Guillain Barre Syndrome and Its Implications
Guillain–Barré syndrome is a disorder which is thought to be caused by the body's immune system attacking its own peripheral nervous system. It is not fully understood and still continues to be studied.
The syndrome afflicts about one person in 100,000. Either gender can be affected in any age group, however risk increases with age. This disorder usually follows a viral illness such as influenza, mononucleosis or infectious hepatitis. Flu vaccines have also been associated with the development of Guillain–Barré syndrome.
It is known that the myelin sheath, which insulates the nerve fibers, comes under attack and becomes damaged. Because its function is to help promote conduction of nerve impulses, its integrity is essential to proper functioning of the peripheral nervous system.
Symptoms begin rapidly with the first manifestations becoming apparent in the lower body, mainly in the feet and legs.Tingling may be felt along with weakness. Both sides of the body are usually affected. Less commonly, symptoms may begin in the upper body or even the face. The weakness spreads accompanied by numbness and sometimes pain in the larger muscles. The patient may also report crawling sensations on the skin or feeliings like vibration.
Some paralysis results which can be mild to severe. Only about 28% of afflicted patients are able to walk. Often the limbs become so weakened and feel so heavy that it becomes impossible to perform self care or even eat unaided. If the facial muscles are affected, the patient may find speaking extremely difficult or impossible. In the most severe cases, the larynx, pharynx and diaphragm become weak or paralyzed so that full life support measures must be implemented which includes mechanical ventilation, clearing of the patient's airway via suction and feeding via tube. About 33% of patients that develop Guillain–Barré syndrome require intensive care and ventilatory support.
How is Guillain–Barré syndrome treated?
There is no cure for Guillain–Barré syndrome, however the good news is that most people recover fully. The most important treatment is to support breathing and clearance of secretions from the airway since the patient may be too weak to fully expand the lungs and cough effectively. A rotating bed may be used to help prevent pneumonia and bed sores. If mechanical ventilation will be needed long term, a tracheostomy is usually performed to make the patient more comfortable and to help avoid pressure sores on the lips or in the nostrils due to use of an endotracheal tube.
There are some additional therapies that may be tried to expedite recovery. The physician may order plasmapheresis which involves removing blood from the patient, separating the blood cells from the plasma, then returning the blood cells diluted in saline solution with sterilized human albumin protein. This therapy has been proven to be effective although temporary. As with any procedure, there are risks but the benefit to the patient is most likely worth it.
A newer treatment is to give the patient an intravenous infusion of gamma globulin taken from donors. This is effective because it blocks the receptors where damaging antibodies attach themselves. Nerves are then able to heal quicker and give the patient a faster recovery time.
The progress of Guillain–Barré syndrome takes about 2-4 weeks, then an additional 2-4 weeks before the patient begins to recover. Most do become fully functional again but recovery can take months and be very frustrating. Physical therapy will be necessary and respiratory augmentation many be required for some time. Approximately 25% of patients will have some muscular weakness remaining but the majority do well. Speech, respiratory and occupational therapy may also be needed during the recovery process. The paralysis resolves gradually along the same path it began in. The patient will need to take it slow in learning to swallow food again to avoid choking. During the recovery period, the feeding and tracheotomy tube may be left in place until it is felt they may be safely removed.
Fortunately, reoccurance of Guillain–Barré syndrome is rare. It is thought that about 3% of patients that have experienced it once will develop it again. There is also no clear genetic link to support any higher risk of developing the disorder by inheritance.
Written by Marilyn Eisele, Registered Respiratory Therapist
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