1. Guillain-Barre Syndrome

2. Guillain-Barre syndrome - also known as acute post-infective polyneuritis - is a disease of the peripheral nervous system, affecting the nerves to the arms, legs, head and trunk, but not the brain or spinal cord.
An autoimmune reaction following an acute infection
Affects peripheral nerve myelin
Causes acute, rapid sergmental demyelination of peripheral nerves and some cranial nerves
Not inherited,
Genetic factors may make some people more likely to develop autoimmune conditions.
Complete recovery may take upto 2 years
Death may occur in 3-8 % of patients and it is due to respiratory failure, autonomic dysfunction, sepsis or pulonary emboli

3. Pathophysiology
Myelin sheath covers nerves, insulates, speeds conduction of impulses
Myelin produced by Schwann cell
In Guillain-Barre Syndrome Schwann cell spared – mylination later becomes possible.
Cell mediated immune attack on myelin sheath
Inflammation of the myelin  destruction of the myelin

5. Clinical Manifestations
Initial ly headache, vomiting, fever
Back and limb pain
Followed by paralysis
Starts as tingling and numbness followed by increasing weakness.
Paralysis is progressive and ascending
May have a sudden onset and affect all four limbs at once. The degree of paralysis varies.
H/O viral illness in the previous few weeks
Weakness in all the limbs symmetrical
Paresthesias in the feet and hands

6. Begins with muscle weakness and diminished reflexes of the lower extremities
Upward Progression of the above symptoms over several days to one month
May lead to quadriplegia
Respiratory muscles may be affected leading to respiratory failure
About 25% of patients may require mechanical ventilation within 18 days of symptom onset.Clinical Manifestations
Sensory symptoms : paraesthesias of the hands and feet and pain related to the demyelination of sensory fibers

7. Blindness – optic nerve demyelination
Bulbar muscle weakness – 9th and 10th nerve demyelination
10th nerve involvement – autonomic dysfunction – instability of the cardiovascular system. Leading to tachycardia, bradycardia, hypertension or orthostatic hypotension
Autonomic dysfunction – rapidly resolves Guillain-Barre Syndrome does not affect cognitive function or level of consciousness.

8. Diagnosis
CSF proteins elevated without any change in the other cells more than 45 mg//dL within 3 weeks
Evoked potential sutdies demonstrate a progressive loss of nerve conduction velocity
Abnormalities of F waves (absence, dispersion , impersistence) in at least two limbs
Motor nerve conduction block, or slowing (motor nerve conduction velocity below 80% of normal

9. Medical Management A medical emergency Intensive care unit management
Ventilatory support may be needed
Prevent complications of immobility
Plasmapheresis – IVIG
Continuous ECG monitoring
For tachycardia and hypertension – beta blockers
Hypotension – IV fluid

10. Nursing interventions
Maintain respiratory function : incentive spirometer, chest physiotherapy, monitor vital capacity, early intervention and mechanical ventilation if vital capacity is < 12 to 15 ml/Kg for 4 to 6 hours or if patient is not able to clear secretions
BP and heart rate assessed frequently – if autonomic dysfunction – intervene
Enhance physical mobility : extremities that are paralysed splinted in functional position; physiotherapy, prevent bed sore

11. Cheking with spirometer whether Respiratory muscles are being weakened

12. Treatment Options
Corticosteriods:  Steroids have been used to try to increase muscle usage, but no evidence supports this therapy .
Plasmapheresis (Plasma Exchange): Approximately 200 to 250mL/kg of plasma is exchanged over 7-14 days to filter out possible antibodies and harmful substances in the blood.  This treatment has been shown to provide improvement for only a small population of patients .
Intravenous immunoglobulin: Injections of high dosages of human immunoglobulin (0.4 g/kg per day for 5 days) have been found to be somewhat effective for a small population of patients.
Antibiotics:  Possible early treatment with erythromycin may help produce a shorter duration of illness if the patient has campylobacter associated GBS .
Rehabilitation: Physical therapy to improve muscle tone and strength as well as counseling is the major form of treatment.