Guillain-Bare Syndrome (GBS)



GBS is an acute, symmetrical, auto-immune, demyelinating, post-infectious disorder involving the anterior roots of the spinal cord, peripheral nerves and occasional cranial nerves, presenting with motor weakness.

GBS can cause muscle weakness, reflex loss, and numbness or tingling in parts of your body. It can lead to paralysis, which is usually temporary.

It’s most common in people 50 years old or older.

Causes

  • Viral infections like HIV, Enterovirus, Herpes zoster
  • Post immunization
  • The diseases usually follows respiratory or gastrointestinal infections
  • In rare cases, surgery like piles surgery and dental procedures or vaccinations

More than 50% of cases have a clear history of an upper respiratory tract infection 1-3 weeks prior to the onset of neuropathy or gastroenteritis is also common.

Symptoms 

Symptoms arise within 14 days.

  • Usually begins with myalgia or paresthesia of the lower limbs followed by weakness which ascends to involve pelvic girdle, abdomen, thoracic and upper limb muscles.
  • Weakness of intercostal muscles, neck muscles and finally cranial nerves.
  • Symmetrical weakness of muscles
  • Less of tone/ flaccidity
  • Type ii respiratory failure
  • Tachypnea and dyspnea
  • Inability to count loudly up to 15 or 20 by holding the breath
  • Diminished cough mechanism
  • Inability to blow off the lighted candle kept at the distance of 2 feet
  • Bilateral facial weakness due to involvement of 7th cranial nerve 

Investigations

·         CSF protein content begins to rise after the 1st week of the illness and continues to rise for several weeks

·         Periodic pulmonary function tests/ ABG analysis- detect type ii respiratory failure

·         Nerve conduction velocities are less than 60% of normal 

GBS classification

1.       Acute inflammatory demyelinating polyneuropathy (AIDP) – AIDP with secondary degeneration

2.       Axonal pattern- Acute motor axonal neuropathy (AMAN)

                             Acute motor sensory axonal neuropathy (AMSAN)

3.       Fisher syndrome


Treatments

  •            Medical management

             -ICU monitoring

             -Ventilatory support

             -angiotensin-converting enzyme inhibitor or beta-blocking agent

             -intermittent catheterization

             -Postural hypotension treated with fluid bolus or positioning


  •           Physiotherapy management

             1.       Respiratory care

-          Clear the respiratory tract from secretions- breathing exercises, chest percussion/ manipulation

-          Resistive inspiratory training

-          Postural drainage

-          After removing the ventilator, teach effective coughing

-          Respiratory muscle training

2.                       2. Range Of Motion exercises

Passive ROM to limbs; especially shoulder, elbow, wrist, hip, ankle and feet

Facial muscle stimulation and exercises for facial muscles

1.                       3. Management of flaccidity- muscle strengthening

  •            Isometrics
  •            Static cycling
  •            Bridging, hip hiking
  •            Hip and knee movements- strengthening exercises by using weight cuff/ sand bags/ springs
  •           Squatting
                 4. Functional training

-                   -Bed mobility, transferring techniques

-                   -Hand function training

-                   -Balance training

-                   -Posture corrections

-                   -Sensory integrations techniques

-                   -Gait training

 

2.                                 5. Assistive device management

3.                                6.  Prevention of pressure sores