Guillain-Barre Syndrome

History and Background


Guillain-Barre Syndrome (GBS) is an inflammatory disorder of the peripheral nervous system (nerves outside of the brain and spinal cord). Normally a persons immune system recognizes and destroys foriegn “invaders” that enter the body. In GBS, a persons immune system starts to recognize the nerves as something foreign and the immune system destroys these healthy nerve structures. Specifically, the axon and surrounding myelin sheath.

Axons and Myelin Sheath                                               

The axons are like wires that connect our entire nervous system. Peripheral nerves are very similar to electrical wires. Nerves carry an electrical charge giving the muscles the “power” needed to contract.  The myelin sheath conducts the electrical current.  So depending on the severity of the damage to the myelin sheath, the nerve conduction velocity (the speed in which the messages travel down the nerve) will slow down or in the case when the myelin sheath is severly damaged, no electrical impulse down the nerve will be possible and therefore muscles attached that that nerve will not get the needed “electrical current” to contract.

Single  nerve axon with sheath.  Similar in appearance and function to an electrical wire.  The sheath conducts the current down the nerve to the muscle

Neuro-muscular junction where the nerve gives the electrical current to the muscle so the muscle can contract.

How is Guillain-Barre Syndrome Diagnosed?

A physician can often times come to this diagnosis based on the clinical symptoms and from the pateints medical history.  However, certain tests can help to solidify the diagnosis and possible identify the cause.  The following are additional tests that a physician may order. Nerve Conduction Test  This is when a doctor will send an electrical current down the nerve and measure the speed at which it travels to get to the muscle. Blood Test A blood test can detect the antibodies in the blood that may be causing the auto-immune response.  The results are helpful when deciding the course of treatment. MRI A MRI may be ordered to rule out other possible causes for the weakness including a possible tumor, stroke, or multiple sclerosis which have similar clinical presentations.

What are the Symptoms of Guillain-Barre Syndrome?

Depending on the severity of this attack on the nervous system, and/or the length of time it takes for treatments to take effect (reversing this autoimmune attack on the nervous system) will effect the type and severity of the symptoms.

Common Symptoms

Rapid onset of weakness beginning in the feet and hands
Loss of sensation
Pain
Fluctuations in blood pressure
Irregular heart rate

Less Common Symptoms Constipation Incontinence Blurred vision Difficulty swallowing And drooling

Medical Treatment

Medication
Medication can help to stop the inflammatory process

Intravenous Immunoglobulin (IVIG) treatment or plasmaphoresis
This will help to remove the antibodies that are attacking the nervous system

 

Physical Therapy


Physical Therapy Goals

– Prevent injury to joints while weak muscles recover

– Gradually progress exercises maintaining intensity at a submaximal level

– Teach energy conservation strategies

– Make recommendations for adaptive equipment

It is important to maintain exercises at a submaximal level.  Although the muscles appear to be “weak”, it is important to understand that it is the “energy source” (the nerve supplying the muscle) that is the problem, not the “machine” (the muscle itself).  Asking the muscles to perform above and beyond the available energy source can damage the muscle or cause muscle failure which will delay the recovery process.