onset in less than five days, according to the World Health Organization (WHO) definition acute weakness divided into UMN and LMN From physical examination UMN we will found which originate from the primary motor cortex of the cerebrum and possess long axons forming corticospinal and corticobulbar tract characterized by spasticity increase muscle tone increase deep tendon reflexes positive pathological reflexes UMN : transverse myelitis, multiple sclerosis, tumor, acute disseminated encephalomyelitis, brainstem encephalitis, and acute myelitis can be excluded

35. Dd pasien weakness berdasarkan keluhan utama LMN type based on location: 1) from the motor neuron/anterior horn: poliomyelitis and spinal muscular atrophy 2) the axon: Guillain-barre syndrome , porphyric neuropathy, diphtheritic neuropathy, heavy-metal poisoning , paraytic shellfish poisoning, and tick paralysis 3) the neuromuscular junction: myastenia gravis, snake bite, botulism 4) on muscle: muscular distrophy , periodic paralysis, polimiositis /dermatomyositis

36. Whats is possible complication in this patient short and long term Short-term complications Respiratory failure Autonomic dysfunction: This can cause problems with heart rate, blood pressure, digestion, and bladder control. Pain: some children with GBS experience pain Long term complication Residual weakness: Some children may have some residual weakness or fatigue that can last for months or even years Persistent pain: Some children may continue to experience pain after the other symptoms of GBS have resolved Balance problems: Children may have difficulty with balance and coordination, which can make it difficult to walk or run.

37. Whats is the purpose of mecobalamin in your patien In gbs we will found the axonal damage. methylcobalamin , an analogue of vitamin B12 , promotes axonal growth in peripheral nerve injury , by acting on Schwann cells, and promoting RNA and protein synthesis

38. Whats is the purpose of ivig in your patien GBS is an autoimmune disorder where the immune system mistakenly targets healthy peripheral nerves. this attack damage the myelin sheath (protective layer) and/or the axons (core of the nerve fiber) that made nerve dysfunction. Neutralizing antibodies: Some antibodies in IVIg directly neutralize the harmful antibodies produced by the patient's own immune system Immunomodulation: IVIG suppressing activity and decrease the overall immune response. Blocking complement activation: IVIG blocking this pathway for prevent further damage to nerve cells.

39. Ivig adverse effect Immediate Reactions: Headache, Fever, Muscle aches, Nausea and vomiting Delayed Reactions: These develop hours to days after the infusion and can be more serious. However, they are still uncommon, affecting less than 5% of patients receiving IVIG treatment for GBS. Examples include:Renal problems: Kidney dysfunction, although rare, can occur. It's important to stay hydrated during IVIG treatment.Thromboembolic events: Blood clot formation is a potential risk, especially in patients with pre-existing risk factors.

40. Whats relation of history his cold and cough of weakness Two-thirds of cases of GBS are associated with an antecedent infection In molecular mimicry, the antigenic structures of pathogens and humans are sufficiently similar to induce an autoreactive response This similarity leading mistaken attack on healthy nerves by the antibodies and immune cells.

41. How did u make sure the patient had nutritional intake From anamnesis of his mother with daily intake and from body weight of this patient

42. Why u did not continue corticosteroid from the puskesmas Corticosteroids in treating Guillain-Barré syndrome (GBS) in children is an area with limited evidence and no established role. Corticosteroids, despite their anti-inflammatory properties, haven't shown clear benefits in this age group. Intravenous immune globulin (IVIG) and plasma exchange are the well-established treatment options for GBS in children

43. How did u make sure did rule out the spinal injury Pain: Severe pain or pressure in the neck or back, especially at the injury site, Loss of movement: Weakness, paralysis, or a complete inability to move limbs below the injury is a hallmark symptom. This can affect one or both sides of the body. Numbness or tingling: Loss of sensation or a prickling sensation in the extremities is another frequent occurrence. Loss of bladder or bowel control: Inability to control urination or bowel movements can happen due to disrupted nerve signals.

44. Whats the last condition the patien when he discharge From anamnesis the patient with no numbness and tingling in his arms but still less tingling occasionaly in his legs There was any increasing of muscle strength in this patien in upper and lower extremity, the legs can not moved before the treatment of ivig but after got treatment the leg can move and against gravity with mild resistance The patient can standing but not unable to walk

45. Whats is graphestesia test the individual's ability to use sensory input to identify a number or letter drawn onto hishand with closed eyes

46. Apa yg diharapkan dari lumbal pungsi Elevated protein: In GBS, the protein level in the CSF is often elevated, while the white blood cell count remains normal. This finding, known as albuminocytologic dissociation, strongly suggests GBS . Normal white blood cell count: The absence of elevated white blood cells helps differentiate GBS from infections that can mimic its symptoms (meningitis, encephalitis).