Guillain-Barre Syndrome Analysis

The syndrome was named after Georges Guillain and Jean Alexandre Barre in 1916, Guillain-Barre Syndrome is an autoimmune disease, activated by an infection, or surgery that causes the immune system to attack the lower motor neurons in the peripheral nervous system, but will gradually work its way distally to more proximal. “This syndrome can affect people in any age group and occurs in 1 in 100,000 of the population.” (Lescher, 2011).
Guillain Barre Syndrome typically occurs following an infection. It is believed that respiratory, stomach, and intestinal infections are most likely to be a trigger for Guillain-Barre, such as, pneumonia, food poisoning, flu like symptoms, and in some circumstances can be caused after surgery. Although there

seems to be a good understanding of Guillain-Barre, its cause is still widely unknown, but there are theories. One of the theories is that the immune system is tricked into attacking its own myelin sheath in the peripheral nervous system, which can cause disruption to the muscles contracting (Lescher, 2011). “Since GBS specifically attacks myelin, Guillain-Barre syndrome is characterized as an acute inflammatory demyelinating polyneuropathy (AIDP).” (Cameron, 2011) There are different types of Guillain-Barre Syndrome, but all occur with acute or subacute dysfunction in the peripheral nervous system. At about 4 weeks, the symptoms will be at their maximum deficit. (Cameron, 2011). While Guillain-Barre syndrome is a rapidly developing disease that can completely alter someone's life in a matter of days, a person suffering from Guillain-Barre is at their most vulnerable condition approximately three weeks after the onset of symptoms.
Typically Guillain-Barre will affect the more distal limbs first, such as, the hands and feet and gradually work its way to the rest of the body. One of the first common signs is numbness, and shortly after tendon reflexes will be lost as well. Naturally this will result in paralysis of all the affected limbs, and can potentially lead to death if it reaches the lungs or the heart muscles (Schenkman, M. L., 2013).
The etiology of Guillain-Barre is relatively unknown, and is similar to other demyelination diseases which makes diagnosing this syndrome complicated; however, the rapid onset of symptoms can be a good indicator to the disease.

A good test for confirming Guillain-Barre is the nerve conduction test. If there is a sign of demyelination this test will show that the nerve impulse will take a longer time to contract the muscle. Another test for confirming Guillain-Barre would be testing the blood for cortisol. It has shown that patients with Guillain-Barre will have higher levels of cortisol in their plasma (Lescher, 2011). Efferent paralysis is more prevalent than afferent loss; however, in most variations of Guillain-Barre, sensory deficits will occur on both sides, symmetrically. As stated before, it is more severe in hands and feet; this is commonly stated as, glove-and-stocking sensory loss. “This distal pattern of sensory loss is caused by axonal transport, or the dying-back phenomenon, wherein the parts of the axon most affected are those most remote from the cell bodies in the dorsal root ganglia." (Schenkman, M. L.,

2013).
Although there are no known cures for Guillain-Barre, treatment will be more focused on the symptoms to recover. Some of the medical procedures that can be done include plasmapheresis, supportive care, and intravenous immunoglobulin. The medical procedure plasmapheresis is where the blood it taken out of the patient, plasma is removed and the blood is then returned to the patient, the body will produce more plasma to make up for the discrepancy. Another procedure is intravenous immunoglobulin. Intravenous Therapy normally is the favored method for treatment; this process is done by injecting antibodies that help stabilize the patient’s autoantibody. (Bowyer, H. R. & Glover, M, 2010)
Physical Therapy with Guillain-Barre Syndrome is substantial and is one of the key reasons why patients will recover quicker after symptoms have subsided. While these interventions will not treat the syndrome itself, it will help the patient to become more comfortable and is more focused in supportive care. Patients will generally work through passive and active range of motion exercises, as this will also help recuperation time once symptoms begin to withdraw (Lescher, 2011). If Guillain-Barre reaches the respiratory system, it will be imperative for respiratory physical therapy, and monitoring lung function and strength. In certain circumstances an autonomic dysfunction can occur, it will be essential to monitor basic vital signs (Bowyer, H. R., & Glover, M., 2010). In such a case, mechanical ventilation may be required. (Dennis, D., & Mullins, R., 2013). Because of the motor loss and paralyzing affects of Guillain-Barre it will be critical to instruct family and health care providers on checking the skin for sores and pressure ulcers. Having the patient do range of motion exercises, as well as weight shifting techniques, will help limit the chance of pressure ulcers and help avert any type of joint contracture that may occur. Typically Rehabilitation and physical therapy can greatly affect the improvement of muscle strength and recovery after symptoms have subsided. "One study showed rapid increase in muscle strength during the first 6 months after onset, with continuing gradual improvement of strength even after 12 months. Intensive therapy after discharge from an acute care facility is essential for improving function." (Bowyer, H. R., & Glover, M., 2010). Working on ADL’s will also be key contributor to successful rehabilitation, working on fine motor skills and being able to do everyday tasks will help with recovery time. Another form of therapy that has been shown to be advantageous is Hydrotherapy, because of the zero gravity; patients will be able to improve their range of motion and muscle strength, without much impact and energy expenditure. Limiting energy expenditure will be a key factor with physical therapy. Fatigue with Guillain-Barre is unrelated to age, how long it has occurred, or even how sever the symptoms are, approximately 80% will suffer from sever fatigue. (Sharma, V., Kaur, H., Malhotra, L. K., & Sairam, N., 2015). In such circumstances, physical therapy would also include education on assistive devices. Depending on how affected they are some of the education and training could be on proper gait techniques with walkers, canes or crutches, and utilization of a wheelchair. In such instances patients would progress through treatment, slowly making balance and gait training more complex until they return to normal function.
Prognosis is typically good; although some of the symptoms can be very severe the recovery period may be as little as a few weeks, or as long as a few years. A small amount of patients will experience a relapse of muscle weakness and tingling (NINDS). It will also depend on the severity of the affected limbs, and if it has reached respiratory, or cardiac muscles.
Overall, Guillain-Barre Syndrome is a very scary disease because of the rapid onset of symptoms, taking anywhere from a few days to a week, attacking the LMN and working its way distally to more proximally.

While Guillain-Barre etiology is rather unknown, scientist are looking for answers on why and how Guillain-Barre occurs as well as focusing on finding new treatments and further developing the existing treatments. “The fact that so many cases of Guillain-Barre begin after a viral or bacterial infection suggests that certain characteristics of some viruses and bacteria may activate the immune system inappropriately.” (NINDS). Proper treatment is done so by plasmapheresis, or intravenous immunoglobulin, and after symptoms begin to subside, medical and physical therapy interventions have shown to greatly aid in recovery, and with proper supportive care, typically in about a year, patients will be able to return to a normal

life.