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What is Guillain-Barre Syndrome?


Guillain-Barre Syndrome (GBS) is an inflammatory disorder of the peripheral nervous system (nerves outside of the brain and spinal cord). Normally a person’s immune system recognizes and destroys foreign “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.

What causes muscle weakness and pain?


The structures that are affected by this attack are axons 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 severely 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 patient’s medical history.  However, certain tests can help to solidify the diagnosis and possibly 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

An 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 main 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 affect 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

What is the treatment for Guillain-Barre Syndrome?

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

Can physical therapy help you regain your independence? 


Recovery from this attack is a balancing act between regaining movement WITHOUT “overstressing” the muscles that are trying to recover from this attack. So, what exactly does this mean? If the muscles are taken to a point of fatigue, it will delay their ability to heal and recover. A skilled physical therapist is critical to guide this delicate balance.  

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.

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