Gillian Barre Syndrome

INTRODUCTION:-

Guillain Barre Syndrome is an acute ascending polyneuropathy, usually post infective. It is a disorder in which the body’s immune system attacks part of the peripheral nervous system. Hence, this is an autoimmune disease.

Pathology:
The disease affects the spinal roots and nerve processes that primarily involves the Schwann cells and this results in segmental demyelination of the nerve process initially. Later there is the Schwann cell proliferation. Here, the axon remains intact and hence, the impulses can be conducted, though with much reduced velocity. In severe cases, axon degeneration can also occur leading to complete conduction block.
Recovery takes place by axonal regeneration and remyelination of peripheral axons. In less severe cases, nerve conduction velocity returns to within normal limits, however where axonal damage has occurred, conduction velocities may be permanently abnormal.

Causes:
As such the cause of the disease is unknown. However, it is believed to be an autoimmune disorder.
Viral infection, such as herpes, cytomegalovirus, or Epstein-Barr virus is the cause of over two-thirds of the new cases.
Some people may get Guillain-Barre syndrome after a bacterial infection, certain vaccinations (such as rabies and swine flu), and surgery.

Clinical features:
There is often prominent severe pain in the lower back
Although the weakness usually starts in the proximal legs, it begins in the arms or facial muscles in about 10 percent of patients
Paresthesias in the hands and feet accompany the weakness in more than 80 percent of patients, but sensory abnormalities on examination are frequently mild.
Oculomotor weakness occurs in about 15 percent of patients
Severe respiratory muscle weakness necessitating ventilatory support develops in about 30 percent
Facial weakness occurs in more than 50 percent and oropharyngeal weakness eventually occurs in 50 percent.
Autonomic changes can include the following:

1. Tachycardia
2. Bradycardia
3. Facial flushing
4. Paroxysmal hypertension
5. Orthostatic hypotension
Reflex changes include:
Reflexes absent or hyporeflexic early in the disease course (represent a major clinical finding on examination of the patient with GBS).
Pathologic reflexes, such as Babinski, are absent.
Hypotonia can be observed with significant weakness.

Diagnosis:
CSF – Typical CSF findings include an elevated protein level (100 – 1000 mg/dL) without an accompanying pleocytosis (increased cell count). A sustained pleocytosis may indicate an alternative diagnosis such as infection. The diagnosis is confirmed by the presence of Albuminocytological dissociation in the CSF
Electro diagnostics – Electromyography (EMG) and nerve conduction study (NCS) may show prolonged distal latencies, conduction slowing, conduction block, and temporal dispersion of compound action potential in demyelinating cases. In primary axonal damage, the findings include reduced amplitude of the action potentials without conduction slowing.

Treatment at physioline:
The advent of respiratory assistance, together with improved intensive care, has improved the outcome of GBS.
Care of respiratory function is an aim at physioline, sometime during the recovery phase. Respiratory infections can be reduced by minimal sedation,
Pain can be adequately controlled with analgesia, and helped greatly by frequent passive limb movements.
The joint range should be maintained and improved. The more peripheral joints will require splintage and passive movements for some considerable time.
The proximal muscles recover first and to facilitate voluntary contraction of muscles, techniques like neuromuscular facilitation, free active exercises, hydrotherapy should be used.
Treatments such as immunoglobulin, steroids and plasmapheresis may shorten the course of the disease.
Physiotherapy is vital in the early stages to minimize muscle wasting. Some patients are only mildly affected and make a rapid recovery.
The physiotherapist also has a responsibility towards frequent checking of pressure areas, to prevent the pressure sores. Should a pressure sore develop, the therapist must give ultraviolet radiation or ice cube massage to the sore to enhance the healing process.
Reeducation of sensory awareness by using cutaneous stimulation and Proprioceptive stimulation is included in the treatment.
Most patients in the acute stage will not believe that they will recover. Thus, it is sometimes, but not always, useful for the patient to see a person who has recovered well from the same illness.
The physiotherapist help the patient and often the relatives to gain the will to join in the treatment and so regain a productive and happy life again.
DETAILED TREATMENT :- Kindly contact Physioline for the detailed assessment and treatment program which is individualised according to every patient.