Guillain-Barre Syndrome (GBS) is a problem with the nervous system. It may cause reflex loss, muscle weakness, and numbness or tingling in parts of the body. It can lead to temporary paralysis. Most patients (85%) with Guillain Bureau disease make a full recovery within 6-12 months. Once a person becomes better, the chance of recurrence is very small.
GBS can happen to anyone, but it is likely to attack people 50 years old or older. Many scientists believe that a germ or virus, such as the Zika virus, triggers GBS. Some illnesses alter our nerve cells, so our immune system starts to consider them threats. Sometimes our immune system forgets which cells it should not attack.
GBS usually shows up several days or weeks after a cold, flu, or stomach virus. In rare cases, vaccinations or surgery can trigger it. Have you ever heard about “campylobacter?” It is a type of bacteria associated with GBS. If you contract it, your immune system will begin attacking your nerve cells, weakening their ability to transfer signals to your brain. Your muscles then cannot respond to nerve signals. In consequence, your brain sends fewer messages to your body.
The symptoms of GBS begin with tingling and weakness in the feet and legs that steadily progress to the rest of the body. It is defined as a "symmetrical ascending radiculopathy," meaning that weakness starts in both legs and then gradually moves up to the upper body with both arms, hands, and fingers. Around one in ten patients has the tingling in their face or neck. The weakness then worsens and becomes paralysis. In general, symptoms of GBS include:
- Weakness in lower body, progressing upward
- Instability when walking
- Cramp-like pain
- Severe nerve pain that requires medication
- Lack of control over facial muscles (chewing, swallowing, talking)
- Lack of control over bowel or bladder
- Tachycardia (faster than normal heart rate)
- High or low blood pressure
- Blood clots
- Pressure sores
- Difficulty breathing
- Psychological difficulties (due to the rapid onset of paralysis and the dependence on others with basic everyday tasks)
If your doctor diagnoses you with GBS, he will give you a test to evaluate how well your muscles and nerves work. A spinal tap is also necessary. The doctor inserts a needle into your lower back and extracts a small amount of spinal fluid. He will check the protein level; it is high in patients with GBS. If you have GBS, it is advisable for you to begin treatment immediately.
In some cases, the doctor will conduct a process called plasmapheresis to speed recovery. He will take blood out of your body, clean it, and then return it to you. Immunoglobulin (antibodies) is also beneficial. You will receive high doses of healthy cells through an intravenous immunoglobulin (IV). Some patients with GBS need to be hospitalized for several days or weeks. They will need support until they regain full control of their body. A nurse or beloved one may need to exercise their arms or legs to recover their initial function.
The risk of sepsis and infection can be reduced by the use of minimal sedation, regular physiotherapy, and mechanical ventilation with positive, appropriate end-expiratory pressure. Transfer may be adequate if a facility does not have the proper resources to take care of patients who require prolonged intubation or intensive care.
Prevention of complications of immobility is also necessary. Low molecular weight heparin (LMWH) and thrombo-guards are usually used in the treatment of immobile patients to avoid lower-extremity deep venous thrombosis (DVT) and ensuing pulmonary embolism (PE).
Although bowel and bladder dysfunction is transitory, management of these functions is required to prevent other complications. Management should be aimed at safe evacuation and the prevention of overdistention. Observing for secondary infections (e.g., urinary tract infection) is also an area of concern. Nephropathy has been found in pediatric patients.
Hospitalized patients may experience mental status changes, such as delusions, hallucinations, sleep abnormalities, and vivid dreams. These occurrences are believed to be associated with autonomic dysfunction and are more common in patients with severe symptoms. As the patient recovers, such problems resolve. Psychiatric and psychological problems (e.g., anxiety and depression) are likely to occur. Counseling, education, and medications are needed to manage these problems and help the patient to adjust and improve from their disability.
Nearly 40% of patients who are hospitalized with GBS demand inpatient rehabilitation. Unluckily, no long-term rehabilitation outcomes have been found, and treatment is based mostly on experiences with other neurological conditions. The therapy programs are aimed at reducing functional deficits and targeting impairments and disabilities due to GBS.
In the early acute stage of GBS, patients might not be able to participate fully in a therapy program. At that phase, they benefit from daily ROM exercises and appropriate positioning to prevent joint contractures and muscle shortening. Addressing upright tolerance and endurance may also be a significant issue during the early stage of rehabilitation.
Muscle strengthening can then be introduced and may include isokinetic, isometric, isotonic, or progressive resistive exercises. Mobility skills (e.g., transfers, ambulation, and bed mobility) are targeted functions. Patients should be watched for hemodynamic instability and cardiac arrhythmias, particularly upon initiation of the rehabilitation project. The intensity of the exercise program should also be monitored since overworking the muscles may result in increased weakness.
GBS is a rare yet serious autoimmune disorder that attacks the peripheral nervous system outside of the brain and spinal cord. It attacks the patient’s immune system and then destroys certain groups of healthy cells. The myelin sheaths of peripheral nerves are the targets of the autoimmune response. The myelin sheaths are crucial for carrying nerve impulses.
Up to now, the exact causes of GBS are still unknown, but the disease often ensues soon after other illnesses have happened. At this juncture, there is no cure for GBS, but medications are available to ease symptoms. A vast majority of patients makes a full recovery. Others may suffer lingering, minor problems such as tingling or weakness in some parts of the body. In the beginning, Guillain Bureau disease was considered to be a single condition. However, it is now considered to occur in a number of forms.
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