PPhysiopedia Guillain-Barre Syndrome Introduction

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Differential Diagnosis: •Acute peripheral neuropathies: Toxic, Drugs, Alcohol, Porphyria, Systemic vasculitis, Poliomyelitis, Diphtheria, Tick paralysis, Critical illness polyneuropathy

•Disorders of Neuromuscular Transmission: Botulism, Myasthenia gravis

•Central Nervous System Disorders: Basilar artery occlusion, Acute cervical transverse myelitis

Diagnostic Procedures:

•Cerebrospinal fluid investigation: It will elevated at some stage of the illness but remains normal during the first 10 days. There may be lymphocytosis (> 50000000 cells/L).

•Electrophysiological studies: it includes nerve conduction studies and electromyography. They are normal in the early stages but show typical changes after a week or so with conduction block and multifocal motor slowing, sometimes most evident proximally as delayed F-waves.

The only way to classify a patient as having the axonal or nonaxonal type is electrodiagnostically.

•Further investigative procedures can be undertaken to identify an underlying cause. For example:

•Chest X-ray , stool culture and appropriate immunological tests to rule out the presence of cytomegalovirus or mycoplasma

•Antibodies to the ganglioside GQ1b for Miller Fisher Variant.


•Lumbar Puncture: Most, but not all, patients with GBS have an elevated CSF protein level (>400 mg/L), with normal CSF cell counts. Elevated or rising protein levels on serial lumbar punctures and 10 or fewer mononuclear cells/mm3 strongly support the diagnosis.

Prognosis: Guillain-Barré syndrome can be a devastating disorder because of its sudden and unexpected onset. In addition, recovery is not necessarily quick. As noted above, patients usually reach the point of greatest weakness or paralysis days or weeks after the first symptoms occur. Symptoms then stabilize at this level for a period of days, weeks, or, sometimes, months. The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of those with Guillain-Barré still have a residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack.

Guillain-Barré syndrome patients face not only physical difficulties but emotionally painful periods as well. It is often extremely difficult for patients to adjust to sudden paralysis and dependence on others for help with routine daily activities. Patients sometimes need psychological counselling to help them adapt.[16]

Main likely predictors of prognosis in Guillain Barre´syndrome: derived from findings of prospective literature of studies including a majority of treated patients are:[17]

Management: There is no known cure for Guillain-Barré syndrome. However, there are therapies that lessen the severity of the illness and accelerate the recovery in most patients. There are also a number of ways to treat the complications of the disease.

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