Description of the disease
Guillain-Barré syndrome is a complex disorder of the peripheral nervous system, the result of an abnormal and exaggerated autoimmune response, probably triggered by a viral / bacterial infection. The characteristic symptoms of Guillain-Barré syndrome - analyzed in detail in the previous article - are weakness and progressive paralysis of the lower and upper limbs.
In this final discussion, the focus will be on the analysis of diagnostic strategies and the description of the therapies currently available for the treatment of Guillain-Barré syndrome.
Diagnosis
Progressive limb paralysis is one of the characteristic symptoms of Guillain-Barré syndrome. As we know, paralysis is a recurrent symptom in numerous pathologies, therefore the differential diagnosis must be made between Guillain-Barré syndrome and stroke, encephalitis, poliomyelitis, vasculitis, lead poisoning, myasthenia gravis, botulism and hypokalemia.
A case of suspected Guillain-Barré syndrome can be ascertained by using multiple diagnostic strategies:
- Rachicentesi: most patients with Guillain-Barré syndrome have a high concentration of proteins in CSF, NOT associated with any increase in cerebrospinal fluid cells
- Antibody screening
- Spirometry: useful for assessing the possible need for hospitalization of the patient in intensive care and / or mechanical ventilation
- Electrocardiogram and nerve conduction studies: more reliable confirmation tests to ascertain Guillain-Barré syndrome
Therapy
Early diagnosis is essential: therapy for Guillain-Barré syndrome must start as quickly as possible following the onset of symptoms. Supportive treatment is essential to ensure a good prognosis: patients experiencing respiratory failure should be promptly treated with the positive pressure respirator (PAP, Positive airway pressure ). If necessary, the patient undergoes a tracheotomy.
Treatment for Guillain-Barré syndrome uses:
- plasmapheresis
- Intravenous immunoglobulin administration
- Administration of steroid drugs
- Prevention of complications
PLASMAFERESI has proved to be an optimal therapeutic strategy for patients suffering from Guillain-Barré syndrome: it is a technique that allows the separation of the liquid component of the blood (plasma) from the corpuscular component by centrifugation systems.
- Plasmapheresis removes and filters antibodies from the body: by doing so, the blood is "purified"
Patients suffering from Guillain-Barré syndrome, who have undergone plasmapheresis, recover fairly quickly, recover spontaneous breathing and the ability to walk independently. Moreover, plasmapheresis reduces the risk of complications in patients suffering from Guillain-Barré syndrome, guaranteeing an excellent prognosis even in the long term.
Another effective therapeutic option consists in the administration of IMMUNOGLOBULINE intravenously, useful for neutralizing antibodies: the therapeutic utility of this therapy is similar to that of plasmapheresis. IgG should be administered to the patient suffering from Guillain-Barré syndrome as soon as possible after the first symptoms appear: the efficacy of the treatment is guaranteed when the patient undergoes therapy within 14 days of its onset.
- The choice of a therapeutic strategy rather than another (plasma exchange or IgG ev) depends essentially on the availability of resources
The mere administration of CORTICOSTEROIDS does not significantly modify the course of Guillain-Barré syndrome. Steroid drugs can only accelerate the recovery of Guillain-Barré syndrome patients when combined with immunoglobulin therapy.
Drugs for the treatment of Guillain-Barré syndrome »
Prevention of complications
Another not inconsiderable goal is the COMPLICATION PREVENTION : as we know Guillain-Barré syndrome can degenerate into deep vein thrombosis. It is possible to escape this complication by putting simple "mechanical" devices into practice: in similar situations, it is advisable to wear elastic compression stockings, which are useful for promoting the return of blood to the heart and preventing the formation of thrombus. The administration of anticoagulant drugs (eg heparin) is also particularly indicated.
For further information: read the article on drugs for the treatment of deep vein thrombosis.
During and after treatment of the acute phase of Guillain-Barré syndrome, the patient must follow a multidisciplinary rehabilitation therapy:
- Physiotherapy: useful for promoting correct movement, increasing muscle strength, improving posture and walking
- Speech therapy: the patient with Guillain-Barré syndrome often has serious language and swallowing difficulties, especially after tracheotomy or long-term assisted ventilation.
- Dietician: the figure of the dietitian and the expert in nutrition is useful to ensure nutritional support in patients suffering from Guillain-Barré syndrome. During therapy, mechanically ventilated patients must be fed using small-caliber nutritional probes. In some patients total parenteral nutrition is required.
Occupational / rehabilitative therapy is essential to speed up the recovery of autonomy in patients affected by Guillain-Barré syndrome.
