Guillain-Barré syndrome

Individuals with Guillain-Barré syndrome (GBS) have sudden-onset polyneuropathy. This is characterised by muscle weakness, which occurs because of damage to the peripheral nervous system.

Guillain-Barre syndrome: management and treatment options for patients with moderate to severe progression

Guillain-Barre syndrome (GBS) is a syndrome that affects the immune system and attacks the peripheral nervous system. Discussion includes defining GBS as well as its etiology and differential diagnosis. Patients with GBS are not uncommon, and therefore it is important to be educated and to have a more precise understanding. GBS patients need to be treated holistically through emotional and physical support and known effective treatments. Through this article, readers will be able to achieve a thorough understanding of GBS and management options/strategies. Clinical features and manifestation of presenting symptoms will assist in determining initial laboratory studies, imaging, and any other testing that should be performed. Proper and quick diagnosis of GBS will be critical to further optimize treatment options and to decrease the likelihood of further immediate progression. Treatment modalities will be discussed as well as management during the acute hospital course and after discharge from the acute care facility. Discussion will focus on moderate to severe cases and associating treatment plans evaluated from evidence-based practice.

The morbidity and outcome of patients with Guillain-Barré syndrome admitted to the intensive care unit

One third of patients with Guillain-Barré syndrome (GBS) require admission to the intensive care unit (ICU), associated with significant risk of morbidity, mortality, and incomplete recovery.

METHODS

76 adult patients with GBS admitted to the ICU at a regional referral center over a 20-year period were studied. We determined the frequency, nature, and predictors of complications they experienced while in the ICU; this morbidity was related to long-term functional recovery and time to regain independent ambulation, extracted from longitudinal follow-up data.

RESULTS

ICU stay was a median 21 days and mechanical ventilation (MV) was required in 78% (median duration 28 days). Two-thirds suffered at least one major complication, most commonly pneumonia (54%). Morbidity was strongly associated with MV and male sex. Mortality occurred in only 5 patients (6.5%). Over an average 3 years follow-up, recovery of independent ambulation was seen in 75%, with advanced age being the most powerful predictor of poor outcome. Prolonged MV and severe axonal loss did not preclude a favorable recovery. Time to ambulate was a median 198 days, although recovery could occur as late as ten years after onset; slower recovery was associated with ICU complications, prolonged MV, and early axonal abnormalities.

CONCLUSION

Although patients with GBS suffer significant morbidity during protracted ICU stays, with meticulous supportive care, many make gratifying functional recoveries. In severely afflicted patients, this may only be appreciated after extended follow-up.

The effects of Guillain–Barré syndrome on the close relatives of patients during the first year

OBJECTIVE

To study the impact of Guillain-Barré Syndrome (GBS) on the psychosocial functioning of the closest relative and on family functioning during the first year after GBS.

METHOD

At 1 (=T1), 3 (=T3), 6 (=T6), and 12 months (=T12) after the onset of GBS, relatives of patients received the General Health Questionnaire (GHQ28) and the Family Assessment Device (FAD). Sixty-three relatives returned the GHQ28 at all four designated intervals. At T1 the relatives also received a questionnaire that contained questions on the impact on their daily life. The answers to these questions yielded a Daily Living Impact index. From the 110 relatives, 86 returned this questionnaire.

RESULTS

72% of the 86 relatives reported one or more problems in daily living. At T1 the scores of the GHQ subscales ranged from normal to mildly disturbed. The relatives showed significant improvement in their somatic complaints and anxiety during the first half year. Social dysfunction remained somewhat less than normal, severe depression was not found. At T1 and T3 the scores of the GHQ28 and some subscales differed significantly depending on the severity of the functional status of the patient, but not at T6 and T12. Relatives of patients with severe residua at 1 month score worse on the GHQ28 and most subscales at 6 months. The FAD was normal at all moments measured.

CONCLUSIONS

Psychological morbidity of close relatives is significantly higher in the first months after the onset of GBS. The patient's condition has an important impact on the psychosocial functioning of close relatives. Therefore, a family approach is recommended to neurologist and other medical personnel during the first period of the disease. Also patient support groups may play a beneficial role for the relatives of GBS patients.

Supportive care for patients with Guillain-Barré syndrome

A multidisciplinary consensus group searched MEDLINE from 1966 to May 2003, extracted relevant references, and prepared recommendations on supportive care for Guillain-Barré syndrome. In the absence of randomized controlled trials, we agreed on recommendations by consensus based on observational studies and expert opinion. In the acute phase in bed-bound adult patients, the group recommended the use of heparin and graduated pressure stockings to prevent deep vein thrombosis, monitoring for blood pressure, pulse, autonomic disturbances, and respiratory failure, and the timely institution of artificial ventilation and tracheostomy. Pain management is difficult, but carbamazepine or gabapentin may help. The cautious use of narcotic analgesics may be needed. Disabled patients should be treated by a multidisciplinary rehabilitation team and should receive an assistive exercise program. Persistent fatigue following Guillain-Barré syndrome is common and may be helped by an exercise program. Because of a very small and possibly only theoretical increase in the risk of recurrence following immunization, the need for immunization should be reviewed on an individual basis. More research is needed to identify optimal methods for all aspects of supportive care.

Understanding Guillain-Barré Syndrome and Central Nervous System Involvement

Guillain-Barré syndrome is a rare neurological disease that causes paralysis and may necessitate hospitalization for some patients in its acute stages. It primarily affects the peripheral nervous system, though recent research has shown that for some patients, the central nervous system is involved. The acute phase often requires intensive care services. Recognition is growing that recovery is not as smooth and free of symptoms as previously thought. Following "recovery" some people endure long-term residual symptoms, such as fatigue and pain. Nursing input can be of value by providing support, information, explanations, and empathy to reassure patients and families. A greater understanding of the nature and course of the disease and its ramifications can lead to more effective nursing management and a faster rehabilitation process.

Two decades have passed ... and still it is her eyes that I remember: reflections of a pediatric nurse

A pediatric nurse reflects on her practice by recounting her experience while caring for a child with Guillian Barre 20 years ago. Principles and lessons relevant to guide pediatric nursing practice in today's health care environment are identified.

The ventilated patient undergoing hydrotherapy: a case study

The ascending peripheral neuropathy and paralysis that result from Guillain-Barre Syndrome's (GBS) demyelination of peripheral nerves is a challenge to health professionals; the patient requires support during the acute disease process and during the remyelination recovery period, often lasting months to years. The staff of a major metropolitan teaching hospital's critical care unit (CCU) and physiotherapy departments developed a hydrotherapy treatment programme for a ventilated patient with GBS. Through careful planning and appropriate preparation, it was found that hydrotherapy could successfully and safely be incorporated into a patient's treatment regimen. The benefits included improved range of movement due to the supportive nature of water, anecdotal increased strength, size and movement of remyelinating muscles and a psychological improvement. Although this patient has not recovered from GBS to be independent, hydrotherapy was a valuable part of the treatment regimen and it could be suggested the increase muscle strength lead to improved respiratory function and enabled weaning from ventilation, reducing intensive care length of stay and cost.

Recovery from depression associated with Guillain Barré syndrome

Guillain Barré Syndrome is a rare disease, affecting primarily, but not solely, the peripheral nervous system. Because it is rare, many physicians, nurses, and health care practitioners see few cases in their careers. A case study, in which the patient/author was not diagnosed for approximately a year, is interesting because of associated depression. Recovery from depression is not simple. The steps achieved by the author took a great deal of effort. However, mental health nurses could play a more active role in raising questions for patients without a diagnosis or with evidence of mental confusion, and in assuring empathetic regard.

Meeting the challenge of Guillain-Barré syndrome

Acute Guillain-Barré syndrome (GBS) is the most frequent cause of flaccid paralysis in otherwise healthy adults. Here, learn how the health care team can best meet the needs of patients with this challenging, mysterious condition.

Guillian-Barré syndrome--a case study

'Acute Guillian-Barré Syndrome is an acute inflammatory demyelinating disease of the peripheral nerves' (Pfister & Bullas 1990) which affects the normal transmission of electrical impulses along these nerves and consequently the function of the organs and tissues which they innervate (Springhouse 1998, Waldock 1995). This disorder can rapidly replace an individual's busy and active lifestyle with one of total dependence, often lasting months (Waldock 1995). It is important, therefore, that nurses understand the pathophysiology of the disease and its effect on the organs and tissue within the body, to enable them to provide a high standard of care for patients suffering from this condition. This discussion of Guillian-Barré Syndrome (GBS) will be in relation to patient (who shall be called Jane Smith for the purpose of this discussion) who was admitted to the Accident and Emergency (A&E) department and diagnosed with GBS (see Box 1 for patient history). Within this discussion GBS will be defined and its pathophysiology explained. The epidemiology and aetiology of the disease will also be highlighted. The majority of the discussion will focus on the physiological effects of GBS on the components of the peripheral nervous system and the appropriate assessment and treatment measures. Finally, the outcomes of the disease will be highlighted. The focus will be on the management of this condition within the A&E department.

'Just the ticket': case studies, reflections and clinical supervision (Part III)

An earlier paper in this series of three has detailed the background development and organization of a pilot complementary therapy service. The setting was a neuroscience ward with existing staff carrying out the treatments. Outcome measures including physiological indices and patient feedback were reported on in Part II (Dryden et al. 1999). This paper will now focus on both the records of the practitioner's reflections and the recurring themes of their monthly clinical supervision sessions. Subgroups of four patients with Guillain-Barre Syndrome (GBS) are discussed in detail, as they received the most number of treatments between them.