Guillain Barre Syndrome

Definition:
 A form of acute polyneuropathy
 Produces rapid muscle weakness
sometimes leading to paralysis
 Presumed cause is an autoimmune
reaction - attacks the myelin sheath
 Demyelination blocks impulse
transmission from node to node
 Rare disorder with incidence of 1:100,000
 Affects all races and age groups
 Onset usually occurs 1 to 3 weeks after an
illness, infection or immunization
 Syndrome usually develops over days or
weeks
 Can progress to full paralysis
 Mortality rate is approximately 5%
 95% of patients recover
 Since nerve axons are spared, recovery
eventually takes place, though slowly
 In a smaller percentage of patients it
becomes chronic or recurrent
4 Major forms of GBS

1. Ascending GBS: most common form;

weakness and numbness begin in legs
and work upwards; 50% of pts
experience respiratory insufficiency;
Sensory involvement is present
2. Pure motor GBS: is similar to ascending
form but there is no sensory involvement;
usually a milder form of the disease
3. Descending GBS: begins with weakness
in muscles controlled by cranial nerves,
then progresses downwards; respiratory
system is quickly impaired
4. Miller Fisher Syndrome: variant of GBS,
rare and primarily involves the eyes, loss
of reflexes and severe ataxia
General information

 Cranial nerves may also be involved

 The 5th nerve is the most commonly
involved
 When the 7th, 9th and 10th cranial nerves
are involved, difficulties in swallowing,
speaking and breathing will result
 The medulla oblongata may be affected
 Pain and paresthesias are present if
sensory nerves are affected
 Tingling sensation is common
 Pain is usually a cramping in the
extremities - requires analgesics
 Autonomic dysfunction, may include B/P
instabilities, dysrhythmias, tachycardia or
bradycardia, flushing, sweating, urinary
retention and paralytic ileus
 It does not affect pts LOC or alertness
 It progresses through 3 stages
1. Initial stage lasts 1 to 3 weeks and ends
when no physical deterioration
2. Followed by plateau period lasting from a
few days to a few weeks
3. Then recovery period which can last from
6 months to a year
 Remyelination of damaged nerves occurs
during the recovery phase
Signs and Symptoms
 Weakness
 Tingling and loss of sensation
 Fluctuations in Blood Pressure
 Urinary retention
 Dysrhythmias
 Loss of reflexes
 Paresthesias
 Loss of sphincter control
Investigations
 CSF analysis: an increased protein may
reveal the disease
 Electromyography: may reveal slowed
nerve conduction
 CBC: Presence of leukocytosis in early
illness due to inflammatory processes
associated with demyelination
Treatment
 Largely supportive - aimed at preventing
complications until recovery process can
begin
 Respiratory support is always the priority
 IV immunoglobulins 0.4g/kg daily for 5 days
(see current EDLIZ)
 Analgesics to control pain
 Stool softeners and laxatives to prevent
fecal impaction and minimize incontinence
Exercises and activity:
 ROM exercises after acute phase
Nutritional support
 High fibre diet- to prevent constipation
 Parenteral feedings and gastric feedings if
pt unable to chew or swallow
Nursing care
 ***Ineffective breathing pattern related to
neuromuscular weakness and paralysis***
 Altered nutrition: less than body
requirements related to inability to chew
and/or swallow
 Knowledge deficit regarding predisposing
factors, signs and symptoms, required
care related to unfamiliarity with condition
 Impaired physical mobility related to
paralysis in the lower extremities
 Activity intolerance related to
neuromuscular weakness or paralysis

 See current EDLIZ for section on

Progressive Generalized Weakness,
and Peripheral Sensory Symptoms