Clinical Picture and Treatment of Guillain Barre Syndrome

A cute infective polyneuritis

"Landry Guillain Barre Syndrome"

 

Aetiology:

• It is due to an allergic or auto-immune reaction secondary to a previous non-specific virus infection.

Clinical picture:

Febrile stage:

• it starts with an influenza-like attack with fever, headache, malaise, pains all over the body with no nervous symptoms.

Latent stage:

• the above symptoms disappear and the patient is free for 1-4 weeks.

Paralytic stage:

• There is acute severe weakness or paralysis starting in the loewr limbs and ascending to involve the trunk and respiratory muscles, followed by the upper limbs muscles.
• Contrary to other types of polyneuropathy, the weakness is proximal more than distal.
• In spite of severe degree of paralysis, wasting is not present early in the disease.
• Sensory impairment may occur resulting in stock and glove hypothesia and deep sensory loss.

• Early in the disease there is tenderness of the calves.
• The cranial nerves are usually involved specially cranial nerves 7,10 resulting in bilateral facial paralysis and bulbar symptoms.
• C.S.F. show cytoalbuminous dissociation.
• Prognosis is good in 85% of the cases where recovery occurs in 3-4 weeks.

Treatment:

1)Absolute rest in bed till the heart rate reaches below 100/min.(i.e. return of the vagal tone).
2)Care of the bulbar muscles by:

• Frequent suction of secretions feom the pharynx.
• Neostigmine 1 mg hourly I.M.
• Tube feeding in case of phayngeal paralysis.

3)Care of the respiratory muscles by:

• Frequent suction to keep a patient airway.
• Tracheostomy may be needed.

4)Corticisteriods(Prednosone or Prednisolone 60 mg/day).
5)Gamma-globulins and plasmapheresis:

•  the most recent and effective treatment.

6)Vitamins B1,B6,B12(Trivarol,Tri-B),I.M. daily.
7)A.T.P. 25 mg daily I.M.(Adenoplex).
8)Antibiotics e.g. tetracycline to guard against 2ry infection.
9)Physiotherapy:

• Massage.
• Passive and active exercises.
• Proper positioning and electrical stimulation.