Guillain-Barré Syndrome

Presented by: Maddie Pedlar, Andrew Marrs, Andrew Kozerski, Rachel Arking, Zach Yarger
 Outline
1 2 3
Populations, Prevalence, Risk Factors Transmission
Incidence

4 5 6
Genetics Prevention Mechanism of Pathology

7 8 9
Signs and Symptoms Diagnostic Criteria, Considerations and
Prognosis, Medical Implications for Physical
Treatment Therapists
• Between 0.84 and 1.191 cases per
100,000 persons in North America
and Europe
o Varies on geographical location
Populations,
• More prevalent in males and with
increasing age
Prevalence, and
• Different subtypes are more
prevalent in different geographical
Incidence
locations
 Risk
Factors
• Infection with campylobacter
• Influenza virus
• Cytomegalovirus
• Epstein-Barr virus
• Zika Virus
• COVID-19 virus
• Trauma
• Surgery
• Hodgkin’s lymphoma
• Mycoplasma pneumonia
• HIV
• Hepatitis A, B, C and E
Transmission
• GBS is an autoimmune disease with
an unknown cause

• GBS is sporadic with no clear

pattern of inheritance

• The disorder usually appears days

or weeks after a respiratory or
digestive tract infection

• Most commonly, infection with

campylobacter, a type of bacteria
often found in undercooked poultry

• HIV, Zika, Influenza, Pneumonia,

Hep A B C E

• Recent surgery or vaccination can

also trigger GBS.
Genetics

No patterns of inheritance have been noted.

Prevention
• Risk of GBS can increase when exposed
to outbreaks of infectious illnesses; it
can be triggered

• If suspected, test for:

o Complete blood cell counts
o Blood tests for glucose,
electrolytes, kidney function, and
liver enzymes
o Do a CSF examination

• Can rule in/out GBS and other diseases

that might mimic GBS
 Mechanism of Pathology
• Can be triggered
by campylobacter, influenza,
cytomegalovirus, and Epstein-Barr virus.
• The myelin on axons is destroyed, leading
to decreased conduction of action
potentials
• Although infection can cause GBS, GBS is
not an infection.
• Peripheral nervous tissue, specifically
oligodendrocytes, are destroyed by this
pathology.
• GBS is an autoimmune disorder which
means your own immune system attacks
otherwise healthy tissue in your
own body.
• Secondary issues include muscle weakness
and in severe cases paralysis due to the
primary issue of demyelination.
• This first noticeable signs of this disease is
tingling in the LEs, which progresses to
tingling in both LEs and UEs. Then muscle
weakness can be noticed, which can progress
into complete paralysis in a worst-case
scenario.
• Resolution is possible through intravenous
immunoglobulin therapy (IVIG). IVIG is the
infusion of healthy antibodies into the body
which help replace the harmful antibodies that
are causing demyelinating
 • Symptoms often begin with tingling and weakness starting in
feet and legs and spreading to upper body and arms
• As the syndrome progresses, muscle weakness can turn into
paralysis.
• People with GBS usually experience their most significant
weakness withing two weeks after symptoms begin
• Severe cases can result in death

Signs and • Common S&S of GBS are:

Symptoms o

o
A pins and needles sensation in your fingers, toes, ankles,
or wrists
Weakness in your legs that spreads to your upper body
o Unsteady walking or inability to walk or climb stairs
o Difficulty with facial movements, including speaking,
chewing, or swallowing
o Double vision or inability to move the eyes
o Severe pain that may feel achy, shooting or cramp like and
may be worse at night
o Difficulty with bladder control or bowel function
o Rapid heart rate
o Low or high blood pressure, difficulty breathing
 Diagnostic Criteria, Prognosis & Medical
Treatment
• Required factors for diagnosis •
o Progressive bilateral
weakness of the arms and
legs (typically begins with
symptoms manifesting in
the legs).
o Diminished or absent
tendon reflexes in the
affected limbs.
• Modalities used to confirm the
diagnosis
o Spinal tap (lumbar
puncture)
o Electromyography
o Nerve conduction studies
Prognosis • Medical Treatment
o Studies of outcome suggest that
at the end of one year from the
onset of neuropathy ~
▪ 65% of patients reach
almost complete
physiologic regeneration
allowing for completion of
manual work
▪ 35% do not regain function
▪ 8% of the 35% who do not
regain function will die in
the acute phase, usually
from pulmonary emboli or
cardiac arrhythmias
o Good intensive care,
respiratory support,
positive pressure
ventilation and passive
limb movement
o Plasma exchange and
intravenous
immunoglobin shorten
recovery time at the
initial stages of
neuropathy
 Considerations & Implications for Physical Therapists
• Signs & Symptoms to Be
Aware of:
o Quick advancing bilateral
weakness of legs and/or arms
▪ Decreased or absent
reflexes
o Atypical Features
▪ Weakness and sensory
signs asymmetrical or
mainly proximal or distal
▪ Appear in young
children (<6 y/o) unable
to bear weight or have
an unsteady gait
• Contraindications
o Healthcare settings are
carefully assessed
▪ Be cautious of potential
irregular heartbeat, shifts
in BP, or signs of
respiratory distress
o Be conscious of the patient’s
fatigue level and muscle pain
• Precautions for Treatment
o Recognize early signs of
psychological distress
o Mental status can influence
physical recovery
• Physical Therapy Involvement
o Regain motor/sensory functions
o Return to original physical
lifestyle
• Physical Therapy Implications
o Rehabilitation may include ROM
exercises or walking
o Intensity is adjusted based on
physical status of the pt.
▪ Overworking muscles can
lead to damage or fatigue
o Two-phase rehabilitation
process
▪ One at the early stages of
recovery and the other at
the later stages
• There are more studies on the disease in North America and
Europe than anywhere else in the world

• Patients with GBS end up in the ICU commonly for respiratory failure
Clinical
• Patients with GBS typically experience their most significant muscle Pearls
weakness withing two weeks after symptoms begin

• A two-phase rehabilitation process is recommended; phase one at the

early stages of recovery and phase two at the later stages of recovery
 Review Test Questions
1. Which of the following is NOT true regarding GBS?
a. Nerve conduction studies are used to confirm the diagnosis of GBS
b. There is diminished or absent tendon reflexes in the affected limbs
c. Patients experiencing GBS typically have rapidly advancing
UNILATERAL weakness in their extremities
d. Although infection can cause GBS, GBS is not an infection

2. True or False: It has been found that GBS is more prevalent in

males with increasing age.
References
Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain Barré syndrome in
ten steps. Nat Rev Neurol. 2019;15(11):671-683. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6821638/.
Accessed September 25, 2022.

McGrogan A, Madle GC, Seaman HE, de Vries CS. The epidemiology of Guillain-Barré syndrome worldwide. A
systematic literature review.Neuroepidemiology. 2009;32(2):150-163. doi:10.1159/000184748.
https://www.karger.com/Article/Pdf/184748. Accessed September 25, 2022.

Pruthi S. Guillain-Barre syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/guillain-

barre-syndrome/symptoms-causes/syc-20362793. Published June 14, 2022. Accessed September 25,
2022.

Simatos Arsenault N, Vincent PO, Yu BH, Bastien R, Sweeney A. Influence of Exercise on Patients with
Guillain-Barré Syndrome: A Systematic Review. Physiother Can. 2016;68(4):367-376.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125499/. Accessed September 25, 2022.
Winer JB. Guillain Barré syndrome. Molecular pathology: MP.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1187127/. Published December 2001. Accessed
September 24, 2022.
 Maddie’s dog, Sully

Our Pets Zora Zach’s dog, Finn

Bella

Marley
Rachel’s dog, Tipper Zach’s dogs, Zach’s dog, Winnie