guillain-barré syndrome presentation

GUILLAIN-BARRÉ SYNDROME

Linda Roybal & Sarah Jane Calub

DESCRIPTIONAcute autoimmune disease marked by inflammation of the peripheral nerves, affecting arms and legs

Involves destruction of the myelin sheath surrounding largest, most myelinated sensory and motor fibers, resulting in disrupted proprioception and weakness.

ETIOLOGY

No clear cause

Neither contagious nor hereditary

Inappropriate immune response

Possible vaccine causal link

INCIDENCE & PREVALENCE

GBS affects 2 per 100,000 annually (1,500 people/year)

Nondiscriminatory: can affect persons of any gender, age, or ethnic background

SIGNS AND SYMPTOMS

Numbness and tingling in hands and feet

Distal progression: muscle weakness, diminished reflexes and proprioception, decreased sensation

For some, progresses to trunk, face, and cranial nerves, resulting in difficulty swallowing, chewing, speaking, and facial expressions

Deep, aching pain/hypersensitivity to touch

Respiratory/cardiac dysfunction and failure

COURSE/PROGNOSIS

80% experience complete recovery

Recovery may last from 2 months to 2 years

3 distinct phases:

Acute (4 wks) - initial rapid onset of symptoms

Plateu (few days to few weeks) - symptoms neither worsen nor improve

Recovery - gradual improvement

DIAGNOSIS

Diagnostic testing for GBS includes

Physical and neurological exam

Lumbar puncture

Computed Tomography (CT) scan

MEDICAL/SURGICAL MANAGEMENT

Intravenous immunoglobin therapy: prevents immune system from further attacking Schwann cells and myelin by blocking receptors on microphages

Plasmapheresis: filters blood plasma to remove antibodies and aids in replacing lost fluids

Corticosteroids: inhibit inflammation associated w/ symptoms

IMPACT ON CLIENT

Limited physical mobility

Inability to engage in meaningful occupations because of pain, extreme muscle weakness in arms and legs, and fatigue

Sensory functions impaired

Using cultural contexts to structure intervention activities

REFERENCES

Guillain-Barré Syndrome Support Group (2009) A Quick Guide to Guillain-Barré Syndrome and

CIDP. Guillain-Barré Support Group, Sleaford.

Little evidence that supports a causal link between most vaccines and Guillain-Barre syndrome.

(2009). Drugs & Therapy Perspectives, 25(11), 21-23.

Lugg, J. (2010). Recognising and managing Guillain-Barre syndrome. Emergency Nurse, 18(3),

27-30.

Lundy-Ekman, L. (2007). Neuroscience: fundamentals for rehabilitation (3rd ed.). St. Louis,

Mo.: Saunders/Elsevier.