Guillain-Barre Syndrome

Introduction
Guillain-Barré syndrome is an autoimmune disorder that affects the nerves.
Autoimmune disorders occur when the immune system malfunctions and attacks the body's
own tissues and organs. In Guillain-Barré syndrome, the immune response damages peripheral
nerves, which are the nerves that connect the central nervous system (the brain and spinal
cord) to the limbs and organs. Specifically, the immune response affects a particular part of
peripheral nerves called axons, which are the extensions of nerve cells (neurons) that transmit
nerve impulses. Guillain-Barré syndrome can affect the neurons that control muscle movement
(motor neurons); the neurons that transmit sensory signals such as pain, temperature, and
touch (sensory neurons); or both. As a result, affected individuals can experience muscle
weakness or lose the ability to feel certain sensations.
Muscle weakness or paralysis are the characteristic features of Guillain-Barré syndrome.
The weakness often begins in the legs and spreads to the arms, torso, and face and is
commonly accompanied by numbness, tingling, or pain. Additional signs and symptoms of the
condition include difficulty swallowing and difficulty breathing. Occasionally, the nerves that
control involuntary functions of the body such as blood pressure and heart rate are affected,
which can lead to fluctuating blood pressure or an abnormal heartbeat (cardiac arrhythmia).
There are several types of Guillain-Barré syndrome, classified by the part of the peripheral
nerve involved in the condition.

 Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)

The most common type of Guillain-Barré syndrome is acute inflammatory demyelinating
polyradiculoneuropathy (AIDP). In AIDP, the immune response damages myelin, which is
the covering that protects axons and promotes the efficient transmission of nerve
impulses.
 Acute Motor Axonal Neuropathy (AMAN) and
 Acute Motor-Sensory Axonal Neuropathy (AMSAN)
In two other types of Guillain-Barré syndrome, acute motor axonal neuropathy (AMAN)
and acute motor-sensory axonal neuropathy (AMSAN), the axons themselves are
damaged by the immune response. In AMAN, only the axons of motor neurons are
damaged. In AMSAN, the axons of sensory neurons are also damaged. Because of
sensory nerve damage, affected individuals can lose the ability to sense the position of
their limbs and can have abnormal or absent reflexes (areflexia).
 Miller Fisher syndrome
Another type of Guillain-Barré syndrome, involves cranial nerves, which extend from the
brain to various areas of the head and neck. Miller Fisher syndrome is characterized by
 three features: weakness or paralysis of the muscles that move the eyes
(ophthalmoplegia), problems with balance and coordination (ataxia), and areflexia.
People with this condition can have other signs and symptoms common in Guillain-Barré
syndrome, such as muscle weakness.

Guillain-Barré syndrome occurs in people of all ages. The development of the condition usually
follows a pattern. Prior to developing the condition, most people with Guillain-Barré syndrome
have a bacterial or viral infection. The first phase of Guillain-Barré syndrome, during which signs
and symptoms of the condition worsen, can last up to four weeks, although the peak of the
illness is usually reached in one to two weeks. During the second phase, called the plateau,
signs and symptoms of Guillain-Barré syndrome stabilize. This phase can last weeks or months.
During the recovery phase, symptoms improve. However, some people with Guillain-Barré
syndrome never fully recover and can still experience excessive tiredness (fatigue), muscle
weakness, or muscle pain.

Etiology
The exact cause of Guillain-Barre syndrome isn't known. The disorder usually appears days or
weeks after a respiratory or digestive tract infection. Rarely, recent surgery or vaccination can
trigger Guillain-Barre syndrome. Recently, there have been cases reported following infection
with the Zika virus.

Prevalence
The prevalence of Guillain-Barré syndrome is estimated to be 6 to 40 cases per 1 million people.
The occurrence of the different types of Guillain-Barré syndrome varies across regions. AIDP is
the most common type in North America and Europe, accounting for approximately 90 percent
of cases of Guillain-Barré syndrome in those regions. AMAN and AMSAN together account for
30 to 50 percent of cases in Asian countries and Latin America but only 3 to 5 percent of cases
in North America and Europe. Miller Fisher syndrome is also more common in Asian countries,
accounting for approximately 20 percent of cases in these countries but less than 5 percent in
North America and Europe.

Incidence
Most studies show annual incidence figures similar to those in the United States, without
geographical clustering. AMAN and AMSAN occur mainly in northern China, Japan, and Mexico,
making up only 5-10% percent of GBS cases in the United States. AIDP accounts for up to 90%
of cases in Europe, North America, and the developed world.

Risk Factors
Guillain-Barre syndrome can affect all age groups. But your risk increases as you age. It's also
more common in males than females.
Guillain-Barre syndrome may be triggered by:
 Most commonly, infection with campylobacter, a type of bacteria often found in
undercooked poultry
 Influenza virus
 Cytomegalovirus
 Epstein-Barr virus
 Zika virus
 Hepatitis A, B, C and E
 HIV, the virus that causes AIDS
 Mycoplasma pneumonia
 Surgery
 Trauma
 Hodgkin's lymphoma
 Rarely, influenza vaccinations or childhood vaccinations
 COVID-19 infection

Pathophysiology
Clinical Manifestations
• Often begins in the lower limbs
• Ascending muscle weaknesses & paralysis
– Proximal muscle weakness very frequent, especially initially, with
subsequent distal arm and leg weakness
• Pain (some may not experience)
– Mostly in shoulder, back and thigh
• Reduced or absent reflexes
• Symmetric paresthesia
– Areflexia/ hyporeflexia
• Sensory disturbance
• Facial and oropharyngeal weakness usually appears after the trunk and limbs are
affected
• Cranial nerves III-VII and IX-XII may be affected. Common complaints include:
 Facial Palsy
 Diplopia
 Dysarthria
 Dysphagia
 Ophthalmoplegia
• Respiratory inadequacy
 Possible respiratory failure
• ANS dysfunction:
 Urinary retention
 cardiac arrhythmias
 Sinus tachycardia
• Altered mental status

Diagnostic Procedures
• History and physical examination
• Clinical Diagnosis
– Diagnostic criteria
• Progressive, symmetric weakness of >1 limb
• Hyporeflexia/areflexia
• Progression <4weeks
• Symmetric weakness
• EMG & nerve conduction test can be used to confirm/differentiate
– (conduction block, decreased F-wave, Sural sparing)
 • Lumbar puncture (“Albuminocytologic dissociation”)
– Normal WBC
– Elavated CSF Protein
– These findings may not be present in all individuals
• Further investigative procedures can be undertaken to identify an underlying cause
 Chest X-ray
 MRI

Nursing Diagnosis
1. Ineffective Breathing Pattern
2. Acute Pain
3. Impaired Physical Mobility
4. Impaired Urinary Elimination
5. Anxiety

Nursing Management
• Assess motor strength or functional level of mobility
• Monitor nutritional needs as they associate with immobility
• Place the client in a position of comfort and provide frequent position changes as
tolerated
• Provide padding to bony prominences such as elbow and heels.
• Assess level of pain and ability to engage in activities
• Perform active, passive and isotonic range of motion exercises as appropriate
• Evaluate the need for assistive devices and provide a safe environment
• Monitor intake and output every 4 to 8 hours and palpate bladder every 2 hours; assess
for cloudy, foul-smelling urine
• Instruct to report any reduction or absence of urinary elimination.
• Assist client in urinary elimination rehabilitation program
• Assess oxygen saturation and review client’s arterial blood gases result
• Keep the head of bed elevated at around 35-45° to increase lung expansion and cough
effort minimizes the work of breathing and the risk of aspiration of secretions

Prevention and Supportive Management

• 2- hourly change in patients position from supine to side-lying. If the sores have
developed then UVR or ice cube massage to enhance healing
• Assistive devices such as wheelchairs, walking sticks and quadrupods should be made
available to individuals if required in order to facilitate safe and effective ambulation
Drug Therapy
1. Plasma Exchange (PE)
– Also known as plasmapheresis
– A catheter is inserted into the patient’s veins in which some blood is removed.
The blood cells from the plasma are extracted and returned to the patient.
– Seems to reduce the severity and duration of GBS.
– Removes by removing the bad antibodies that have been damaging the nerves
2. Immunoglobulin Therapy (IVIg)
– Intravenous injections of immunoglobulins which are developed from a pool of
thousand donors.
– The result of IVIg can lessen the immune attack on the nervous system and
shorten recovery time.
– Lowers the effectiveness of the antibodies that are attacking the nerves by
“diluting” them with non-specific antibodies.

Surgical Management
There is no available surgical management for Guillain-Barre Syndrome.

Prevention of Complications
 Nerve pain
○ One-third of patients experience nerve pain, which can be treated with
medication
 Breathing problems
○ Up to 22% of patients need help from a machine to breath within the first week
that they are hospitalized
 Residual numbness and other sensations
○ Most people recover quickly or experience minor residual weakness, numbness,
or tingling
 Heart and blood pressure problems
○ Constant monitoring of blood pressure and heart rate.
 Bowel and bladder function problems
 Blood clots
○ Immobile patient are more at risk.
○ Taking blood thinners and wearing support stocking
 Pressure sores
○ Immobile patients are more at risk
○ Frequent repositioning
 Relapse
 ○ 2-5% of people with GBS experience relapse

Prognosis
“The overall prognosis of GBS is quite good with approximately 85% of survivors making a good
functional recovery.” —M. Koc, N. Ozalp, and B. Zulfikaroglu (2002)

The Guillain-Barre syndrome has a 4-7% mortality rate, in which 60-80% patients are able to
walk at 6 months, 60% attain full recovery of motor strength after one year, and 5-10% of
patients experience prolonged recovery with several months of ventilator dependency.

REFERENCES:
Guillain-Barré Syndrome Fact Sheet. (2018, June). Retrieved January 18, 2021, from National Institute of
Neurological Disorders and Stroke: https://www.ninds.nih.gov/disorders/patient-caregiver-
education/fact-sheets/Guillain-barr%C3%A9-syndrome-fact-sheet

Guillain-Barre syndrome. (2020, September 17). Retrieved January 18, 2021, from Mayo Clinic:
https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symptoms-
causes/syc-20362793#:~:text=Guillain%2DBarre%20(gee%2DYAH,eventually%20paralyzing
%20your%20whole%20body

Guillain-Barré syndrome. (2020, February 6). Retrieved January 18, 2021, from NHS UK:
https://www.nhs.uk/conditions/guillain-barre-syndrome/

Cafasso, J. (2019, February 27). Guillain-Barré Syndrome. Retrieved January 18, 2021, from Healthline:
https://www.healthline.com/health/guillain-barre-syndrome

Guillain-Barre Syndrome. (n.d.). Retrieved January 19, 2021, from Physiopedia: https://www.physio-
pedia.com/Guillain-Barre_Syndrome

Prepared by:
Dimaocor, Zainab
Dimaporo, Alaisah S.
Dimaporo, Jannah Marie A.