GBS_seminar.pptx is good to have knowledge of this thing

Jimma University
Institute of Health
Faculty of Medical Sciences
Department of Physiotherapy
Seminar Presentation On: GULLIAN BARRE SYNDROM
By: Tariku Demlew
Kalkidan Dereje

Outline
 Definition
 Epidemiology
 Etiology
 Pathophysiology
 Sub Types of GBS
 Clinical manifestation
 Diagnosis Criteria and Differential diagnosis
 Physiotherapy Assesssment & Managements
 Outcome Tool
 Reference

Introduction
 Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy.
 GBS is a serious disorder that occurs when the body's defense (immune) system
mistakenly attacks part of the nervous system.
 Mostly characterized by rapidly progressive, symmetric ascending weakness and
areflexia
 Causing limb weakness that progresses over a time period of
days or up to 4 weeks.

Cont...
 Starts at level of nerve root=conduction blocks & muscle weakness
 Weakness is usually distally predominant, but an initially proximal pattern of
weakness is seen in 15–20% of children, and cranial nerve involvement is common
in paediatric GBS.
 It can cause life-threatening complications, particularly if the breathing muscles are
affected or if there is dysfunction of the autonomic nervous system.

Epidemiology
 Worldwide incidence rate of GBS is 1–2 cases per 100,000 people per year, affecting all
age groups.
 Slightly common in males than in females .
 The global number of cases of GBS increased from 90,249 in 1990 to 150,095 in 2019.
(Bragazzi et al., 2021, Leonhard et al., 2019)
 As per epidemiological studies of North American and European the prevalence is
/100,000/year in children (aged < 16 years).
(McGrogan et al., 2009)

Cont...
 The true incidence of GBS in many LMIC remains largely unknown.
(Papri et al., 2021)
 In 6 years retrospective study done at tikur anbessa (Ethiopia), 112 children were
identified with M:F ratio of 1.6.
 All had motor weakness, only one patient (0.9%) had sensory loss, 34(30.3%) had
cranial nerve involvement and 37 (32.9%) had dysautonomia.
 Respiratory involvement which necessitated ventilation was found in 14 (12.5%) of
cases.Acute motor axonal neuropathy was the commonest subtype.
(Bacha et al., 2018)

Eteology
 The exact cause of GBS is not known
 It is not contagious or inherited
 Most cases usually start a few days or weeks following a respiratory or
gastrointestinal viral infection
 In rare cases vaccinations may increase the risk of GBS

Risk factors
 Age (15-35) and (60-75)
 In men more likely than woman.
 Recent gastrointestinal or respiratory infection by viruses or bacteria.
 Recent vaccination (especially influenza and meningococcal)
 Recent surgery
 History of lymphoma, Systemic lupus erythromatosus, or HIV and AIDS

Cont...
Axonal Damage:
 In some variants of GBS, such as acute motor axonal neuropathy (AMAN), the
immune response primarily targets the axons (the long projections of nerve cells),
leading to axonal damage and subsequent muscle weakness without significant
demyelination.
 This inflammation further contributes to nerve damage and the symptoms associated
with GBS, including weakness, numbness, and tingling.

Cont...
Demyelination:
 In the majority of cases (around 80-90%), GBS manifests as acute inflammatory
demyelinating polyradiculoneuropathy (AIDP). In AIDP, the immune system
targets and damages myelin sheath.
 Inflammatory Response: The immune response leads to inflammation in
the peripheral nerves (peripheral neuropathy).

Cont...
Autoimmune Response:
 GBS is triggered by an aberrant immune response, often following an infection.
 The immune system, in attempting to fight off the infection (commonly respiratory
or gastrointestinal), mistakenly attacks the myelin sheath or, in some cases, the nerve
axon.

C0mmon SubTypes of GBS
1. Acute Inflammatory Demyelinating Polyneuropathy (AIDP):
 AIDP is the most common in Western countries, accounting for about 80-90% of
cases.
 Pathologically, it involves widespread inflammation and demyelination of
peripheral nerves.
 Symptoms typically include progressive muscle weakness starting in the legs
and often ascending to involve the arms and cranial nerves.
 Sensory symptoms such as numbness and tingling can also occur.

Cont...
2. Acute Motor Axonal Neuropathy (AMAN):
 AMAN is more common in China, Japan, and Mexico, and accounts for a smaller
percentage of cases globally.
 AMAN primarily affects the motor axons rather than the myelin sheath.
 It is associated with more rapid progression of muscle weakness and less
involvement of sensory nerves compared to AIDP.

Cont...
3. Acute Motor and Sensory Axonal Neuropathy (AMSAN):
 AMSAN is a severe variant of GBS that is rare but can lead to more profound
and prolonged disability.
 Similar to AMAN, AMSAN primarily affects both motor and sensory axons,
causing severe muscle weakness and sensory deficits.
 It is characterized by axonal damage without significant demyelination.

Cont...
4. Miller Fisher Syndrome (MFS):
 MFS is characterized by a triad of symptoms: ataxia (uncoordinated movements),
areflexia (loss of reflexes), and ophthalmoplegia (paralysis of eye muscles).
 Unlike other variants, MFS often presents with cranial nerve involvement early
in the disease course.
 it is associated with antibodies against gangliosides, which are components of
nerve cell membranes.

Cont...
5. Acute Motor Neuropathy with Respiratory Failure (AMN with
RF):
 it is characterized by rapid progression of motor weakness leading to respiratory
failure, necessitating mechanical ventilation.
 It can overlap with AMAN or AMSAN in terms of pathology but presents with
more severe involvement of motor nerves early in the disease.

Clinical manifestation
 Muscle Weakness: This is usually the initial symptom and often begins in the
legs before spreading to the arms and face.
 Tingling and Numbness: Many people with GBS experience abnormal
sensations such as tingling (paresthesias), numbness, or pain, often starting in the
toes and fingers and spreading inward.
 Loss of Reflexes: A hallmark sign of GBS is the loss of reflexes, particularly the
deep tendon reflexes like the knee jerk reflex.

Cont...
 Difficulty Moving Eyes or Facial Muscles: Weakness in the muscles that
control eye movements or facial expressions can occur, leading to problems like
double vision (diplopia) or facial drooping.
 Autonomic Nervous System Involvement: GBS can affect the autonomic
nervous system, leading to symptoms such as fluctuations in blood pressure,
heart rate abnormalities, or problems with sweating.
 Pain: Some individuals experience significant pain, particularly in the back, legs,
and arms.

Diagnosis
 rely on History and PE
 Laboratory ( CSF analysis)
 Imaging (MRI)
 Functional testing (Nerve conduction studies)
 Electro diagnostic tests of nerves and muscles

Diagnostic Criteria
Required:
 Progressive, relatively symmetrical weakness of two or more limbs due
to neuropathy.
 Areflexia/ hyporeflexia
 Disorder course < 4 weeks.
 Exclusion of other causes.

Cont...
Supportive:
 Relatively symmetric weakness accompanied by numbness and/or tingling.
 Mild sensory involvement.
 Facial nerve or other cranial nerve involvement.
 Absence of fever.
 Typical CSF findings obtained from lumbar puncture.
 Electrophysiologic evidence of demyelination from electromyogram.

Differential diagnosis
 Intracranial or Spinal cord Abnormalities
• Spinal cord compression
• Brain stem encephalitis
 Peripheral Nerve Abnormalities
• CIDP
• Porphyria
 Neuromuscular Junction Abnormalities
• Myasthenia gravis
 Muscular Abnormalities
• Polymyositis
• Dermatomyositis

Complications
 Cardiac arrhythmias
 Infections
 Deep vein thrombosis
 Pain
 Depression
 Urinary retention
 Constipation
 Rispiratory distress

Medical Management
 There is no known cure for Guillain-Barré syndrome.
 currently two treatments are commonly used to interrupt immune-related nerve
damage.
• plasma exchange (PE, also called plasmapheresis) &
• high dose immunoglobulin therapy (IVIg)

Physiotherapy Assessment
 Subjective assessments
 Objective assessments
• Posture
• Balance
• Sensation
• Reflexes
• Plantar Reflex (Babinski's Sign)
• Muscle tone
• Muscle power
• Coordination
• Functional assessments
• Gait

Physiotherapy Managements
Acute Phase
 Prevention of pressure sores by proper
positioning
(Positioning every 2 hours)
 Improve patient's posture.
 Support joint in functional position to
minimize damage or deformity

Cont...
 Maintain Normal Range of Movement
 Gentle passive movements through full
ROM at least 3 times a day especially
at hip, shoulder, wrist, ankle, feet.

Cont...
Cardiorespiratory Training
 Manual techniques like vibration
with/ without over pressure
 Breathing exercise, chest percussion
 Chest expansion exercise
 Postural drainage
 Huffing & cuffing technique

Cont...
Chronic Phase
 Strengthening exercises  Endurance training
involves progressively
increasing the intensity and
duration of functional
activities such as walking or
stair-climbing.

Cont...
 Functional re-training
• Rolling
• Supine to sit, sit to supine
• Sitting
• Bridging
• Standing
• Transfer
 Balance training
 Gait and mobility
 Assistive device

Outcome Tool
 Guillain-Barré syndrome (GBS) Disability Score
 The Guillain-Barré syndrome (GBS) disability score is a widely accepted scoring
system to assess the functional status of patients with GBS.
Score Description
0 A healthy state
1 Minor symptoms and capable of running
2 Able to walk 10m or more without assistance but unable to run
3 Able to walk 10m across an open space with help
4 Bedridden or chairbound
5 Requiring assisted ventilation for at least part of the day
6 Dead

Refference
1. Bacha T, Gezahegn W, Tazebew AJEMJ. The clinical presentation, epidemiology, and
short-term outcome of Guillain-Barré Syndrome in Tikuranbessa Hospital: A 6-year
retrospective study. 2018;56(2):141-46.
2. McGrogan A, Madle GC, Seaman HE, De Vries CSJN. The epidemiology of Guillain-Barré
syndrome worldwide. 2009;32(2):150-63.
3. Bragazzi NL, Kolahi A-A, Nejadghaderi SA, Lochner P, Brigo F, Naldi A, et al. Global,
regional, and national burden of Guillain–Barré syndrome and its underlying causes from
1990 to 2019. 2021;18(1):1-11
4. Nehal S, Manisha S. Role of physiotherapy in Guillain Barre Syndrome: A narrative review.
Int J Heal. Sci. & Research: 5 (9): 529. 2015;540.
5. El Mhandi L, Calmels P, Camdessanché JP, Gautheron V, Féasson L. Muscle strength
recovery in treated Guillain-Barré syndrome: a prospective study for the first 18 months
after onset. Am J Phys Med Rehabil. Sep 2007;86(9):716-24
6. Virtual Mentor. 2007;9(8):552-554. doi:

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