Guillain–Barré syndrome

Guillain-Barré syndrome in neurology is a severe disease characterized by the destruction of the myelin sheath, which is the sheath of nerve fibers. The pathological process primarily affects the structures of the peripheral nervous system. Still, in the absence of adequate treatment in the later stages of progression, it can also affect the central nervous system.

The development of Guillain-Barré syndrome (GBS) is accompanied by impaired motor activity due to damage to peripheral nerves. However, in the later stages of progression, due to damage to the structures of the central nervous system, there is a risk of developing more severe disorders, up to paralysis or impaired respiratory activity.

The pathological process is considered autoimmune. That is, the destruction of the myelin sheath of nerves occurs due to dysfunction of the human immune system. At the same time, the classification of GBS includes three forms of this disease:

• Classical – occurs in 90% of cases and is characterized by damage to both motor and sensory nerve fibers;
• Axonal – this form accounts for about 15% of cases of GBS. It is characterized by an isolated lesion of only motor fibers;
• Miller-Fisher syndrome – no more than in 3% of occurrences, characterized by cerebellar ataxia, ophthalmoplegia, and mild paresis.

Reasons for the development of the disease

Even with the current level of medicine development, it is impossible to establish the exact cause of the Guillain-Barré syndrome. Experts agree only on the autoimmune mechanism of the development of the disease. It is also noted that in most cases, the development of GBS begins after the patient has had an infectious disease.

In addition to an infectious disease, after which autoimmune disorders occur, possible factors in the development of Guillain-Barré syndrome include:

• surgical interventions transferred by the patient;
• consequences of vaccination;
• AIDS

Treatment

Treating patients with Guillain-Barré syndrome implies mandatory hospitalization in the department, where there are resuscitation and intensive care boards. Treatment for this pathological process is conservative; an integrated approach is essential for the patient’s recovery. In most cases, the prognosis is favorable, but the treatment process can take six months to 1 year (with complete functional recovery achieved).

Features of conservative treatment depend on the clinical case, but the most common and effective areas of therapy are:

• The use of plasmapheresis or class G immunoglobulins – such actions are aimed primarily at stopping the autoimmune reaction of the body. Both treatment options demonstrate approximately the same effectiveness and are interchangeable;
• membrane plasmapheresis – this therapy is especially important for severe paresis, and this option also makes it possible to reduce the duration of artificial lung ventilation in patients who need it;
• symptomatic therapy – in this case, drugs are prescribed entirely based on the patient’s clinical picture. These can be antipyretics, muscle relaxants, immunomodulators, agents to prevent thrombosis, etc.

Rehabilitation for Guillain-Barré syndrome

Given the overall duration of treatment for Guillain-Barré syndrome and associated complications, each patient requires full rehabilitation after recovery. At Kliniken Schmieder, rehabilitation programs for each patient are developed individually, taking into account the characteristics of the clinical case, age, and other factors.

In some cases, rehabilitation techniques are already used at treatment stages, for example, if the patient needs to restore swallowing function, etc. Otherwise, rehabilitation programs after treatment for Guillain-Barré syndrome may include:

• Restoring the swallowing function – for this, experienced speech therapists who own the technique of speech therapy massage are involved. The specialist develops a cycle of exercises that allow you to work out the muscle structures of the pharynx, tongue, etc., weakened after an illness. In addition, this part of rehabilitation necessarily includes dietary adjustments until the swallowing function is restored correctly.
• Movement rehabilitation – Because of paralysis and other movement disorders caused by Guillain-Barré syndrome, patients develop hypotension and muscle atrophy rapidly. One of the main areas of rehabilitation is restoring muscle strength and the patient’s motor activity. Physical therapy techniques, swimming pool exercises, passive physical education methods in bed, and apparatus physiotherapy (for example, electrical stimulation) are used. Special rehabilitation systems and equipment are used for the early verticalization of the patient, which speeds up the recovery process.
• Recovery of respiratory function is another important part of rehabilitation, especially for patients who need a ventilator. This part of the rehabilitation program includes breathing exercises with an instructor. The result is the return of the previous volume of the lungs, the strengthening of the diaphragmatic muscle, and the respiratory muscles in general.
• Psychological help – even when the patient is on the mend, recovering from such a severe illness is not easy. Patients are in dire need of psychological and emotional support. Sessions of a psychologist and psychotherapist avoid depression and apathetic states and allow the patient to return to society faster and easier.

These and other rehabilitation measures are selected for each patient individually. The main goal of the rehabilitation team is to enable the patient to fully recover or acquire new skills that will help in everyday life.