Guillain-Barré Syndrome (GBS)
Definition:
Guillain-Barré Syndrome is an acute, rapidly progressive autoimmune disorder where the
body’s immune system attacks the peripheral nervous system, leading to muscle weakness,
numbness, and in severe cases, paralysis. It often follows an infection and can be life-
threatening if respiratory muscles are involved.
Incidence:
Affects 1 to 2 per 100,000 people annually.
Can occur at any age, but is more common in adults and males.
Increased incidence seen after viral infections or vaccinations.
Types (with elaboration):
1. Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) – Most
common in the U.S.
o Immune attack on myelin of peripheral nerves.
o Symptoms begin in the legs and spread upward.
2. Acute Motor Axonal Neuropathy (AMAN) – More common in Asia and Central
America.
o Pure motor form; primarily affects axons of motor neurons.
3. Acute Motor-Sensory Axonal Neuropathy (AMSAN)
o Severe form involving both motor and sensory axons.
o Slower recovery, often residual deficits.
4. Miller Fisher Syndrome (MFS)
o Characterized by ophthalmoplegia, ataxia, and areflexia.
o Anti-GQ1b antibodies often present.
Etiology:
Often follows infections (approx. 2-4 weeks prior):
o Campylobacter jejuni (most common trigger)
o Cytomegalovirus (CMV)
o Epstein-Barr virus
o Influenza
o Zika virus
o COVID-19
Rarely post-surgery or post-vaccination
Risk Factors:
Recent viral or bacterial infection
History of autoimmune diseases
Male gender
Older adults
Immunizations (rarely linked)
Surgery or trauma
Pathophysiology (Flow Chart Format):
Triggering Event (e.g., Infection)
↓
Immune System Activation
↓
Cross-reactivity: Autoantibodies attack myelin/axons
↓
Inflammation & Demyelination of Peripheral Nerves
↓
↓ Nerve conduction velocity / signal blockage
↓
Muscle Weakness → Paralysis
↓
Possible Respiratory Failure & Autonomic Dysfunction
Clinical Manifestations:
Initial Symptoms:
o Tingling and numbness in fingers and toes
o Muscle weakness (typically ascending)
Progressive Features:
o Flaccid paralysis (starts in legs)
o Loss of deep tendon reflexes (areflexia)
o Facial weakness, difficulty speaking or swallowing
o Respiratory muscle involvement → Respiratory failure
Autonomic Symptoms:
o Fluctuating blood pressure
o Cardiac arrhythmias
o Urinary retention or bowel dysfunction
Diagnostic Evaluations:
1. History and Physical Examination
2. Lumbar Puncture – Elevated protein in CSF with normal cell count
(albuminocytologic dissociation)
3. Nerve Conduction Studies / Electromyography (EMG) – Slowed or blocked nerve
signals
4. MRI – May show nerve root enhancement
5. Pulmonary Function Tests (PFTs) – To assess respiratory involvement
Pharmacological Management:
Intravenous Immunoglobulin (IVIG) – Blocks damaging antibodies
Plasmapheresis (Plasma Exchange) – Removes circulating autoantibodies
Analgesics – For pain relief (e.g., gabapentin, opioids)
Anticoagulants – Prevent deep vein thrombosis (e.g., enoxaparin)
Supportive Medications:
o Antihypertensives for BP control
o Medications for constipation or urinary retention
Surgical Management:
There is no direct surgical treatment for GBS, but surgical interventions may be needed
for:
Tracheostomy in prolonged respiratory failure
Gastrostomy tube placement if long-term feeding support is required
Nursing Management:
1. Airway and Breathing:
o Monitor respiratory rate, SpO₂, ABGs
o Prepare for intubation if vital capacity falls
2. Neurological Monitoring:
o Assess motor strength, reflexes, and cranial nerve function regularly
3. Mobility and Skin Care:
o Frequent repositioning
o Passive ROM exercises
4. Nutrition and Hydration:
o Monitor swallowing ability
o Use enteral nutrition if needed
5. Pain Management:
o Assess and manage neuropathic pain
6. Psychological Support:
o Support anxiety and fear due to paralysis
o Involve family in care
7. Monitor for Complications:
o Autonomic dysfunction, infections, pressure ulcers
Nursing Diagnoses (NANDA-I):
1. Impaired Physical Mobility related to neuromuscular impairment.
2. Ineffective Breathing Pattern related to respiratory muscle weakness.
3. Risk for Aspiration related to impaired swallowing.
4. Acute Pain related to nerve root inflammation.
5. Impaired Verbal Communication related to facial weakness.
6. Risk for Impaired Skin Integrity related to immobility.
7. Anxiety related to fear of progression or loss of function.
8. Deficient Knowledge related to condition and management.
