GBS

• Guillain-Barre Syndrome (GBS)


  Ascending Paralysis/ Caudocephalic, Bilateral symmetrical. Caused by acute rapid segmental demyelination of peripheral nerves, usually precipitated by viral infection
• GBS


  • Affects the myelin sheath, unlike Multiple Sclerosis which has no chance of remyelination, GBS has a chance to remyelinate because Schwann cells are spared
• Autoimmune attack on peripheral nerve myelin

  Causes acute, rapid segmental demyelination
• Demyelination of peripheral nerves and some cranial nerves

  Ascending weakness with dyskinesia, hyporeflexia, and paresthesias
• Antecedent event


  Most often a viral infection that precipitates clinical presentation
• Infectious agents that can cause GBS

  • Campylobacter jejuni (most common)
  • Cytomegalovirus
  • Epstein-Barr virus
  • Mycoplasma pneumoniae
  • H. influenzae
  • HIV
• GBS


  • More frequent in males, 16 - 25 years and between 45 - 60 (bimodal distribution)
• Recovery


  60% to 75% of patients recover completely
• Molecular mimicry


  Infectious organism contains an amino acid that mimics the peripheral nerve myelin protein, leading the immune system to attack and destroy the peripheral nerve myelin at the ganglioside GM1b location
• Symptoms of GBS


  1. Muscle weakness and diminished reflexes of the lower extremities leading to tetraplegia

  2. Neuromuscular respiratory failure and bulbar weakness (weakness in facial and throat muscles) during plateau

  3. Paresthesias of the hands and feet and pain related to the demyelination of sensory fibers

  4. Optic nerve demyelination leading to blindness

  5. Glossopharyngeal and vagus nerve demyelination leading to bulbar muscle weakness and inability to swallow or clear secretions

  6. Vagus nerve demyelination leading to autonomic dysfunction (tachycardia, bradycardia, hypertension, or orthostatic hypotension)
• Patient presentation


  • Symmetric weakness, diminished reflexes, and upward progression of motor weakness
• Medical management


  1. Manage in intensive care unit

  2. Support pulmonary function and ensure adequate oxygenation

  3. Prevent complications of immobility (use anticoagulants, anti-embolism stockings, sequential compression boots)

  4. Plasmapheresis and IVIG to directly affect peripheral nerve myelin antibody level and reduce time on mechanical ventilation

  5. IVIG is therapy of choice due to fewer side effects