Guillaine-Barre syndrome (GBS) is an acute immune mediated inflammatory or post infective demyelinating polyneuropathy. It causes a rapidly progressive, symmetrically ascending flaccid paralysis. It is the most common cause of flaccid paralysis. Around 5% of the patients die because of the disease and 10% receive severe motor disability. (Raphael. , C 1999). It is a relatively rare disease which affects only 3 people out of 100,000. more than two out of three times, it is preceded by n infection. These can be bacterial or viral.
Common organisms include Campylobacter jejuni or cytomegalovirus. Its starting symptoms include weakness of the distal part of the appendages i. e. fingers or toes. From here, the parasthesia progresses upwards, worsening in condition. By around the 3rd week, areflexia may be present (McLean, S. ,2008). Some sensory involvement can occur. And there is a risk of autonomic involvement as well. Autonomic involvement leads to “hypotension, urinary retention, impaired papillary responses and cardiac arrhythmias.
In the most severe cases, involvement of the bulbar muscles causes difficulty with chewing and swallowing with an increased risk of aspiration. ” (McLean, S. ,2008). We can categorize GBS according to the types of nerves it affects. Acute motor axonal neuropathy (AMAN) is one type. It affects only the motor system and is responsible for more than 75% of the cases (Winer, J. B 2002). Another type of GBS is the Acute Motor and Axonal Neuropathy (AMSAN). This type is rarer and occurs with the involvement of both motor and sensory neurons.
These include supportive care and active treatment modalities (Winer, J. B 2002). Supportive care: The integration of supportive care management with active therapy aimed at limiting and/or reversing neurological damage, the mortality rate of GBS has greatly reduced from 30% to a mere % percent. (Winer, J. B 2002). Prophylaxis for deep venous thrombosis (DVT) through use of heparin and pressure stockings, physiotherapy, G. I care, respiratory support through positive pressure ventilation has influenced the prognosis of GBS patients a great deal.
Pain control through analgesics is also an important component of the support care. Plasma exchange: This was the first immunomodulatory treatment that was known to be beneficial in the case of GBS. Multiple randomized studies have been conducted to look into GBS treatment. A study was conducted in North America to compare randomized patients response to plasma exchange when compared with support care alone. Only the patients who were unable to walk due to disease severity were included in the study. This relates to the clinical grade 3 of the disease.
Upon use of the treatment, it was found that plasma exchange increases the likelihood of reducing the clinical grade in 28 days time. It shortened the time required for the recovery from 44 days to 30 days. 2 studies have conducted to see the effects of increasing the number of plasma exchanges on the recovery of patients suffering from GBS. 304 patients who could stand on their own were included in the study and were randomized into groups which either received 2 exchanges or 4 exchanges. It was noted that the patient who received 4 exchanges recovery relatively quicker when compared with patients receiving 2 plasma exchanges.
. 4 plasma exchanges were found to be the optimal number of exchanges to be used in moderate to severe cases. . It was found even effective against moderate to severe forms of the disease. The study further showed that further increase in the number of plasma exchanges were of no added benefit to the patient. It was noted that patients who underwent 4 plasma exchanges had a relatively reduced time on ventilator support and their hospital stay time was reduced, compared to patients who underwent 2 exchanges. (Winer, J. B 2002).