Guillain syndrome

Guillain syndrome is an acute inflammatory neurological disease, which is also called:

acute inflammatory demyelinating polyradiculoneuritis;
infectious idiopathic polyneuropathy;
Guillain-Barre-Strohl syndrome;
Landry-Guillain-Barre syndrome.
The content of the article:
Classification of Guillain-Barre syndrome
Diagnosis of Guillain-Barre syndrome
Differential diagnosis
Treatment of Guillain-Barre syndrome
Prognosis for Guillain-Barre syndrome
Prevention of Guillain-Barre syndrome
Guillain syndrome
The disease belongs to the group of autoimmune inflammatory diseases of the peripheral nervous system. With such a disease, the human nervous system changes its polarity and begins to destroy its own neurons, which entails a violation of autonomic dysfunction, and in the absence of adequate treatment — paralysis.

It manifests itself as a sluggish paresis in symmetrical limb muscles with sensitive and vegetative disorders. Sometimes the treatment of this disease requires urgent resuscitation. The development and progression of Guillain syndrome occurs acutely and quickly (often after suffering from colds). However, with timely and adequate treatment, complete rehabilitation is possible.

The prevalence of the disease is approximately 2 cases per 100 thousand people. Guillain-Barre syndrome mainly affects young and able-bodied people (the manifestation of the disease occurs in 30-40 years). Men and women get sick with the same frequency.

The causes of its occurrence are not fully known, as well as the factors provoking it. Therefore, Guillain-Barre syndrome is also called idiopathic polyneuropathy. A few weeks before the clinical presentation of Guillain syndrome, most patients show signs of intestinal infection or respiratory tract. Since this disease is associated with immuno-mediated factors, it can be caused by herpes viruses, hemophilic bacillus, mycoplasmas. In some cases, this disease can serve as a manifestation of HIV infection.

An infection that has infected the body somehow provokes an autoimmune reaction when the human immune system begins to destroy its own cells. In some cases, vaccinations, surgical intervention, traumatic disorders in the peripheral nervous system become such provocateurs.

Among the possible causes of this disease are:

Traumatic brain injuries that provoked the appearance of brain edema or tumors in it.
Viral infections that significantly affect the immune system during a prolonged attack.
Genetic predisposition. A person who has a relative with such a disease automatically falls into the risk zone. Minor injuries or infections can provoke the onset of the disease.
Classification of Guillain-Barre syndrome
Guillain-Barre syndrome is divided into several types.

1 view. Demyelinating type, in which only myelin sheaths are affected, and the destruction of axon cylinders is not observed. As a result, the speed of impulses and the development of paralysis, which can be reversed, slows down. The anterior roots of the spinal cord are most often affected, but sometimes pathological changes are observed in other parts of the nervous system. It is considered that the demyelinating type is a classic manifestation of Guillain-Barre syndrome.

2 view. Acute motor axonal neuropathy, acute motor-sensory axonal neuropathy, acute pandisautonomia (damage to the autonomic nervous system), in which axonal axial cylinders are disrupted. This leads to the formation of severe degrees of paresis and paralysis. After the axonal view, motor functions are not fully restored. These subtypes have their own geography — observations show that they are more common in China, Japan and Spain.

3 view. Miller-Fisher syndrome. it is characterized by weakness of the oculomotor muscles, ptosis of the upper eyelid, cerebellar ataxia, minor damage to reflexes.

Recently, scientists have identified another manifestation of Guillain-Barre syndrome — acute cranial polyneuropathy, which is very rare.

Diagnosis of Guillain-Barre syndrome
The primary role in recovery is assigned to timely diagnosis and adequate treatment. To determine the diagnosis of GBS, methods specially developed by American scientists are used, which formed the basis of the criteria proposed by experts of the World Health Organization to determine the diagnosis of GBS.

Criteria used in the diagnosis of GBS:

Signs necessary for the diagnosis of this disease (decrease in muscle tone in the extremities, deterioration of tendon reflexes).
Signs that support the diagnosis of GBS. Clinical signs, progression — increasing symptoms of motor reflex disorders stabilize by the fourth week of the onset of the disease, symmetrical lesions, sensory disturbances, facial nerve damage. Characteristic recovery — most patients are rehabilitated within four to five weeks, disorders of the autonomic system. Possible variants of the disease, changes in the cerebrospinal fluid that support the diagnosis of the disease (a significant and rapid increase in protein, a change in the cellular composition of the fluid).
Signs that cause doubt in the diagnosis (asymmetry of motor disorders, etc.).
To establish a clear and correct diagnosis, a number of necessary studies are carried out:

Electromyography. The conduction of the nerve impulse is slowed down in GBS.
Lumbar puncture of cerebrospinal fluid. Laboratory analysis shows an increase in protein levels and a change in cellular composition.
Differential diagnosis.
Differential diagnosis
To make an accurate diagnosis of GBS, it is necessary to differentiate from a number of other diseases with a similar clinical picture, such as:

Intoxication, which leads to disorders of neuromuscular transmission;
Polio;
Myasthenia gravis;
Botulism;
Intoxication after taking drugs: hydralazine, gold products, glutetimide, metronidazole, etc;
Intoxication after taking alcohol;
Neuropathies caused by diseases such as diabetes mellitus, polyarthritis nodosum, rheumatoid arthritis;
Deficiency of folic acid and vitamin B12 in the body;
Genetically inherited polyneuropathies — Charcot-Marie-Toute disease, Dejersha-Sotta neuritis;
Damage to the nervous system as a result of oncological diseases;
Infectious diseases, complications after them;
Complications of diphtheria;
Ischemic stroke of the brain stem.
Treatment of Guillain-Barre syndrome
After the diagnosis of this disease, the patient is subject to urgent hospitalization in a hospital hospital, in some cases — in intensive care. Sometimes, due to rapidly developing acute pulmonary insufficiency, artificial ventilation of the lungs is required, since the respiratory system is affected and a person may die without appropriate treatment and procedures. With a vital lung capacity of 25-30%, intubation or tracheotomy is recommended for the patient. This procedure will be necessary until the swallowing and coughing reflexes improve. Disconnection from the device occurs gradually.

Drug therapy
Most often, the introduction of plasmapheresis with intravenous administration of immunoglobulin is used. Plasma is partially separated from the patient’s blood and shaped elements are returned.
Glucocorticoid drugs are also used for treatment — prednisone (2 mk / kg per day), diphenhydramine and suprastin are administered as antihistamines.
In the presence of tachycardia and severe arterial hypertension, calcium ion antagonists, beta-blockers are usually stopped.
Arterial hypertension is eliminated by injecting fluid into the vein to increase the volume in the vessels.
To prevent bedsores, the patient must be turned over every 2-3 hours.
Pressure and pulse surges can be explained by acute urinary retention and expansion of the bladder. In such cases, a catheter is installed.
For early rehabilitation and prevention of contractures, physical therapy, massage procedures, four-chamber baths are often prescribed.
Prognosis for Guillain-Barre syndrome
With timely and proper treatment, most patients have a good chance of complete rehabilitation. A significant proportion of cases have a favorable prognosis.

The progression of the disease process lasts about 3-4 weeks, then there is a process of restoration of functions (about a year). 10-15% of people who have suffered from Giain-Barre syndrome suffer from a residual neurological deficit — they feel weakness, decreased reflexes. 10% of patients develop a relapse about a year after recovery, or severe complications may occur.

In rare cases, there is a fatal outcome (in about 3% of cases).

Possible complications of Guillain-Barre Syndrome:

Shortness of breath. Deaths in most cases occur precisely because of damage to the respiratory muscles.
Residual numbness or tingling in the extremities.
Disorders of the cardiovascular system – the occurrence of cardiac arrhythmia, fluctuations in blood pressure. Such disorders can also cause death with untimely treatment.
Pain syndromes, which can be extinguished only with the help of painkillers.
The breakdown of thrombosis due to the immobile state of the body. While the patient is immobilized, it is necessary to take blood thinning medications and wear elastic stockings.
Bedsores. It is necessary to change the position of the patient’s body.
Disorders of the bowel and bladder (urinary retention and sluggish intestinal peristalsis).
Relapse of the disease.
Prevention of Guillain-Barre syndrome
There is no clear system of prevention against Guillain-Barre syndrome. But during the recovery period, the patient must adhere to certain rules. It is necessary to refrain from vaccination during the first year after the onset of the disease, as vaccination can cause a relapse. If the development of the disease occurred within six months after vaccination, then in the future this drug is strictly prohibited to be administered.

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