Guillain barre syndrome symptoms and treatment. Diagnostic criteria for Guillain-Barré syndrome

What is Guillain-Barré Syndrome? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. Zhuykov A.V., a neurologist with an experience of 17 years.

Definition of illness. Causes of the disease

Guillain-Barré Syndrome (GBS)- acute autoimmune disease peripheral nervous system characterized by muscle weakness. This disorder covers a group acute disorders peripheral nervous system. Each variant is characterized by features of the pathophysiology and clinical distribution of limb and cranial nerve weakness.

In 70% of patients with GBS, a previous infection before the advent neurological symptoms.

Guillain-Barré Syndrome Symptoms

SARS symptoms or disorders gastrointestinal tract observed in 2/3 of patients. The first symptoms of GBS are paresthesia of the fingers, followed by progressive muscle weakness. lower extremities and gait disturbances. The disease progresses over several hours or days, weakness occurs upper limbs and develop paralysis cranial nerves. The paralysis is usually symmetrical and, of course, of a peripheral nature. In half of patients, pain may be the initial complaint, making diagnosis difficult. Ataxia and pain are more common in children than in adults. Urinary retention is observed in 10%-15% of patients. Damage to the autonomic nerves is manifested by dizziness, hypertension, excessive sweating and tachycardia.

At objective examination ascending muscle weakness is revealed, as well as areflexia. Tendon reflexes of the lower limbs are absent, but reflexes of the upper limb may be elicited. Muscle weakness can also involve the respiratory muscles. Damage to the cranial nerves is noted in 35-50%, autonomic instability in 26%-50%, ataxia - in 23%, dysesthesia - in 20% of cases.

The most common signs autonomic dysfunction are sinus tachycardia or bradycardia and arterial hypertension. Patients with severe autonomic dysfunction show changes in peripheral vasomotor tone with hypotension and lability blood pressure.

Infrequent options clinical course diseases include fever at the onset of neurological symptoms, severe sensory impairment with pain (myalgia and arthralgia, meningismus, radicular pain), sphincter dysfunction.

The possibility of GBS should be considered in any patient with rapid development acute nervous muscle weakness. On the early stage GBS should be distinguished from other diseases with progressive symmetrical muscle weakness, including transverse myelitis and myelopathy, acute toxic or diphtheritic polyneuropathy, porphyria, myasthenia gravis, and disorders electrolyte metabolism(eg, hypokalemia).

The pathogenesis of Guillain-Barré syndrome

The neurophysiological processes underlying GBS are divided into several subtypes. The most common subtypes include:

• acute inflammatory demyelinating polyradiculopathy;
• acute motor axonal neuropathy;
• acute motor and sensory axonal neuropathy;
• Miller-Fisher syndrome, as a variant of GBS, is characterized by a triad of signs: ophthalmoplegia, ataxia and areflexia.

It is believed that GBS develops due to the production of antibodies against the protein of the infectious agent, which cross-react with gangliosides. nerve fibers person. Autoantibodies bind to myelin antigens and activate complement, with the formation of a membrane attack complex on outer surface Schwann cells. Damage to the sheaths of the nerve trunks leads to conduction disturbances and muscle weakness (on late stage axonal degeneration may also occur). Demyelinating lesion is seen along the entire length peripheral nerve including nerve roots.

All types of nerves are affected, including autonomic, motor and sensory fibers. Involvement of motor nerves occurs much more often than sensory ones.

Complications of Guillain-Barré syndrome

Patients with GBS are at risk for life-threatening respiratory complications and autonomic disorders.

Indications for transfer to the department intensive care include:

• rapid progression of motor weakness with damage to the respiratory muscles;
• ventilation respiratory failure;
• pneumonia;
• bulbar disorders;
• severe autonomic failure.

Treatment complications requiring intensive care include fluid overload, intravenous immunoglobulin anaphylaxis, or hemodynamic disturbances during plasmapheresis.

15%-25% of children with GBS develop decompensated respiratory failure which requires mechanical ventilation. Respiratory disorders are more common in children with rapid disease progression, upper limb weakness, autonomic dysfunction, and cranial nerve involvement. Tracheal intubation may be required in patients for protection respiratory tract, conducting mechanical ventilation of the lungs. With GBS, rapid progression, bilateral paralysis facial nerve and autonomic dysfunction predetermine increased likelihood intubation. Planning for early intubation is essential to minimize the risk of complications and the need for emergency intubation.

Autonomic dysfunction increases the risk of endotracheal intubation. On the other hand, dysautonomy may increase the risk of hemodynamic reactions to drugs used to induce anesthesia during intubation.

Signs indicating the need for mechanical ventilation:

1. ventilation respiratory failure;
2. increasing oxygen demand to maintain SpO2 above 92%;
3. signs of alveolar hypoventilation (PCO2 above 50 mm Hg);
4. rapid decline vital capacity by 50% compared to baseline;
5. inability to cough

Autonomic dysfunction is the main factor in mortality in GBS. Fatal cardiovascular collapse due to autonomic dysfunction observed in 2%-10% of seriously ill patients. Monitoring of heart rate, blood pressure, and electrocardiogram should continue for as long as patients require respiratory support. Transcutaneous pacing may be required for severe bradycardia. Hypotension is corrected by circulating blood volume (CBV) replenishment, and if the patient is unresponsive to CBV replenishment, α-agonists such as norepinephrine, mezaton, epinephrine are used.

In unstable hemodynamics, continuous recording of arterial and central venous pressure should be carried out to control the volume of infusion therapy.

Arterial hypertension may occur, but this complication does not require special treatment unless complicated by pulmonary edema, encephalopathy, or subarachnoid hemorrhage.

Diagnosis of the Guillain-Barré syndrome

Instrumental diagnostics

Lumbar puncture

At lumbar puncture CSF results usually show elevated level protein (> 45 mg/dl), no pleocytosis (<10 клеток/мм3) (белково-клеточная диссоциация). Иногда уровень белка может оставаться нормальным, при умеренном повышении количества клеток (10-50 клеток/мм3). Цитоз выше, чем 50 клеток/мм3, свидетельствует против диагноза ГБС. В ряде случаев могут быть необходимы повторные люмбальные пункции для уточнения диагноза.

Neurofunctional diagnostics

ENMG (Electroneuromyography)- the only instrumental diagnostic method that allows confirming the diagnosis of GBS and clarifying the nature of pathological changes (demyelinating or axonal) and their prevalence.

Needle electromyography is characterized by the presence of signs of the current denervation-reinnervation process in polyneuropathy. Examine the distal muscles of the upper and lower extremities (eg, tibialis anterior, extensor digitorum common) and, if necessary, proximal muscles (eg, quadriceps femoris).

ENMG study in patients with GBS depends on the clinical manifestations:

• with distal paresis, long nerves on the arms and legs are examined: at least four motor and four sensory (motor and sensory portions of the median and ulnar nerves; peroneal, tibial, superficial peroneal and sural nerves on one side).

Assessment of the main ENMG parameters:

• motor responses (distal latency, amplitude, shape and duration), the presence of conduction blocks and dispersion of responses; the speed of propagation of excitation along the motor fibers in the distal and proximal areas is analyzed.
• sensory responses: amplitude and speed of excitation conduction along sensory fibers in the distal regions.
• late ENMG phenomena (F-waves): latency, form and amplitude of responses, chronodispersion value, dropout percentage are analyzed.
• with proximal paresis, it is mandatory to study two short nerves (axillary, musculocutaneous, femoral, etc.) with an assessment of the parameters of the motor response (latency, amplitude, shape).

The first signs of the denervation process appear two to three weeks after the onset of the disease, the signs of the reinnervation process - a month later.

Treatment of Guillain-Barré syndrome

General supportive care and care

Patients requiring intensive care require meticulous general care. Constipation is observed in more than 50% of patients with GBS as a result of dynamic intestinal obstruction.

Paracetamol is used for pain. Katadolon and tramadol are used for severe pain syndrome. For neuropathic pain, carbamazepine and gabapentin are effective.

In the treatment of GBS, various types of immunomodulatory therapy are being undertaken.

Intravenous immunoglobulin is given as a daily infusion (at a dose of 0.4 g/kg/day) for 5 days during the first 2 weeks of illness. A second course of immunoglobulin may be required in 5%-10% of patients, with a negative trend after initial improvement. The mechanism of action of intravenous immunoglobulin is probably multifactorial and is believed to include modulation of complement activation, neutralization of idiotypic antibodies, suppression of inflammatory mediators (cytokines, chemokines).

Side effects of immunoglobulin include headache, myalgia and arthralgia, flu-like symptoms, and fever. Patients with IgA deficiency may develop anaphylaxis after the first course of intravenous immunoglobulin.

Plasmapheresis promotes the removal of antibodies involved in the pathogenesis of GBS. During each session, 40-50 ml/kg of plasma is replaced with a mixture of 0.9% sodium chloride solution and albumin. Plasmapheresis leads to a reduction in recovery time and a decrease in the need for mechanical ventilation. These benefits are evident if plasmapheresis is performed within the first two weeks of illness onset. Complications associated with plasmapheresis include hematoma at the site of venipuncture, pneumothorax after catheterization of the subclavian vein, and sepsis. Plasmapheresis is contraindicated in patients with severe hemodynamic instability, bleeding, and sepsis.

The combination of plasmapheresis and immunoglobulin has shown no clinical benefit.

Corticosteroids should not be used in the treatment of GBS, as they do not hasten recovery, do not reduce the likelihood of mechanical ventilation, and do not affect the long-term outcome.

Forecast. Prevention

GBS remains a serious disease despite improved treatment outcomes. Compared with adults, children often have a more favorable course of the disease, with a complete rather than a partial recovery. The causes of poor outcome in GBS are respiratory failure, complications of mechanical ventilation (pneumonia, sepsis, acute respiratory distress syndrome and thromboembolic complications), cardiac arrest secondary to dysautonomia.

Recovery usually begins two to four weeks after symptoms stop progressing. The average time from the onset of the disease to complete recovery is 60 days. Data on the long-term outcome of GBS are limited. 75% - 80% of patients recover completely. About 20% of patients cannot walk after six months.

The younger age group (less than 9 years), rapid progression and maximum muscle weakness, the need for mechanical ventilation are important predictors of long-term motor deficit.

Bibliography

• 1. Latha Ganti, Joshua N. Goldstein. Neurologic Emergencies: How to Do a Fast, Focused Evaluation of Any Neurologic Complaint 1st ed. 2018 Edition
• 2. Martin A. Samuels, Alan H. Ropper. Samuel's Manual of Neurologic Therapeutics Ninth Edition
• 3. Elan D. Louis, Stephan A. Mayer, Lewis P. Rowland. Merritt's Neurology Thirteenth Edition
• 4. Pediatric Demyelinating Diseases of the Central Nervous System and Their Mimics: A Case-Based Clinical Guide 1st ed. 2017 Edition
• 5. Diseases of the peripheral nervous system: A guide for doctors / Ya.Yu. Popelyansky - M.: MEDpress-inform, 2005. - 368 p., illustration.
• 6. Nobuhiro YUKI. Guillain–Barré syndrome and anti-ganglioside antibodies: a clinician-scientist’s journey. Proc Jpn Acad Ser B Phys Biol Sci. 2012 Jul 25; 88(7): 299–326
• 7. Mazen M. Dimachkie, Richard J. Barohn. Guillain-Barré Syndrome and Variants. Neurol Clinic. May 2013; 31(2): 491–510
• 8. Christa Walgaard, Hester F. Lingsma et al. Tracheostomy or Not: Prediction of Prolonged Mechanical Ventilation in Guillain–Barré Syndrome. Neurocrit Care. 2017; 26(1): 6–13

Guillain-Barré syndrome is a disease in which the sheath of nerve fibers (myelin) is destroyed, which leads to movement disorders, sensitivity disorders. Usually develops some time after the infection.

Myelin is a special sheath of nerve fibers that is necessary for the conduction of nerve impulses. In Guillain-Barré syndrome, it is destroyed by the body's own immune system. Normally, the immune system detects and destroys foreign objects (for example, pathogens of infectious diseases), but in some cases it begins to fight native cells. As a result of damage to the myelin sheath, manifestations of the disease occur: a decrease in muscle strength, tingling in the limbs, etc. Most patients require hospitalization.

Timely treatment allows you to achieve a complete recovery, although some people may have weakness in the muscles, a feeling of numbness.

Russian synonyms

Acute inflammatory demyelinating polyradiculoneuropathy, acute polyradiculitis.

SynonymsEnglish

Guillain-Barre syndrome, Acute Idiopathic Polyneuritis, Acute Inflammatory Demyelinating Polyradiculoneuropathy.

Symptoms

• Decreased strength in the muscles, tingling - first in the legs, then in the overlying parts of the body
• Intense pain in the shoulder girdle, back, hips
• Violation of chewing, swallowing, pronouncing sounds, facial expressions as a result of a decrease in the strength of the muscles that perform these functions
• Increased or slow heart rate
• Increase or decrease in blood pressure
• Respiratory disorders, the growth of which may require artificial ventilation of the lungs (performed by a special apparatus when spontaneous breathing is ineffective)
• Urinary retention
• constipation

General information about the disease

Guillain-Barré syndrome is a disease in which the myelin sheath of the nerves is destroyed, resulting in impaired nerve impulse conduction and reduced muscle strength.

The exact causes of the disease are unknown. In most cases, symptoms appear 1-3 weeks after an acute infection of the respiratory system, gastrointestinal infections.

These infections can be caused by these and other pathogens:

• campylobacter - found in the meat of infected birds and cause a gastrointestinal infection when it enters the human body with food;
• influenza virus;
• Epstein-Barr virus (the causative agent of infectious mononucleosis);
• mycoplasma - can cause pneumonia in people infected with the immunodeficiency virus (HIV).

Also, vaccinations, surgical interventions can be a triggering factor for the development of the disease.

Autoimmune mechanisms also play an important role. The immune system fights foreign objects that enter the body. In response to an infection, special protein particles are produced - antibodies. They detect and neutralize various infections, viruses. According to researchers, in Guillain-Barré syndrome, antibodies not only destroy infectious agents, but also damage the sheath of nerve cells, this is possible due to the similarity in the molecular structure of these objects.

The myelin sheath covers the nerve fibers and provides a certain speed of nerve impulses between the brain and various structures of the body. Violation of the passage of nerve impulses to muscle fibers leads to a decrease in strength in the muscles. The nerve fibers of the autonomic nervous system (which regulates the activity of internal organs) are also affected. In this case, the work of the cardiovascular system can be disrupted, the heart rhythm, blood pressure, etc. can change.

In severe forms of the disease, the following complications are possible.

• Respiratory failure. It occurs as a result of weakness or paralysis (complete lack of ability to move) of the respiratory muscles and threatens the patient's life. In cases where spontaneous breathing is ineffective, artificial ventilation of the lungs is performed (using a special apparatus).
• Disorders in the work of the cardiovascular system.
• Prolonged immobility. Increases the risk of thromboembolism (blockage of blood vessels by blood clots, leading to circulatory disorders).
• Bedsores are dead skin, underlying soft tissues that occur with prolonged immobility of patients due to impaired blood supply.

The disease develops within a few weeks, and the restoration of lost functions may take several months. In most cases, a complete recovery occurs.

Who is at risk?

• Persons of young and old age.
• Patients with certain types of infectious diseases.
• Postponed surgical interventions.

Diagnostics

Diagnosis of Guillain-Barré syndrome is quite difficult, since there are no specific studies to identify it. In this case, the diagnosis is based on the analysis of clinical manifestations, the study of the history of the disease, tests to exclude other diseases of the nervous system.

Laboratory diagnosis is of great importance.

• Protein is common in liquor. Cerebrospinal fluid (CSF) bathes the brain and spinal cord. Various diseases of the nervous system cause certain changes in its composition. With Guillain-Barré syndrome, the level of protein in the cerebrospinal fluid increases.

To exclude other diseases, the following laboratory tests may be required:

• . Allows you to determine the amount of formed elements in the blood:,. A decrease in the number of red blood cells and possibly with an increase in the level of leukocytes - with various inflammatory processes.
• . This indicator deviates from the norm in various diseases, in particular, it increases with inflammatory processes in the body.
• . With insufficient amounts of vitamin B 12 in the body, anemia and disturbances in the functioning of the nervous system may develop. Some symptoms of damage to the nervous system in B 12 -deficiency anemia are similar to the manifestations of Guillain-Barré syndrome.
• Detection of heavy metals in urine. The accumulation of heavy metals (for example, lead) in the body contributes to the defeat of the nervous system and the development of polyneuropathy (damage to various nerves).

Other studies:

• Electromyography. Allows you to fix the electrical impulses that come through the nerves to the muscles. According to their intensity, the conductivity of nerve fibers is assessed; for this, special electrodes are applied to the muscle under study. The study is performed in a calm state and with muscle contraction.

Additional Research

• Magnetic resonance imaging (MRI). A diagnostic method based on the effect of a magnetic field on the human body. After processing the received signals, layer-by-layer images of the internal structures of the body are obtained. Allows you to exclude the presence of other diseases of the nervous system (for example, space-occupying formations).

Treatment

Treatment of the disease is conservative. Various drugs are used to eliminate individual manifestations of the disease, to combat the complications of Guillain-Barré syndrome.

The most effective are the following methods:

• Plasmapheresis. The patient takes blood, which is divided into a liquid part (plasma) and a part containing blood cells (erythrocytes, leukocytes, platelets). The blood cells are then returned to the human body and the liquid part is removed. This achieves a kind of blood purification from antibodies that can destroy the myelin sheath of nerves.
• The introduction of immunoglobulin intravenously. Immunoglobulin contains antibodies from healthy blood donors. They block the destructive effect of the patient's antibodies on the nerve sheath.

It is very important to maintain impaired body functions (artificial lung ventilation), carefully care for the patient, and prevent complications associated with prolonged immobility of patients.

In the recovery period, physiotherapy exercises, physiotherapy are used to restore the strength of various muscle groups.

Prevention

There is no specific prevention of Guillain-Barré syndrome.

• Total protein in liquor

Literature

• Dan L. Longo, Dennis L. Kasper,J. Larry Jameson, Anthony S. Fauci, Harrison's principles of internal medicine (18th ed.). New York: McGraw-Hill Medical Publishing Division, 2011. Chapter 385. Guillain-Barré Syndrome.
• Corey Foster, Neville F. Mistry, Parvin F. Peddi, Shivak Sharma, The Washington Manual of Medical Therapeuticts (33th ed.). Lippincott Williams & WilkinsPhiladelphia, 2010.23 Neurologic Disorders. Guillain-Barré Syndrome.

Diseases of an autoimmune nature have not been fully understood to date. They can be diagnosed in both a child and an adult, and manifest themselves in different ways. One such problem is Guillain-Barré syndrome. It is accompanied by damage to the myelin sheath of the nerves, which leads to the formation of symptoms of motor and sensory disorders.

As a rule, this violation is the result of an infection or a long-term suppression of the body's defenses. Treatment of the syndrome is best started as soon as possible after the first signs appear. It is aimed at combating movement disorders and cleansing the blood of abnormal immune complexes.

The main signs of Guillain-Barré syndrome

Initially, the pathology has much in common with viral infections and is manifested by fatigue and weakness, a rise in body temperature and aching joints. As Guillain-Barré disease progresses, it acquires pronounced specific symptoms:

1. Weakness of the arms and legs, which begins with discomfort in the feet, then spreads to the shins and hands. The pain is replaced by a complete lack of sensitivity and numbness of the limbs, and both left and right are affected immediately. The patient loses control over his own movements: he is not able to get out of bed and hold any objects in his hands.
2. Since the main pathogenesis of the disease is muscle damage, difficulty in swallowing is manifested. A person chokes not only on food and drink, but also on his own saliva. At the same time, along with paralysis of the larynx, weakening of the masticatory muscles also develops.
3. Guillain-Barré disease also accompanies such a symptom as incontinence. The bladder and urethral sphincters relax, which leads to unpleasant consequences. In 90% of cases, such a manifestation is also associated with flatulence, as well as the inability to control the passage of gases from the intestines.
4. Patients have a significant increase in the volume of the abdomen. It is difficult for them to breathe from the chest due to the weakening of the diaphragm, so they have to use the abdominal muscles. The consequences of such a symptom can be threatening, as it leads to asphyxia.
5. The most dangerous are autonomic disorders, manifested by a decrease in blood pressure, a decrease in the frequency of respiratory movements and tachycardia.

Polyradiculoneuropathy (multiple lesions of peripheral nerves, manifested by flaccid paralysis, sensory disturbances, trophic and vegetovascular disorders) diffusely affects the body, that is, many nerves, both central and peripheral, are involved in the process. This is the reason for such a variety of symptoms.

It is also customary to distinguish several forms of the disease. Polyradiculoneuropathy accounts for up to 90% of cases of problem detection and is accompanied by a variety of manifestations of dysfunctions of nervous structures. The axonal type of disorder proceeds with a selective lesion of the motor fibers. Miller-Fisher syndrome is another type of disease that is manifested by cerebellar ataxia and the absence of reflex reactions.

Causes of pathology

The exact pathogenesis of the formation of Guillain-Barré syndrome is currently unknown. Only the fact of the presence of a provoking factor, which is an immunological reaction, has been confirmed. Autopsy of patients with this diagnosis revealed a large number of macrophages involved in damage to the myelin sheath of nerve structures. This explains both the pre-existing infection syndrome and the clinical manifestations of the problem.

One of the most studied triggers of the disease is Campylobacter jejuni, a bacterium that provokes the development of gastrointestinal disorders. Cytomegalovirus also takes an active part in the formation of autoimmune processes that provide clinical manifestations of the disease. Normally, only the formation of antibodies against these pathogens occurs. In patients with Guillain-Barré syndrome, pathological activity of complement is recorded - one of the components of the immune response, as well as macrophages. They react with their own glycolipids, which are part of the nerve sheath, and this causes the manifestation of clinical signs. This pathogenesis explains the success of methods based on the replacement of patients' blood plasma.

Since the disease has an autoimmune nature, the factors that influence its occurrence are in one way or another connected with the work of the body's defenses.

1. Various infections, both bacterial and viral, provoke the development of polyneuritis. Normally, antibodies are formed to fight the pathogen, but with Guillain-Barré syndrome, these compounds also attack healthy cells of the nervous system, causing the development of the clinical picture. At the same time, one of the reasons, also indirectly associated with the penetration of a foreign agent into the body, is vaccination. The greatest danger is the manifestation of polyneuritis in HIV-positive patients.
2. Damage to the nervous structures, such as traumatic brain injury or violation of the integrity of peripheral connections, provoke the development of the inflammatory process. Since the immune system takes an active part in this cascade of reactions, damage to normal neurons occurs, which entails further neurological deficit.
3. The significance of genetic predisposition does not have precise medical evidence, but the presence of cases of detection of autoimmune polyneuritis in the patient's family history increases the risks of its diagnosis in the future.
4. Inhibition of the natural defense reaction associated with surgical interventions, the course of taking corticosteroid drugs, as well as chemotherapy treatment increases the risk of the disease.

Diagnostics

Identifying Guillain-Barré syndrome is usually not difficult. A careful history and duration of clinical manifestations, as well as the infectious problems preceding them, are important. Diagnosis is carried out by a neurologist who examines the patient to determine the severity of motor and sensory disorders. The examination includes non-specific urine and blood tests, as well as electromyography, which allows you to confirm the presence of anomalies in neuromuscular impulse transmission.

Of great importance is differential diagnosis, which is aimed at excluding pathologies characterized by similar clinical signs. These include Epstein-Barr syndrome, peripheral paresis against the background of poliomyelitis, stroke. This may require a number of specific tests, as well as a photo of the brain using magnetic resonance imaging if a central origin of the anomaly is suspected. It is important to determine the root cause of the onset of symptoms, since the further prognosis depends on this.

Therapeutic activities

The basis of the treatment of Guillain-Barré syndrome is the relief of autoimmune processes and the maintenance of the functioning of vital organs. All patients with a confirmed diagnosis require hospitalization.

Non-drug methods

The most dangerous complication of polyneuropathy accompanying the disease is a violation of normal respiratory activity. This is due to paralysis of the diaphragm and intercostal muscles. In such cases, patients require oxygen therapy aimed at preventing hypoxia. Intubation is carried out, which consists in installing a special tube for artificial ventilation of the lungs. Such a procedure is possible only in stationary conditions and requires the patient to be placed in the intensive care unit and intensive care unit.

Proper care is also important. Bladder catheterization is performed, which avoids complications associated with incontinence. It is also important to prevent the formation of bedsores in patients who cannot independently change position.

Drugs and plasmapheresis

The basis of drug treatment is the use of class G immunoglobulins. Their use improves the outcome of the disease and allows the restoration of spontaneous respiration in patients undergoing mechanical ventilation. Side effects from the administration of the drug are rare.

An effective method is plasmapheresis - the replacement of the liquid part of the patient's blood. This allows you to cleanse the body of pathological immune complexes that provoke disruption of the nervous system.

Surgical treatment

Surgical intervention is indicated in the absence of restoration of normal respiratory activity. It consists in the formation of a tracheostomy. Its installation is also indicated for spasm of the larynx, when asphyxia occurs as a result of paralysis of the upper respiratory tract. Many patients are difficult to feed. If the person is not receiving adequate nutrition, a gastrostomy is indicated. It is a tube placed in the stomach. Surgical treatment in many cases is associated with a poor prognosis and a long period of rehabilitation.

Symptomatic therapy

This type of treatment is aimed at restoring the salt balance due to intravenous infusions of solutions. With severe arterial hypertension and tachycardia, specific agents are used, for example, adrenoblockers. Often, Guillain-Barré syndrome is also associated with pain, which is stopped with the help of non-steroidal anti-inflammatory drugs. The use of antidepressants also has good reviews, since many patients are diagnosed with severe anxiety.

Forecast

The outcome depends on the severity of clinical manifestations and the reasons that provoked their manifestation. Mortality in the disease is low, but the percentage of complications is high. After the patient is discharged from the hospital, he needs long-term assistance to restore a normal lifestyle. The prognosis is also related to the accuracy of following the doctor's recommendations.

Guillain-Barré syndrome is an acute form of progressive inflammatory polyneuropathy characterized by muscle weakness and polyneuritic sensitivity disorder. The disease is also called acute idiopathic polyneuritis, Landry's palsy, or inflammatory demyelinating polyradiculoneuropathy. The disease is a representative of autoimmune anomalies. Usually, the pathology has specific signs that make it possible to recognize it at the earliest stages of development and start adequate treatment on time. It has been proven that more than 80% of patients have a favorable prognosis and are completely cured.

autoimmune demyelination of nerves in Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) occurs in all age groups, but is especially prevalent in people aged 35-50 years, with equal frequency in both women and men. The incidence per 100,000 people is from 0.4 to 4 cases.

Causes of the disease

Scientists from different countries have been studying the syndrome for over 100 years, but they still cannot figure out the exact causes that provoke the onset of the disease.

It is believed that the appearance and development of an anomaly occurs due to a malfunction of the patient's immune system. When a person is completely healthy, when foreign cells enter the body, the immune system begins to fight the infection, rejecting all its dangerous elements. The patient is recovering. With GBS, the body begins to confuse "friends and foes": the patient's neurons are accepted as foreign and are "attacked". There is a destruction of the nervous system - a syndrome occurs.

Because of what there are violations in the work of the immune system itself is not fully known. The most common causes include:

• Traumatic brain injury. A strong blow to the head, any damage to it, as well as swelling, tumors or hemorrhages in the brain can become the main factor in the development of the syndrome. That is why when a patient contacts a specialist, first of all, the doctor should find out about the presence of any craniocerebral injuries.
• Infections. Recent viral infections greatly weaken a person's immune system, thereby increasing the likelihood of GBS. The body's defense mechanism perceives neurons as an infection and continues to kill them with the help of white blood cells. In this case, the syndrome manifests itself one to three weeks after the infectious disease.
• Allergies. The disease often develops in allergic people, for example, after chemotherapy, vaccination against polio and diphtheria, or major surgery.
• genetic predisposition. Most diseases are inherited, and Guillain-Barré syndrome is no exception. If someone in the family has already suffered a pathology, then, most likely, it will also occur in descendants. In this case, you need to especially monitor your health: take care of your head and try not to start infectious diseases.

In childhood, the syndrome develops extremely rarely. The disease may be congenital or acquired. Any anomalies of intrauterine development can lead to the development of the syndrome:

1. preeclampsia;
2. Frequent use of drugs during pregnancy;
3. The presence of autoimmune diseases in the mother;
4. Prolonged infections during the period of bearing a child;
5. Use of drugs, alcohol or smoking.

Acquired reasons include:

1. Passive smoking of a child;
2. Hormonal disruptions in the body;
3. Vaccinations;
4. self-medication;
5. Metabolic disease;
6. Disorders of a neurological nature;
7. Development of tumor processes.

Symptoms

The disease can manifest itself in 3 forms:

• Acute. All signs of the disease appear simultaneously within 1-2 days.
• Subacute. The incubation period is 15 to 20 days.
• Sluggish, chronic. This is one of the most dangerous forms, as it is practically untreatable.

The first symptoms of GBS in both children and adults resemble infection with a common viral respiratory infection:

1. Aches in bones, joints;
2. Hyperthermia;
3. severe weakness;
4. Inflammation of the upper respiratory tract;
5. Numbness of the limbs;
6. Sometimes patients are concerned about various disorders of the gastrointestinal tract.

In addition to common features, there are also more distinct ones:

• Weakness of the limbs. Due to the destruction of nerve cells, there is a decrease or complete loss of sensitivity in the muscle area. At first, pain appears only in the shin of the legs, after - discomfort affects the hands and feet. The patient is disturbed by tingling and numbness of the fingers. In severe cases, coordination of movements is disturbed: it becomes difficult for a person to hold a pen on his own, write with the affected limb. It is worth noting that the symptoms of the disease appear symmetrically: 2 arms or legs are simultaneously affected.
• An increase in the abdomen, which is noticeable even visually. A protruding abdomen is one of the main indicators of the presence of the disease. This is due to the fact that the patient's breathing is rebuilt to the abdominal type due to the weakening of the diaphragm.
• Incontinence. In a person with GBS syndrome, the normal functioning of the bladder is disrupted, and urine begins to flow involuntarily.
• Difficulty swallowing. The swallowing reflex is disturbed due to the fact that the muscles of the pharynx are weakened. In this case, the patient may even choke on saliva. The muscles of the mouth gradually weaken, which leads to discomfort while chewing food.

Guillain-Barré syndrome affects almost all organ systems, so unreasonable hypertension, tachycardia or banal visual impairment can be the first, albeit hidden, sign of the development of pathology.

What is the danger of the syndrome?

Usually the anomaly develops slowly over 2-3 weeks. First, there is a slight weakness in the joints, which intensifies over time and really begins to cause discomfort to the patient.

Immediately after the tingling, in the acute course of the disease, there is a general malaise, weakness in the shoulder and hip sections. After a few hours, there are difficulties in breathing. In this case, it is imperative to seek help from the hospital. Usually, the patient is immediately connected to the artificial respiration system, and then the necessary medication and physiotherapy are provided.

In the acute form of the disease, pathology can completely paralyze any limb already on the second or third day.

Also, in the absence of timely treatment, the patient is threatened with:

1. Decreased immunity;
2. respiratory failure;
3. stiffness of the joints;
4. peripheral paralysis;
5. Problems of adaptation in society;
6. Difficulty in life;
7. Disability;
8. Fatal outcome.

Diagnosis of the disease

In order to diagnose GBS in a patient, several aspects need to be clarified:

• When was the last time a person was ill with any viral disease. It has been proven that in 80% of cases the syndrome occurs due to recent infections.
• Is the patient currently taking any medications, and if so, which ones? They will also help cause the development of GBS.
• How long ago the patient was vaccinated against any diseases.
• Whether the patient suffers from autoimmune or neoplastic diseases.
• Has the person had recent surgery?
• Whether there were serious injuries to any part of the body.

The following studies should also be carried out:

1. General analysis of blood and urine;
2. Blood chemistry;
3. Serological and virological examinations;
4. Examination of cerebrospinal fluid;
5. Magnetic resonance imaging;
6. electrocardiography;
7. Registration of electrical activity of muscles;
8. X-ray or ultrasound of the affected area;
9. Examination of external respiration;
10. Study of the main vital indicators.

Muscle weakness in several limbs at the same time and tendon areflexia can be another clear sign of Guillain-Barré syndrome. This also includes various disorders in the pelvic area, polymorphonuclear leukocytes, asymmetries of paresis and sensitivity disorders.

Differential Diagnosis

Although the symptoms of GBS are similar to those of many other diseases (diphtheria, porphyria, transverse myelitis, botulism, and myasthenia gravis), they still need to be distinguished for proper treatment. In differential diagnosis, the following factors should be considered:

• If poliomyelitis is suspected, it is necessary to collect data from an epidemiological study, take into account the symptoms of the gastrointestinal tract, identify high cytosis in the cerebrospinal fluid, asymmetry of the lesion and the absence of sensory disturbances. The diagnosis can be confirmed by serological or virological analysis.
• Polyneuropathy is characterized by the appearance of psychopathological signs, as well as pain in the pelvis and abdomen. The deviation of the main indicators from the norm in the urine also indicates the development of the disease.
• Transverse myelitis accompanies a violation of the functioning of the pelvic organs, the absence of damage to the nerves of the skull.
• Symptoms of an anomaly can be confused with a cerebral infarction. But in this case, the pathology affects the body in a few minutes and often leads to coma. An MRI will help determine the exact cause of the dysfunction of the body's systems.
• Botulism is characterized by the absence of sensitivity disorders and any changes in the cerebrospinal fluid.

Treatment

Patients with a diagnosis of GBS must be hospitalized in a hospital. In about 30% of cases, it is necessary to carry out mechanical ventilation. Pathology therapy is performed at the following levels:

1. resuscitation;
2. symptomatic;
3. Blood-purifying;
4. Preparative;
5. Muscle recovery;
6. Preventive.

Resuscitation therapy

If the anomaly is in an acute form, resuscitation treatment is carried out, which is aimed at relieving symptoms:

• The patient is connected to the artificial respiration system;
• Apply a catheter to remove urine;
• Install a tracheal tube and probe if there are problems with swallowing.

Symptomatic therapy

This type of treatment is carried out using various medicines:

1. Antihypertensive drugs: Anaprilin, Metaprolol;
2. Antibiotic therapy: "Norfloxacin";
3. Drugs that help stabilize heart rate and pressure: Propranolol, Anaprilin (with tachycardia), Piracetam (with bradycardia);
4. Low molecular weight heparin: "Gemapaxan", "Certoparin";
5. Pain-relieving drugs - NSAIDs or Gabapentin, Pregabalin;
6. Antipyretic, when the temperature rises above 38 degrees: "Ibuklin", "Next";
7. Laxatives: Bisacodyl, Laxatin.

Plasmapheresis

One of the most effective procedures aimed at the treatment of GBS is hardware blood purification - plasmapheresis. It helps to stop the autoimmune process in the body. It is indicated for severe and moderate course of the disease. Usually, about 4-6 operations are performed with a break of one day. Instead of plasma, a special isotonic solution of sodium or albumin is injected into the blood, through which the blood is cleansed and the functioning of all body systems is normalized.

Surgical treatment of the syndrome

If mechanical ventilation was carried out for more than 7-10 days, a tracheostomy should be applied - an artificial respiratory throat. In severe cases, a gastrostroma may also be required - an opening in the stomach created by surgery to feed the patient.

Non-drug therapy with folk remedies

It is impossible to cure GBS with folk remedies. But to cope with some of its symptoms is quite real:

• Elevated temperature. Plentiful drinking and airing of the room is recommended. Tea with lemon, decoctions with various berries and dried fruits will help bring down the temperature: cranberries, strawberries, currants, blueberries, raspberries and dried apricots. You can brew lime blossom, chamomile, St. John's wort, aspen buds, mint and thyme - leave for half an hour, then drink in small sips.
• Bone ache. Lingonberry tea, a compress of fresh cabbage leaves, horseradish and burdock, baths with coniferous extract or decoctions of medicinal herbs will help to cope with it.
• Weakness. Doctors recommend as often as possible to breathe fresh air and ventilate the room. You should try to eat more protein. You also need food rich in vitamins and minerals. And sweet strong tea or chocolate will help to cheer you up.

Rehabilitation

Due to the fact that the syndrome affects not only neurons, but also the circumosseous muscles, the patient will have to learn to walk again and perform simple movements with the limbs.

To normalize the healthy functioning of the muscles, you can use traditional treatment, the complex of which includes:

1. electrophoresis;
2. Trituration;
3. Baths with radon;
4. Massage;
5. Baths for relaxation of the body and muscle tone;
6. Masks and compresses with paraffin or beeswax;
7. Recreational gymnastics.

During the recovery of the body, you should definitely go on a special therapeutic diet and take a course of vitamin preparations in parallel. Complexes that contain calcium, potassium, magnesium and vitamin B will be especially useful.

Patients with GBS should be registered with a neurologist and regularly undergo preventive examinations. It is worth remembering that timely high-quality therapy can return the patient to a full life.

Syndrome prevention

There is no special prevention of pathology. Doctors can only advise against any vaccinations for a year so that the disease does not return again. After this time, vaccination is allowed, but only if it is really necessary.

It is also worth refusing to take alcoholic beverages, avoid overheating, hypothermia and reduce physical activity. In this case, the recurrence of the disease is excluded.

Forecast

Most often, with Guillain-Barré syndrome, the prognosis is favorable. Usually, the normal functioning of the limbs is restored after 7-12 months in 85% of people. The disease becomes chronic in 7-15% of cases. Lethal outcome is approximately 5%. The cause of death may be respiratory failure, pneumonia or viral infections. But most often all this can be prevented by contacting a specialist in time.

Video: lecture on Guillain-Barré syndrome

Video: Guillain-Barré syndrome in the program “Live Healthy”