Guillain-Barre

Question 1

What’s the technical name for guillain barre? how does it affect the nervous system?

Answer 1

Acute inflammatory demyelinating polyneuropathy (AIDP) - Autoimmune disease that attacks the myelin around the axon slowing or impeding the conduction of nerve impulses - Lesions occur throughout peripheral nervous system from spinal nerve roots to distal end of motor, sensory, and autonomic fibers

Question 2

What are some possible causes of GB?

Answer 2

1. May be related to bacterial or viral infection - Campylobacter Jejuni; 2/3 pts report respiratory or GI sx in the 3wk before the onset of GBS sx 2. No significant research showing a link between GBS and vaccinations (flu, hepatitis, tetanus) 3. Stressful events and surgeries may also trigger the disease 4. Link with disease to Zika virus

Question 3

What are S and S of GB?

Answer 3

1. Characterized by ascending symmetrical motor and sensory impairments and autonomic symptoms 2. Motor - Distal more than proximal – LE’s usually before UE’s; Can affect cranial nerves; May affect respiratory muscles creating need for intubation – 25% of all cases 3. Sensory - Absence of DTR’s; Paresthesias (numbness and tingling) 4. Autonomic - Urinary retention; Blood pressure instability; Cardiac arrythymias; Slowing on gastrointestinal motility 5. Other - Fatigue; Pain of limbs or back with movement

Question 4

What are the criteria required for diagnosis of GB?

Answer 4

1. Bilateral symptoms 2. Progressive weakness in more than 1 extremity 3. Loss of DTR’s Sx to support: - Weakness develops rapidly and progression stops by week 4 - Symmetric weakness - Mild sensory symptoms - Facial weakness - Autonomic changes - Absence of fever

Question 5

What does an EMG show in GB?

Answer 5

shows nerve conduction velocity slowed or blocked

Question 6

What does a lumbar puncture reveal with GB?

Answer 6

cerebrospinal fluid shows increased protein levels after 1 week and continue to increase and normal WBC count

Question 7

what is the progression of GB symptoms?

Answer 7

• peak within 4 wks (90% progression ends by 4 weeks; 25% require mechanical ventilation, mean hospital stay is 7 days) - plateau - gradual recovery over 1-2 yrs (77% completely recover in 1 year, 20% have LT impairments [10% of which are severely disabled], 3% mortality)

Question 8

what usually contributes to mortality in GB?

Answer 8

respiratory distress, PE, cardiac arrest

Question 9

What are the subtypes of GB?

Answer 9

1. Acute inflammatory demyelinating polyneuropathy – AIDP (most common form 85-90% of cases) 2. Acute motor axonal neuropathy – AMAN; Motor changes more prominent, respiratory involvement, more typical in younger patients 3. Acute sensory axonal neuropathy – ASAN; Sensory changes more prominent, more typical in adult patients 4. Miller Fisher syndrome; Present with ataxia, areflexia, and paralysis of extraocular muscles 5. Acute autonomic neuropathy; Rarest subtype, autonomic symptoms, especially cardiac and visual, recovery is slow

Question 10

What are complications of GB?

Answer 10

1. Anxiety and Depression 2. Respiratory distress 3. Contractures 4. Skin breakdown 5. DVT’s and embolisms 6. Pneumonia 7. Aspiration

Question 11

What is medical treatment of GB?

Answer 11

1. Plasma exchange - First line of therapy; Removes plasma from blood and filters it to remove or dilute circulating antibodies; 2-4 sessions performed within 7 days of symptom onset 2. Intravenous immunoglobulin (IVIg) - Protein the immune system normally uses to attack foreign organisms; 1x/day for 5 days within 2 weeks of symptom onset ; Should be considered for nonambulatory patients - RCT’s have shown no benefits to combining IVIg and plasma exchange - Corticosteroids are NOT beneficial and may actually delay recovery

Question 12

What are negative prognostic indicators for GB?

Answer 12

1. Older age at onset 2. More severe and rapid onset of symptoms 3. Disease progression past 4 weeks 4. Need for artificial respiration (mechanical ventilation)

Question 13

What symptom of GB lasts the longest?

Answer 13

severe fatigue - other symptoms resolve first - supervised exercise is recommended - early therapy positively correlated to recovery potential and improved physical outcomes - strength exercises should be done in acute phase

Question 14

What does acute therapy look like for GB?

Answer 14

1 focus is toward prevention of complications associated with immobilization 1. Maintain joint ROM 2. Monitor muscle strength closely 3. Proper skin care 4. Coughing and deep breathing 5. Gentle massage 6. Orthotics or splinting devices 7. Educate pt. and family: - Passive ROM - Turning schedule/position changes - Disease progression and treatment - Talk about fears and frustrations

Question 15

What are precautions for therapy during the acute phase of GB?

Answer 15

**Take extreme care to not over fatigue patients** - May impede recovery by increasing weakness and pain - Do not use high resistance exercises - Gradually increase activity - Monitor day to day - Exercise programs have been shown to be effective for improvement of fatigue

Question 16

At discharge how many pts had neuropathic pain that required medication, foot drop and wear AFO, and needed AD?

Answer 16

80% had neuropathic pain that required medication 60% had foot drop and were advised to wear an AFO 85% needed assistive devices for ambulation - 34% still have foot drop