Guillain-Barré Syndrome- symptoms and treatment

What is Guillain-Barré Syndrome? We will analyze the causes of occurrence, diagnosis and methods of treatment in the article by Dr. Zhuikov A.V., a neurologist with 19 years of experience.

Definition of disease. Causes of the disease

Guillain-Barré Syndrome (GBS)- spicy autoimmune disease peripheral nervous system characterized by muscle weakness. This disorder encompasses a group of acute disorders of the peripheral nervous system. Each variant is characterized by peculiarities of the pathophysiology and clinical distribution of weakness in the limbs and cranial nerves.

70% of patients with GBS had a previous infection before the onset of neurological symptoms.

If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of Guillain-Barré Syndrome

SARS symptoms or disorder gastrointestinal tract are noted in 2/3 of patients. The first symptoms of GBS are paresthesias of the fingers of the extremities, followed by progressive muscle weakness. lower limbs and gait disturbances. The disease progresses over several hours or days, weakness of the upper extremities occurs and cranial nerve palsy develops. Paralysis is usually symmetrical and, of course, peripheral. In half of patients, pain may be the initial complaint, making diagnosis difficult. Ataxia and pain are more common in children than in adults. Retention of urine occurs in 10% -15% of patients. Damage to the autonomic nerves is manifested by dizziness, hypertension, excessive sweating, and tachycardia.

Physical examination reveals ascending muscle weakness and areflexia. Tendon reflexes of the lower extremities are absent, but reflexes of the upper extremity can be elicited. Muscle weakness can also involve the respiratory muscles. The defeat of the cranial nerves is noted in 35-50%, autonomic instability in 26% -50%, ataxia in 23%, dysesthesia in 20% of cases.

The most common signs of autonomic dysfunction are sinus tachycardia or bradycardia and arterial hypertension... In patients with severe autonomic dysfunction, changes in peripheral vasomotor tone with hypotension and lability are observed blood pressure.

Infrequent options clinical course diseases include fever at the onset of neurological symptoms, severe sensory impairment with pain (myalgias and arthralgias, meningismus, radicular pain), sphincter dysfunctions.

GBS should be considered in any patient with rapid development acute neuromuscular weakness. On the early stage GBS should be distinguished from other diseases with progressive symmetric muscle weakness, including transverse myelitis and myelopathy, acute toxic or diphtheria polyneuropathy, porphyria, myasthenia gravis, and disorders electrolyte metabolism(eg hypokalemia).

Pathogenesis of Guillain-Barré syndrome

The neurophysiological processes underlying GBS are subdivided into several subtypes. The most common subtypes include:

• acute inflammatory demyelinating polyradiculopathy;
• acute motor axonal neuropathy;
• acute motor and sensory axonal neuropathy;
• Miller-Fisher syndrome, as a variant of GBS, is characterized by a triad of signs: ophthalmoplegia, ataxia and areflexia.

It is believed that GBS develops due to the production of antibodies against the protein infectious agent that cross-react with gangliosides of human nerve fibers. Autoantibodies bind to myelin antigens and activate complement, with the formation of a membrane-attacking complex on the outer surface of Schwann cells. Damage to the sheaths of the nerve trunks leads to conduction disturbances and muscle weakness (axonal degeneration can also occur at a later stage). Demyelinating lesion occurs along the entire length of the peripheral nerve, including the nerve roots.

All types of nerves are affected, including autonomic, motor, and sensory fibers. Motor nerve involvement occurs significantly more frequently than sensory nerve involvement.

Complications of Guillain-Barré syndrome

Patients with HBS are at risk of life-threatening respiratory complications and autonomic disorders.

Indications for transfer to the intensive care unit include:

• rapid progression of motor weakness with damage to the respiratory muscles;
• ventilation respiratory failure;
• pneumonia;
• bulbar disorders;
• severe autonomic insufficiency.

Complications of ongoing treatment that require intensive care include fluid overload, anaphylaxis to intravenous immunoglobulin administration, or hemodynamic disturbances during plasmapheresis.

15% -25% of children with HBS develop decompensated respiratory failure, which requires mechanical ventilation. Respiratory disorders are more common in children with rapid disease progression, upper limb weakness, autonomic dysfunction, and cranial nerve damage. Tracheal intubation may be required in patients to protect respiratory tract, carrying out mechanical ventilation of the lungs. With GBS, rapid progression, bilateral facial nerve palsy, and autonomic dysfunction determine an increased likelihood of intubation. Planning for early intubation is essential to minimize the risk of complications and the need for emergency intubation.

Autonomic dysfunction increases the risk of endotracheal intubation. On the other hand, dysautonomy may increase the risk of hemodynamic reactions to drugs used to induce anesthesia during intubation.

Signs indicating the need for mechanical ventilation:

1. ventilation respiratory failure;
2. an increase in oxygen demand to maintain SpO2 above 92%;
3. signs of alveolar hypoventilation (PCO2 above 50 mm Hg);
4. rapid decrease in vital capacity by 50% compared to the baseline;
5. inability to cough

Autonomic dysfunction is the main factor in mortality in GBS. Fatal cardiovascular collapse due to autonomic dysfunction occurs in 2% -10% of critically ill patients. Heart rate, blood pressure, and electrocardiogram monitoring should be continued for as long as patients require respiratory support. Percutaneous pacing may be required for severe bradycardia. Hypotension is corrected by circulating blood volume (BCC) replenishment, and if the patient is unresponsive to BCC replenishment, α-agonists such as norepinephrine, mezaton, adrenaline are used.

With unstable hemodynamics, continuous recording of arterial and central venous pressure should be performed to control the volume of infusion therapy.

Arterial hypertension can occur, but this complication does not require special treatment unless complicated by pulmonary edema, encephalopathy, or subarachnoid hemorrhage.

Diagnostics of the Guillain-Barré syndrome

Instrumental diagnostics

Lumbar puncture

With a lumbar puncture, CSF results usually show elevated level protein (> 45 mg / dL), no pleocytosis (<10 клеток/мм3) (белково-клеточная диссоциация). Иногда уровень белка может оставаться нормальным, при умеренном повышении количества клеток (10-50 клеток/мм3). Цитоз выше, чем 50 клеток/мм3, свидетельствует против диагноза ГБС. В ряде случаев могут быть необходимы повторные люмбальные пункции для уточнения диагноза.

Neurofunctional diagnostics

ENMG (Electroneuromyography)- the only instrumental diagnostic method that allows to confirm the diagnosis of GBS and to clarify the nature of pathological changes (demyelinating or axonal) and their prevalence.

Needle electromyography is characterized by the presence of signs of the current denervation-reinnervation process in polyneuropathy. Examine the distal muscles of the upper and lower extremities (for example, the tibialis anterior muscle, the common extensor of the fingers), and, if necessary, the proximal muscles (for example, the quadriceps muscle of the thigh).

The ENMG study in patients with GBS depends on the clinical manifestations:

• with distal paresis, long nerves on the arms and legs are examined: at least four motor and four sensory (motor and sensory portions of the median and ulnar nerves; peroneal, tibial, superficial peroneal and sural nerves on one side).

Assessment of the main ENMG parameters:

• motor responses (distal latency, amplitude, shape and duration), the presence of blocks of conduction and dispersion of responses; the speed of propagation of excitation along the motor fibers in the distal and proximal areas is analyzed.
• sensory responses: the amplitude and speed of excitation conduction along sensory fibers in the distal regions.
• late ENMG-phenomena (F-waves): latency, form and amplitude of responses, amount of chronodispersion, percentage of loss are analyzed.
• in case of proximal paresis, it is mandatory to study two short nerves (axillary, musculocutaneous, femoral, etc.) with an assessment of the parameters of the motor response (latency, amplitude, shape).

The first signs of a denervation process appear two to three weeks after the onset of the disease, signs of a reinnervation process - after a month.

Guillain-Barré Syndrome Treatment

General supportive care and treatment

Patients requiring intensive care require careful general care. Constipation is observed in more than 50% of patients with GBS as a result of dynamic intestinal obstruction.

For pain, paracetamol is used. Katadolon and tramadol are used for severe pain syndrome. For neuropathic pain, carbamazepine and gabapentin are effective.

In the treatment of GBS, various types of immunomodulatory therapy are being undertaken.

Intravenous immunoglobulin is given as a daily infusion (0.4 g / kg / day) for 5 days in the first 2 weeks of illness. A second course of immunoglobulin may be required in 5% -10% of patients, with negative dynamics after initial improvement. The mechanism of action of intravenous immunoglobulin is likely multifactorial and is believed to include modulation of complement activation, neutralization of idiotypic antibodies, suppression of inflammatory mediators (cytokines, chemokines).

Side effects of immunoglobulin include headache, myalgia and arthralgia, flu-like symptoms, and fever. Patients with IgA deficiency may develop anaphylaxis after the first course of intravenous immunoglobulin.

Plasmapheresis helps to remove antibodies involved in the pathogenesis of GBS. During each session, 40-50 ml / kg of plasma is replaced with a mixture of 0.9% sodium chloride and albumin solution. Plasmapheresis leads to a reduction in the recovery time and a decrease in the need for artificial ventilation. These advantages are evident if plasmapheresis is performed within the first two weeks after the onset of the disease. Complications associated with plasmapheresis include venipuncture hematoma, pneumothorax after subclavian vein catheterization, and sepsis. Plasmapheresis is contraindicated in patients with severe hemodynamic instability, bleeding, and sepsis.

The combination of plasmapheresis and immunoglobulin has not shown clinical benefit.

Corticosteroids should not be used in the treatment of GBS, since they do not accelerate recovery, do not reduce the likelihood of mechanical ventilation, and do not affect long-term outcome.

Forecast. Prophylaxis

GBS remains a serious illness despite improved treatment outcomes. Compared to adults, children are more likely to have a more favorable course of the disease, with complete rather than partial recovery. The reasons for an unfavorable outcome in GBS are respiratory failure, complications of mechanical ventilation (pneumonia, sepsis, acute respiratory distress syndrome and thromboembolic complications), cardiac arrest secondary to dysautonomy.

Recovery usually begins two to four weeks after symptom progression stops. The average time from the onset of the disease to complete recovery is 60 days. Data on the long-term outcome of GBS are limited. 75% - 80% of patients recover completely. About 20% of patients are unable to walk after six months.

Younger age group (less than 9 years old), rapid progression and maximum muscle weakness, and the need for mechanical ventilation are important predictors of long-term motor deficits.

Almost every person from time to time gets a cold or even gets a more serious viral infection, gets vaccinated. But after a while after recovery, it begins to seem that the symptoms are returning - the patient feels a lack of strength, aching joints, an increase in temperature. The danger is that these can be signs of a serious illness - Guillain-Barré syndrome, sometimes leading to complete paralysis and death. What kind of disease is this and how to protect yourself from it?

General information

Guillain-Barré syndrome is called an autoimmune lesion of the peripheral nervous system, in which muscle weakness can rapidly develop, turning into paralysis. Often it becomes the cause of acute flaccid tetraparesis, in which the motor activity of the lower and upper extremities decreases. In ICD-10, Guillain-Barré syndrome is designated by the code G61.0 and is included in the group of inflammatory polyneuropathies.

Guillain-Barré syndrome is an autoimmune lesion of the peripheral nervous system.

There are two types of GBS classification - according to the form of the disease and according to its severity. According to the first indicator, the following types of syndrome are distinguished:

• AIDP, also called acute inflammatory demyelinating polyneuropathy. This is the most common form - it affects from 65 to 90% of cases;
• acute axogonal neuropathies of a motor or motor-sensory nature affect from 5 to 20% of patients. Designated in medical practice OMAN and OMSAN, respectively;
• 2-3% get sick with Miller-Fisher syndrome, about the same number of people have a paragenetic form of GBS;
• less than 1% falls on such types as sensory, pharyngo-cervico-brachial and paraparetic.

According to the severity, the following categories can be distinguished:

• Easy, in which the patient does not experience difficulties in self-care. Muscle weakness is almost not expressed, the person walks by himself.
• Medium - the patient cannot walk 5 meters without additional help, his motor functions are impaired, fatigue quickly sets in.
• Severe - the patient is no longer able to move, often cannot take food on his own and requires constant care.
• Extremely difficult when a person needs supporting life support.

The course of Guillain-Barré syndrome is divided into several stages of development:

• in the first, lasting 1-4 weeks, the symptoms increase until the acute period sets in;
• for the second, the disease proceeds smoothly, the patient in this state spends up to 4 weeks;
• the recovery period is the longest, it can last for several years. A person at this time comes back to normal and may even be completely cured.

Guillain-Barré Syndrome Can Be Cured

Causes of Guillain-Barré Syndrome

There is still no reliable information about why this ailment appears. In modern medicine, it is believed that the consequences of past infections, including respiratory, cytomegalovirus, herpes, lead to the disease, and a person can also get sick due to previous mononucleosis and enteritis. Doctors explain this by the fact that immune cells confuse tissues infected with viruses with nerve endings and seeks to destroy them.

Less commonly, the appearance of the syndrome is attributed to trauma (especially craniocerebral), complications after surgery, the influence of systemic lupus, malignant tumors or HIV.

Another risk group is made up of people with a hereditary predisposition. If your family has had the syndrome, then it is better to take care of yourself - avoid infections and injuries.

Other reasons are possible, but it is much more important not to determine where the disease came from, but to notice its first manifestations and start treatment on time.

Guillain-Barré Syndrome Symptoms

It is not easy to identify the first manifestations of GBS; at first, they are quite similar to the signs of acute infectious diseases. Specific indicators appear only at later stages. Typically, the initial symptoms of Guillain-Barré syndrome include:

• the temperature rises sharply to very high, sometimes subfebrile;
• goosebumps and tingling sensations are felt on the tips of the palaces;

One of the symptoms of the disease is a sharp rise in temperature.

• the patient feels muscle pain;
• over time, weakness manifests itself, the patient loses strength.

As soon as you see these symptoms either in yourself or in someone close to you, see your doctor immediately. Every minute wasted increases the risk of developing paralysis and even death.

Complications associated with Guillain-Barré syndrome

The disease has a huge impact on the functioning of the human body. Its course may be associated with such disabilities:

• difficulty breathing and the lack of oxygen caused by them;
• pain and numbness in different parts of the body;
• disorders in the work of the intestines and genitourinary system caused by weakening of smooth muscles;
• the formation of a large number of blood clots;
• heart problems and fluctuations in blood pressure;
• bed sores appear in bedridden patients.

For each of the complications, symptomatic treatment should be applied, aimed at improving the patient's condition and bringing the body back to normal.

Blood pressure fluctuations may appear

Manifestations of Guillain-Barré Syndrome in Children

Adults are more likely to develop GBS, especially after forty. In children, it is much less common, but is characterized by the same symptoms, supplemented by eye paralysis, the absence of some reflexes and incoherent muscle work. Guillain-Barré syndrome in children often does not cause fever, which complicates the diagnosis and leads to complications.

Diagnostics of the Guillain-Barré syndrome

First of all, the doctor collects a complete anamnesis of the disease, while paying attention to both the presence or absence of causes of the disease, and the symptoms identified - the speed of their manifestation, the presence of pain and weakness, impaired sensitivity.

The next stage - a physical examination - should give answers to questions about the clarity of the patient's consciousness, the absence or decrease of reflexes, the presence of pain, autonomic problems. The lesions should be symmetrical and get worse over time.

At the third stage, laboratory tests are carried out. The patient donates blood for biochemical analysis, as well as for the presence of autoantibodies and antibodies to previous diseases. A lumbar puncture is often done for general analysis of cerebrospinal fluid.

The patient needs to donate blood for biochemical analysis

Clinical guidelines for determining Guillain-Barré syndrome suggest instrumental diagnostics. The patient may be prescribed electromyography, which shows the speed of signal movement along the nerves, and a neurophysiological study. It tests the functioning of the long nerves (sensory and motor) in the arms and legs. The survey is subject to at least four of both. The results of the two methods are compared, and a decision is made on the diagnosis.

Guillain-Barré Syndrome Treatment

There are two different systems of therapy that complement each other perfectly - symptomatic and specific. The first is to remove the effects of the disease on the body - to help digestion, take care of the body and eyes, support breathing, and control the work of the heart. Such care should protect the patient from further deterioration and complications.

Specific therapy should help the patient return to normal form. There are several methods:

1. Treatment of Guillain-Barré syndrome with the introduction of immunoglobulin into a vein. This drug is especially important for those patients who cannot walk.
2. Plasmapheresis can speed up recovery in moderate and severe disease. For an easy form, it is not relevant. Removal of large amounts of plasma helps to normalize immune functions.

An important nuance - in no case should you combine both types of therapy for simultaneous use, as this can give unpredictable and dangerous results.

Plasmapheresis in the treatment of Guillain-Barré syndrome

Recovery from GBS

Guillain-Barré syndrome damages both nerve endings and other tissues in the body. The patient often needs comprehensive rehabilitation, which must resume physical activity and the necessary skills in everyday life. For this, massage, electrophoresis, relaxing baths, a contrast shower to raise muscle tone, physiotherapy, therapeutic exercises and much more are usually used. All this will give the patient the opportunity to return to a full life and no longer remember the syndrome.

Prevention of recurrence of the syndrome

There are no special techniques that can protect against GBS recurrence. But by following simple recommendations, you can at least make the risk of the disease less:

• refuse vaccination for at least six months;
• do not visit countries that have reported outbreaks of Zika virus or other dangerous infections;
• regularly visit neurologists and rehabilitation specialists at the clinic;
• temporary disability can be issued to reduce possible workloads.

Forecast for the future

Mortality in GBS is quite low - only up to 5%. It is caused by the most severe manifestations of the syndrome - weakening of breathing, immobility and associated complications - pneumonia, pulmonary embolism and sepsis. The older the patient, the higher the chance of death.

Most people - about 85% - will fully recover and return to a fulfilling life. And only some of them will have the disease again, the rest will leave it in the past forever.

WHO about the syndrome

The World Health Organization is taking a number of measures to reduce morbidity and increase the number of people cured. It improves surveillance of epidemics of viral infections, in particular Zika, makes recommendations for therapy, supports GBS research programs around the world.

Guillain-Barré syndrome is a serious illness, but even if you have been diagnosed with it, do not despair. Timely diagnosis and comprehensive treatment will quickly put you on your feet, literally and figuratively. Enjoy life, be healthy and take care of yourself.

Guillain-Barré syndrome is an acute form of progressive inflammatory polyneuropathy characterized by muscle weakness and polyneuritic sensation disorder. The disease is also called acute idiopathic polyneuritis, Landry's palsy or inflammatory demyelinating polyradiculoneuropathy. The disease is a representative of autoimmune abnormalities. Usually, the pathology has specific signs that make it possible to recognize it at the earliest stages of development and start adequate treatment on time. It has been proven that more than 80% of patients have a favorable prognosis and are completely cured.

autoimmune demyelination of nerves in Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is observed in all age groups, but people aged 35-50 years old are especially susceptible to it, and with equal frequency in both women and men. The incidence per 100,000 people ranges from 0.4 to 4 cases.

Causes of the disease

Scientists from different countries have been studying the syndrome for over 100 years, but they still cannot fully figure out the exact reasons that provoke the onset of the disease.

It is believed that the appearance and development of an anomaly occurs due to a malfunction of the patient's immune system. When a person is completely healthy, when foreign cells enter the body, the immune system begins to fight the infection, rejecting all its dangerous elements. The patient is recovering. With GBS, the body begins to confuse "friends and foes": the patient's neurons are accepted as foreign and are "attacked". There is a destruction of the nervous system - a syndrome occurs.

Because of what there are violations in the work of the immune system itself is not fully known. The most common reasons, experts include:

• Traumatic brain injury. A severe blow to the head, any damage to it, as well as swelling, swelling or hemorrhage in the brain can become the main factor in the development of the syndrome. That is why, when a patient turns to a specialist, first of all, the doctor should find out about the presence of any craniocerebral injuries.
• Infections. Recent viral infections severely weaken a person's immunity, thereby increasing the likelihood of GBS. The body's defense mechanism perceives neurons as an infection and, with the help of leukocytes, continues to kill them. In this case, the syndrome manifests itself one to three weeks after the infectious disease.
• Allergies. The disease often develops in allergy sufferers, for example, after chemotherapy, vaccination against polio and diphtheria, or major surgical interventions.
• Genetic predisposition. Most diseases are inherited, and Guillain-Barré syndrome is no exception. If someone in the family has already suffered a pathology, then, most likely, it will arise in the descendants. In this case, you need to especially monitor your health: take care of your head and try not to start infectious diseases.

In childhood, the syndrome develops extremely rarely. The disease can be congenital or acquired. Any anomalies of intrauterine development can lead to the development of the syndrome:

1. Gestosis;
2. Frequent medication during pregnancy
3. The presence of autoimmune diseases in the mother;
4. Long-term infections during the period of bearing a child;
5. Use of drugs, alcohol, or smoking.

Acquired reasons include:

1. Passive smoking of a child;
2. Hormonal disruptions in the body;
3. Vaccinations;
4. Self-medication;
5. Metabolic disease;
6. Neurological disorders;
7. Development of tumor processes.

Symptoms

The disease can manifest itself in 3 forms:

• Sharp. All signs of the disease appear simultaneously within 1-2 days.
• Subacute. The incubation period is 15 to 20 days.
• Sluggish, chronic. This is one of the most dangerous forms, as it is practically not amenable to treatment.

The first symptoms of GBS in both children and adults resemble those of a common viral respiratory infection:

1. Aches in bones, joints;
2. Hyperthermia;
3. Great weakness;
4. Inflammation of the upper respiratory tract;
5. Numbness of the limbs;
6. Sometimes patients are worried about various gastrointestinal disorders.

In addition to general signs, there are also more distinct ones:

• Weakness of the limbs. Due to the destruction of nerve cells, there is a decrease or complete loss of sensitivity in the muscle area. At first, pain appears only in the shins of the legs, after - discomfort affects the hands and feet. The patient is worried about tingling and numbness of the fingers. In severe cases, coordination of movements is impaired: it becomes difficult for a person to hold a pen on his own, to write with an affected limb. It is worth noting that the symptoms of the disease manifest themselves symmetrically: 2 arms or legs are simultaneously affected.
• Enlargement of the abdomen, which is noticeable even visually. A protruding abdomen is one of the main indicators of the presence of a disease. This is due to the fact that the patient's breathing is rearranged to the abdominal type due to the weakening of the diaphragm.
• Incontinence. In a person with GBS, the healthy functioning of the bladder is impaired, and urine begins to flow involuntarily.
• Difficulty swallowing. The swallowing reflex is impaired because the pharyngeal muscles are weakened. In this case, the patient may even choke on saliva. The muscles in the mouth gradually weaken, which leads to discomfort while chewing food.

Guillain-Barré syndrome affects almost all organ systems, therefore, unreasonable hypertension, tachycardia or banal visual impairment can become the first, albeit hidden, sign of the development of pathology.

Why is the course of the syndrome dangerous?

Usually, the anomaly develops slowly over 2-3 weeks. First, there is a slight weakness in the joints, which intensifies over time and really begins to cause discomfort to the patient.

Immediately after tingling, in the acute course of the disease, there is general malaise, weakness in the shoulder and hip regions. Difficulty breathing appears after a few hours. In this case, it is imperative to seek help from the hospital. Usually, the patient is immediately connected to the artificial respiration system, and then the necessary medication and physiotherapy are provided.

In the acute form of the disease, pathology on the second or third day can completely paralyze any limb.

Also, in the absence of timely treatment, the patient faces:

1. Decreased immunity;
2. Respiratory failure
3. Sedentary joints;
4. Peripheral paralysis;
5. Adaptation problems in society;
6. Difficulty in life;
7. Disability;
8. Fatal outcome.

Diagnosis of the disease

In order to diagnose GBS in a patient, several aspects need to be clarified:

• When was the last time a person had a viral disease. It has been proven that in 80% of cases, the syndrome occurs as a result of recent infections.
• Is the patient currently taking medications, and if so, which ones. They will also help trigger the development of GBS.
• How long has the patient been vaccinated against any disease.
• Whether the patient suffers from autoimmune or neoplastic diseases.
• Whether the person has undergone surgery recently.
• Whether any part of the body has been seriously injured.

The following studies should also be carried out:

1. General analysis of blood and urine;
2. Blood chemistry;
3. Serological and virological examinations;
4. Cerebrospinal fluid examination;
5. Magnetic resonance imaging;
6. Electrocardiography;
7. Registration of muscle electrical activity;
8. X-ray or ultrasound of the affected area;
9. Examination of external respiration;
10. Study of the main vital indicators.

Muscle weakness in several limbs at the same time and tendon areflexia can be another clear sign of Guillain-Barré syndrome. This also includes various disorders in the pelvic region, polymorphonuclear leukocytes, asymmetries of paresis and sensitivity disorders.

Differential diagnosis

Despite the fact that GBS symptoms are similar to those of many other diseases (diphtheria, porphyria, transverse myelitis, botulism and myasthenia gravis), they still need to be distinguished for further correct treatment. In differential diagnosis, the following factors should be considered:

• If poliomyelitis is suspected, it is necessary to collect data from an epidemiological study, take into account the symptoms of the gastrointestinal tract, identify high cytosis in the cerebrospinal fluid, asymmetry of the lesion and the absence of sensory disturbances. The diagnosis can be confirmed using serological or virological analysis.
• Polyneuropathy is characterized by the appearance of psychopathological signs, as well as pain in the pelvic and abdominal region. Deviation of the main indicators from the norm in the urine also indicates the development of the disease.
• Transverse myelitis accompanies dysfunction of the pelvic organs, the absence of damage to the nerves of the skull.
• Symptoms of the abnormality can be confused with a cerebral infarction. But in this case, the pathology affects the body in a few minutes and often leads to a coma. MRI will help to establish the exact cause of the disruption in the functioning of body systems.
• Botulism is characterized by the absence of sensitivity disorders and any changes in the cerebrospinal fluid.

Treatment

Patients diagnosed with GBS must be admitted to a hospital. In about 30% of cases, mechanical ventilation is necessary. Pathology therapy is performed at the following levels:

1. Resuscitation;
2. Symptomatic;
3. Blood-purifying;
4. Drug;
5. Muscular recovery;
6. Preventive.

Resuscitation therapy

If the anomaly is in an acute form, resuscitation treatment is carried out, which is aimed at relieving symptoms:

• The patient is connected to the artificial respiration system;
• A catheter is used to drain urine;
• Place a tracheal tube and probe if there are problems with swallowing.

Symptomatic therapy

This type of treatment is carried out using various medicines:

1. Antihypertensive drugs: Anaprilin, Metaprolol;
2. Antibiotic therapy: Norfloxacin;
3. Drugs that help stabilize heart rate and blood pressure: Propranolol, Anaprilin (for tachycardia), Piracetam (for bradycardia);
4. Low molecular weight heparin: Gemapaxan, Certoparin;
5. Pain relief drugs - NSAIDs or Gabapentin, Pregabalin;
6. Antipyretic, when the temperature rises above 38 degrees: "Ibuklin", "Next";
7. Laxatives: Bisacodyl, Laxatin.

Plasmapheresis

One of the most effective procedures aimed at treating GBS is blood purification - plasmapheresis. It helps to stop the autoimmune process in the body. It is indicated for severe and moderate disease. Usually about 4-6 operations are performed with a break of one day. Instead of plasma, a special isotonic solution of sodium or albumin is injected into the blood, through which the blood is purified and the functioning of all body systems is normalized.

Surgical treatment of the syndrome

If mechanical ventilation has been carried out for more than 7-10 days, a tracheostomy should be applied - an artificial windpipe. In severe cases, a gastrostroma may also be required - an opening in the stomach created by surgery to feed the patient.

Non-drug therapy with folk remedies

It is impossible to cure GBS with folk remedies. But it is quite possible to cope with some of its symptoms:

• Elevated temperature. Drinking plenty of fluids and ventilating the room is recommended. Tea with lemon, decoctions with different berries and dried fruits: cranberries, strawberries, currants, blueberries, raspberries and dried apricots will help bring down the temperature. You can brew lime blossom, chamomile, St. John's wort, aspen buds, mint and thyme - leave for half an hour, then drink in small sips.
• Bone aches. Lingonberry tea, a compress of fresh cabbage leaves, horseradish and burdock, baths with pine extract or herbal decoctions will help to cope with it.
• Weakness. Doctors recommend breathing fresh air as often as possible and ventilating the room. You need to try to consume more protein. You also need food rich in vitamins and minerals. And sweet strong tea or chocolate will help to cheer you up.

Rehabilitation

Due to the fact that the syndrome affects not only neurons, but also the periosteal muscles, the patient will have to learn to walk again and perform simple movements of the limbs.

Traditional treatments can be used to help normalize healthy muscle function:

1. Electrophoresis;
2. Trituration;
3. Radon baths;
4. Massage;
5. Baths to relax the body and muscle tone;
6. Masks and compresses with paraffin or beeswax;
7. Wellness gymnastics.

During the recovery of the body, it is imperative to go on a special therapeutic diet and, in parallel, take a course of vitamin preparations. Complexes containing calcium, potassium, magnesium and vitamin B will be especially useful.

Patients with GBS should be registered with a neurologist and regularly undergo preventive examinations. It is worth remembering that timely high-quality therapy can return the patient to a full life.

Prevention of the syndrome

There is no specific prevention of pathology. Doctors can only advise you to refuse any vaccinations during the year so that the disease does not come back again. After this time, vaccination is permitted, but only if it is actually necessary.

You should also refuse to take alcoholic beverages, avoid overheating, hypothermia and reduce physical activity. In this case, a relapse of the disease is excluded.

Forecast

Most often, with Guillain-Barré syndrome, the prognosis is favorable. Usually, normal functioning of the limbs is restored after 7-12 months in 85% of people. The disease becomes chronic in 7-15% of cases. The lethal outcome is approximately 5%. Respiratory failure, pneumonia, or viral infections can cause death. But most often all this can be prevented by contacting a specialist in time.

Video: Lecture on Guillain-Barré Syndrome

Video: Guillain-Barré Syndrome in the “Living Healthy” program

Guillain-Barré Syndrome (GBS)- acute inflammatory demyelinating polyradiculoneuropathy of autoimmune etiology. A characteristic sign of the disease is peripheral paralysis and protein-cell dissociation in the cerebrospinal fluid (in most cases). The diagnosis of Guillain-Barré syndrome is established when there is increasing weakness and areflexia in more than 1 limb. In this case, other neurological diseases accompanied by peripheral paresis should be excluded: poliomyelitis, acute period of stem stroke, toxic lesions of the central nervous system, etc. Treatment of patients with Guillain-Barré syndrome is carried out in a hospital, since the patient may require mechanical ventilation.

ICD-10

G61.0

General information

Guillain-Barré Syndrome (GBS)- acute demyelinating inflammatory polyneuropathy of autoimmune etiology. A characteristic sign of the disease is peripheral paralysis and protein-cell dissociation in the cerebrospinal fluid (in most cases). Currently, within the framework of GBS, there are four main clinical options:

• classic form of GBS- acute inflammatory demyelinating polyradiculoneuropathy (up to 90% of cases)
• axonal form of GBS- acute motor axonal neuropathy. A characteristic feature of this form of GBS is isolated damage to motor fibers. In acute motor-sensory axonal neuropathy, both motor and sensory fibers are affected (up to 15%)
• Miller-Fisher syndrome- a form of GBS characterized by ophthalmoplegia, cerebellar ataxia and areflexia with mild paresis (up to 3%)

In addition to the above forms of Guillain-Barré syndrome, several more atypical forms of the disease have recently been distinguished - acute sensory neuropathy, acute pandizautonomy, acute cranial polyneuropathy, which are quite rare.

The clinical picture of Guillain-Barré syndrome

The first manifestations of Guillain-Barré syndrome are, as a rule, muscle weakness and / or sensory disorders (feeling of numbness, paresthesia) in the lower extremities, which, after a few hours (days), spread to the upper extremities. In some cases, the disease manifests itself as pain in the muscles of the limbs and lumbosacral region. Very rarely, CN lesions (oculomotor disorders, phonation and swallowing disorders) become the first manifestation. The degree of movement impairment in Guillain-Barré syndrome varies considerably, from minimal muscle weakness to tetraplegia. Paresis, as a rule, are symmetrical and more pronounced in the lower limbs.

Hypotension and a significant decrease (or complete absence) of tendon reflexes are typical. Respiratory failure develops in 30% of cases. Disorders of superficial sensitivity are manifested in the form of mild to moderate hypo- or hyperkinesia of the polyneuritic type. In about half of patients, deep sensitivity disorders (sometimes up to its complete loss) are observed. CN lesions detected in most patients are manifested by paresis of facial muscles and bulbar disorders. Of the autonomic disorders, cardiac arrhythmias, arterial hypertension, sweating disorder, dysfunction of the gastrointestinal tract and pelvic organs (urinary retention) are most often observed.

Diagnosis of Guillain-Barré Syndrome

When collecting anamnesis, it is necessary to pay attention to the presence of provoking factors, since in more than 80% of cases the development of GBS is preceded by certain diseases and conditions (previous infections of the gastrointestinal tract, upper respiratory tract, vaccination, surgery, intoxication, tumor). Neurological examination is aimed at identifying and assessing the severity of the main symptoms of Guillain-Barré syndrome - sensory, motor and autonomic disorders.

It is necessary to conduct general clinical studies (general urine analysis, general blood test), biochemical blood test (blood gas composition, serum electrolyte concentration), cerebrospinal fluid studies, serological studies (if an infectious etiology of the disease is suspected), as well as electromyography, the results of which are of fundamental importance to confirm the diagnosis and determine the form of GBS. In severe cases of the disease (rapid progression, bulbar disorders), daily monitoring of blood pressure, ECG, pulse oximetry and a study of respiratory function (spirometry, peak flowmetry) should be performed.

Confirmation of the diagnosis requires progressive muscle weakness in more than one limb and absence of tendon reflexes (areflexia). The presence of persistent pelvic disorders, pronounced persistent asymmetry of paresis, polymorphonuclear leukocytes, as well as a clear level of sensitivity disorders should raise doubts in the diagnosis of Guillain-Barré syndrome. In addition, there are a number of signs that absolutely exclude the diagnosis of GBS, among them: recent diphtheria, symptoms of lead intoxication or evidence of lead intoxication, the presence of exclusively sensory disorders, impaired porphyrin metabolism.

Differential diagnosis

First of all, the neurologist differentiates Guillain-Barré syndrome from other diseases, which are also manifested by peripheral paresis (poliomyelitis), as well as other polyneuropathies. Polyneuropathy in acute intermittent porphyria may resemble Guillain-Barré syndrome, but is usually accompanied by a variety of psychopathological symptoms (hallucinations, delusions) and severe abdominal pain. Symptoms similar to those of GBS are possible with extensive strokes of the brain stem with the development of tetraparesis, which in the acute period takes on the features of the peripheral. The main differences between myasthenia gravis and GBS are the variability of symptoms, the absence of sensory disorders, and characteristic changes in tendon reflexes.

Guillain-Barré Syndrome Treatment

All patients diagnosed with Guillain-Barré syndrome must be admitted to a hospital with an intensive care unit and intensive care unit. In approximately 30% of GBS cases, due to the development of severe respiratory failure, there is a need for mechanical ventilation, the duration of which is determined individually, focusing on the VC, restoration of swallowing and cough reflex. Disconnection from the ventilator is carried out gradually with a mandatory stage of intermittent forced ventilation.

In severe cases with severe paresis, proper care is of particular importance to prevent complications associated with prolonged immobility of the patient (infection, pressure sores, pulmonary embolism). It is necessary to periodically (at least once every 2 hours) change the position of the patient, skin care, control over the functions of the bladder and intestines, passive gymnastics, and prevention of aspiration. In case of persistent bradycardia with a threat of asystole development, it may be necessary to install a temporary pacemaker.

As a specific therapy for Guillain-Barré syndrome, aimed at arresting the autoimmune process, pulse therapy with class G and immunoglobulins is currently used. The effectiveness of each of the methods is relatively the same, therefore, their simultaneous use is considered impractical. significantly reduces the severity of paresis and the duration of mechanical ventilation. As a rule, 4-6 sessions are carried out with an interval of one day. A 0.9% sodium chloride solution or dextran is used as replacement media.

It should be remembered about contraindications to plasmapheresis (infections, bleeding disorders, liver failure), as well as possible complications (electrolyte disturbance, hemolysis, allergic reactions). Immunoglobulin G class, like plasmapheresis, reduces the duration of stay on mechanical ventilation; it is administered intravenously daily for 5 days at a dose of 0.4 g / kg. Possible side effects: nausea, head and muscle aches, fever.

Symptomatic therapy for Guillain-Barré syndrome is carried out to correct violations of acid-base and water-electrolyte balance, correct blood pressure levels, prevent deep vein thrombosis and thromboembolism. Surgical intervention may be required for tracheostomy in case of prolonged mechanical ventilation (more than 10 days), as well as gastrostomy in case of severe and prolonged bulbar disorders.

Prognosis for Guillain-Barré Syndrome

Most patients diagnosed with Guillain-Barré syndrome experience complete functional recovery within 6-12 months. Persistent residual symptoms persist in about 7-15% of cases. The recurrence rate of GBS is about 4%, the mortality rate is 5%. Possible causes of death are respiratory failure, pneumonia or other infections, pulmonary embolism. The probability of a lethal outcome depends to a large extent on the patient's age: in children under the age of 15, it does not exceed 0.7%, while in patients over 65 years of age it reaches 8%.

Prevention of Guillain-Barré Syndrome

There are no specific methods for preventing Guillain-Barré syndrome. However, the patient should be notified of the prohibition of vaccinations during the first year from the onset of the disease, since any vaccination can cause a relapse of the disease. Further immunization is permitted and must be justified. In addition, Guillain-Barré syndrome, which developed within 6 months after any vaccination, is itself a contraindication to the use of this vaccine in the future.

One of the serious diseases of a neurological nature is Guillain-Barré syndrome, when the immune system reverses polarity and begins to kill its own cells. This pathological process leads to autonomic dysfunctions. The disease is distinguished by a pronounced clinical picture, which allows it to be detected in a timely manner and to start therapy.

Description of the disease

Some pathologies develop in the form of a secondary immune response to the source of infection. They are accompanied by deformation of neurons and impaired nervous regulation. Among such ailments, the most severe course is autoimmune polyneuropathy (Guillain-Barré syndrome, or GBS).

The disease is characterized by numerous inflammatory processes, destruction of the protective layer of the nerves of the peripheral system. The result is rapidly progressive neuropathy, accompanied by paralysis in the muscles of the limbs. The disease usually proceeds in an acute form and develops against the background of previous colds or infectious pathologies. With proper treatment, the chances of a full recovery increase.

History reference

At the beginning of the 20th century, researchers Guillain, Barre and Strol described a previously unknown disease in French soldiers. The fighters were paralyzed, there was a loss of sensation in the limbs. A group of scientists examined the cerebrospinal fluid in patients. In it, they revealed an increased protein content, while the number of other cells was normal. On the basis of the protein-cell association, Guillain-Barré syndrome was diagnosed, which differed from other pathologies of the nervous system of a demyelinating nature by a rapid course and a positive prognosis. Within 2 months, the soldiers recovered completely.

Subsequently, it turned out that this pathology is not as harmless as the discoverers described it. Approximately 20 years before the disclosure of information about her, the neuropathologist Landry monitored the condition of patients with a similar clinical picture. Patients also had paralysis. The rapid development of the pathological process was fatal. Later it became known that a disease diagnosed in French soldiers can also lead to death in the absence of adequate treatment. However, in such patients, a picture of protein-cell association in the cerebrospinal fluid was observed.

After some time, it was decided to combine the two ailments. They were given one name that is used to this day - Guillain-Barré syndrome.

The reasons for the development of pathology

This disease has been known to science for over 100 years. Despite this, all the factors provoking its occurrence have not yet been clarified.

It is assumed that the pathology develops against the background of disturbances in the functioning of the immune system. When an infection enters the body of a healthy person, a protective reaction is triggered and a fierce fight against viruses and bacteria begins. In the case of this syndrome, the immune system perceives neurons as foreign tissues. The immune system begins to destroy the nervous system, as a result of which pathology develops.

Why there are such malfunctions in the work of the body's defenses is a poorly understood question. Common trigger factors include the following:

1. Traumatic brain injury. Mechanical damage, resulting in cerebral edema or the formation of tumors, is especially dangerous.
2. Viral infections. The human body is able to cope with many bacteria on its own. With frequent diseases of a viral nature or long-term therapy, immunity begins to weaken. Prolonged treatment and the use of potent antibiotics increase the risk of Guillain-Barré syndrome.
3. Hereditary predisposition. If close relatives of the patient have already encountered this pathology, he automatically falls into the risk group. Minor injuries and infectious diseases can act as a source of illness.

Other reasons are also possible. The syndrome is diagnosed in people with allergies who have undergone chemotherapy or complex surgeries.

What symptoms indicate illness?

Guillain-Barré neuropathology is distinguished by the symptomatology of three forms of the development of the disease:

• Acute when symptoms persist over several days.
• Subacute, when the pathology "swings" from 15 to 20 days.
• Chronic. Due to the inability to timely diagnose and prevent the development of serious complications, this form is considered the most dangerous.

The primary symptoms of the syndrome resemble a viral-respiratory infection. The patient's temperature rises, weakness appears throughout the body, and the upper respiratory tract becomes inflamed. In some cases, the onset of pathology is accompanied by gastrointestinal disorders.

Also, doctors distinguish other symptoms that distinguish Guillain-Barré syndrome from SARS.

1. Weakness of the limbs. Deformed nerve cells provoke a decrease or complete loss of muscle tissue sensitivity. Initially, discomfort appears in the lower leg area, then the discomfort spreads to the feet and hands. Aching pain is replaced by numbness. A person gradually loses control and coordination while performing simple actions (cannot hold a fork, write with a pen).
2. An enlarged abdomen is another sign of Guillain-Barré syndrome. Photos of patients with such a diagnosis are presented in the materials of this article. The patient is forced to rebuild his breathing from the upper to the abdominal type. As a result, the abdomen increases in size and protrudes strongly forward.
3. Difficulty swallowing. Muscles weakening every day interfere with the swallowing reflex. It becomes more and more difficult for a person to eat, he can choke on his own saliva.
4. Incontinence.

This pathology, as it develops, affects all systems of internal organs. Therefore, attacks of tachycardia, visual impairment and other symptoms of body dysfunction are not excluded.

Clinical course of the disease

During this pathology, doctors distinguish three stages: prodromal, peak and outcome. The first is characterized by general malaise, a slight increase in temperature and muscle pain. During the peak period, all the symptoms characteristic of the syndrome are observed, which, as a result, reach their peak. The outcome stage is characterized by the complete absence of any signs of infection, but manifests itself in neurological disorders. Pathology ends with either the restoration of all functions, or complete disability.

GBS classification

Depending on which clinical symptom predominates, Guillain-Barré syndrome is classified into several forms.

The first three are manifested by muscle weakness:

1. Acute inflammatory demyelinating polyneuropathy. This is the most common form of the disease.
2. Acute axonal motor neuropathy. During the study of the conduction of nerve impulses, signs of damage to the axons are revealed, due to which they are nourished.
3. Acute motor-sensory axonal neuropathy. In addition to the destruction of axons, the examination reveals symptoms of muscle weakness.

Another form of this disease is distinguished, which differs in its clinical manifestations (Miller-Fisher syndrome). Pathology is characterized by double vision, cerebellar disorders.

Diagnostic measures

Diagnosis of Guillain-Barré syndrome begins with questioning the patient, clarifying the symptoms and taking anamnesis. This disease is characterized by bilateral damage to the limbs and the preservation of the functions of the pelvic organs. Of course, there are atypical symptoms, therefore, a number of additional studies are required for differential diagnosis:

• Electromyography (assessment of the speed of movement of impulses along nerve fibers).
• Lumbar puncture (an analysis that can detect protein in the cerebrospinal fluid).
• Blood test.

It is important to differentiate the disease with oncological processes, encephalitis and botulism.

Why is Guillain-Barré syndrome dangerous?

Symptoms and treatment of pathology may vary, but the lack of therapy always leads to serious complications. The disease is characterized by gradual development. Only the appearance of weakness in the extremities forces the patient to seek help from a doctor. Usually 1-2 weeks pass until this point.

Such a period of time allows you to consult with doctors and undergo the necessary examination. On the other hand, it threatens with misdiagnosis and complicated treatment in the future. Symptoms appear very slowly and are often perceived as the onset of a different pathology.

In an acute course, the syndrome develops so rapidly that within a day a person may be paralyzed most of the body. Then tingling and weakness spreads to the shoulders, back. The longer the patient hesitates and postpones the visit to the doctor, the higher the likelihood that the paralysis will remain with him forever.

GBS treatment methods

It is important to hospitalize the patient in a timely manner, since in some cases Guillain-Barré syndrome is characterized by a rapid course and can lead to serious consequences. The patient's condition is kept under constant control, in case of deterioration, they are connected to a ventilator.

If the patient is lying, it is necessary to take care of the prevention of pressure sores. Various physiotherapy treatments can help protect against muscle atrophy.

In case of stagnant processes in the body, bladder catheterization is used to drain urine. For the prevention of vein thrombosis, "Heparin" is prescribed.

Intravenous administration of "Immunoglobulin" and plasmapheresis is a specific option of therapy. Plasma replacement is a procedure during which a liquid portion is removed from the blood and replaced with salt water (saline). Intravenous administration of "Immunoglobulin" allows you to strengthen the body's defenses, which helps him to more actively fight the disease. Both therapy options are especially effective at the initial stage of the development of the syndrome.

Rehabilitation after treatment

This disease causes irreparable damage not only to the nerve cells, but also to the periosteal muscles. During the rehabilitation period, the patient has to re-learn to hold a spoon in his hand, walk and perform other actions necessary for a full-fledged existence. To restore muscle activity, traditional treatment is used (physiotherapy, electrophoresis, massage, exercise therapy, paraffin application).

During rehabilitation, a wellness diet and vitamin therapy are recommended to replenish the deficiency of micro- and macroelements. Patients diagnosed with Guillain-Barré syndrome, the symptoms of which are described in this article, are registered with a neurologist. They should periodically undergo a preventive examination, the main task of which is to identify early prerequisites for relapse.

Forecast and consequences

It usually takes 3 to 6 months for the body to fully recover. Do not expect a quick return to the usual rhythm of life. In many patients, the long-term effects of Guillain-Barré syndrome persist. The disease affects the sensitivity of the fingers and toes.

In about 80% of cases, previously lost functions are returned. Only 3% of patients remain disabled. Death is usually due to a lack of adequate therapy as a result of the development of heart failure or arrhythmia.

Preventive actions

No specific methods of preventing this disease have been developed. General recommendations include giving up addictions, a balanced diet, an active lifestyle, and timely treatment of all pathologies.

Let's summarize

Guillain-Barré syndrome is a disease characterized by muscle weakness and areflexia. It develops against the background of nerve damage as a result of an autoimmune attack. This means that the body's defenses perceive their own tissues as foreign and form antibodies against the membranes of their own cells.

The disease has its own characteristic symptoms, which allows you to recognize the disease in time and start therapy. Otherwise, the likelihood of developing autonomic dysfunctions and paralysis increases.