Guillain-Bare Syndrome (GBS)

Guillain-Bare Syndrome (GBS)

Autoimmune disorder resulting in axonal demyelination of peripheral nerves

Prevalence of GBS

World – Wide Distribution

1 per 100,000

Men = Women (males slightly higher)

Any age (commonly 20-24yo and 70 -74yo)

~3% mortality rate

Etiology of GBS

Unknown cause; often follows respiratory or GI viral illness (enteritis precedes ~41%); increased cases after Zika infection; some cases post‑vaccination

What is the classic pattern of weakness seen in GBS?

Quickly progressing, symmetrical ascendingparalysis and tingling sensation starting with the feet

What kinds of pain are associated with GBS?

Leg pain and low-back pain.

What reflex changes are typical in GBS?

Reduced or absent deep tendon reflexes.

How does sensory loss typically present in GBS?

Mild sensory loss, more pronounced distally than proximally.

How can cranial nerves be involved in GBS?

Facial weakness or facial palsy.

What autonomic nervous system (ANS) issues may occur in GBS?

Postural hypotension, hypertension, and tachycardia.

How does GBS affect respiratory function?

Respiratory muscle paralysis can occur, sometimes requiring ventilation.

What systemic or whole-body symptoms may appear in GBS?

Fatigue

What bladder-related symptom may occur in GBS?

Urinary dysfunction/Autonomic Dysreflexia

How is GBS diagnosed?

Detailed history of symptoms

Physical and neurological examination

Nerve conduction velocity (NCV) test

Cerebrospinal fluid analysis (spinal tap)

Medical management of GBS

Plasmapheresis (plasma exchange)

Intravenous immunoglobulin therapy (IVIG)

No known cure

Plasmapheresis

Blood is withdrawn from the person

The liquid portion or plasma is removed from the blood and replaced

The blood, with all its red and white blood cells, is transfused back into the person.

How often is Plasmapheresis done?

Every other day for 5 treatments (2-3 hours)

Intravenous immunoglobulin therapy (IVIG)

Infusion of gamma globulin, which is thought to block the receptors where the antibodies attach to do their damage.

How often is Intravenous immunoglobulin therapy (IVIG) done?

Daily for 3-5 days

Onset phase of GBS

Acute weakness in at least 2 limbs that progresses to its maximum in 2-4 weeks with increasing symptoms.

20-30% require mechanical ventilation.

Plateau phase of GBS

Greatest disability is present.

No significant change for days or weeks.

Recovery phase of GBS

Remyelination and axonal regeneration occur. 

May last up to 2 years (average 12 weeks).

Prognosis of GBS

Most patients recover from even the most severe cases, although 30% continue to have some degree of weakness after 3 years.

3% may suffer relapses many years later

Where does the plateau phase occur?

Typically in the ICU during plasmapheresis, IVIG

Where does the recovery phase occur?

Typically in inpatient rehab, outpatient, home/work.

OT evaluation areas in plateau phase

Communication, control of the environment, comfort, level of anxiety, ROM

OT evaluation areas in recovery phase

Strengthening, mobility, self-care, leisure, communication, and reintegration into workplace

OT intervention in Plateau phase (GBS)?

•Communication tools (sign or picture board)

•Access to call bell, TV, lights

•Hands-free telephone

•Positioning for optimal function and comfort

•Education to reduce anxiety

OT interventions in Recovery phase (GBS)?

•Therapeutic activities - ROM, strengthening, coordination, sensation

•Splinting

•ADL training with equipment prn

•Mobility and transfer training  -- GET UP ASAP!

•Communication tools

•Energy conservation and fatigue management

•Access to the community

•Home assessment and modification

•Work assessment and modification