Guillain-Barré syndrome medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==
 
* Treatment for Guillan Barre syndrome can be divided into two groups:
* There is no [[cure]] for [[Guillain-Barré syndrome]]. However, many [[treatments]] are available to help reduce symptoms, treat complications, and speed up recovery.
** Supportive therapy:
===Intensive Care Management===
*** Respiratory assistance: WE measure maximal expiratory vital capacity and if vital capacity falls under 15 ml/kg we start mechanical ventilation and endotracheal intubation.
* When symptoms are severe, the patient will need to go to the hospital for breathing help, [[treatment]], and [[physical therapy]].
*** Heart rate and blood pressure monitoring.
* Supportive care with monitoring of all vital functions is the cornerstone of successful management in the acute patient.
*** Prevention of thromboembolic complications by heparin.
* Of greatest concern is respiratory failure due to paralysis of the diaphragm.
*** Reduce respiratory infections by minimal sedation in intensive care units.
* Early [[intubation]] should be considered in any patient with
*** Pain control by analgesics.
** A [[vital capacity]] (VC) <20 ml/kg,
*** Prevention of contracture by early passive movement.
** A Negative Inspiratory Force (NIF) <-25 cmH<sub>2</sub>O
** Immunomodulating therapy
** More than 30% decrease in either VC or NIF within 24 hours
*** Plasma exchange: It is proved in so many studies that plasma exchange is an effective treatment option and can reduce recovery time.<ref name="pmid2893583">{{cite journal |vauthors= |title=Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome |journal=Ann. Neurol. |volume=22 |issue=6 |pages=753–61 |date=December 1987 |pmid=2893583 |doi=10.1002/ana.410220612 |url=}}</ref>
** Rapid progression of disease
*** High dose immunoglobulin
** Autonomic instability
*** Corticosteroids
 
===Immunotherapy===
* Once the patient is stabilized, treatment of the underlying condition should be initiated as soon as possible.
* Either high-dose intravenous [[immunoglobulin]]s (IVIg) at 400mg/kg for 5 days or [[plasmapheresis]] can be administered, as they are equally effective and a combination of the two is not significantly better than either alone.
* Therapy is no longer effective after 2 weeks after the first motor symptoms appear, so treatment should be instituted as soon as possible.
* High-dose immunoglobulin therapy ([[IVIG|IVIg]]) is used to reduce the severity and length of Guillain-Barré symptoms. In this case, the [[immunoglobulins]] are added to the [[blood]] in large quantity, blocking the [[antibodies]] that cause [[inflammation]].
* IVIg is usually used first because of its ease of administration and safety profile, with a total of five daily infusions for a total dose of 2 g/kg body weight (.4kg each day).
* The use of intravenous immunoglobulins is not without risk, occasionally causing hepatitis, or in rare cases, renal failure if used for longer than five days.
* If plasmapheresis is chosen, a dose of 40-50 mL/kg plasma exchange (PE) is administered four times over a week. A method called [[plasmapheresis]] is used to remove [[proteins]], called [[antibodies]], from the [[blood]].
* The process involves taking [[blood]] from the body, usually from the arm, pumping it into a machine that removes the [[antibodies]], then sending it back into the body.
* [[Glucocorticoids]] have '''NOT''' been found to be effective in GBS.
 
===Other Treatments for Preventing Complications===
*[[Blood thinners]] may be used to prevent [[blood clots]].
*If the [[diaphragm]] is weak, breathing support or even a breathing tube and [[ventilator]] may be needed.
*Pain is treated aggressively with [[anti-inflammatory]] medicines and [[narcotics]], if needed.
*Proper body positioning or a [[feeding tube]] may be used to prevent [[choking]] during feeding if the [[muscles]] for [[swallowing]] are weak.
 
===Social Perspective===
 
A fundamental part of hospital treatment should fall on the family.  As hospitals reduce healthcare it becomes impossible to care for patients around the clock.  Patients that reach total paralysis are unable to signal or call for help and this is where family care becomes so important.  Family members provide care and support that patients desperately need and medical staff sometimes don't understand or are unable to provide.  Due to inactivity the body loses tone and flexibility.  It's suggested that learning Range of Motion from medical staff and using stretches and keeping the joints pliable will aid the patient to recover sooner than letting them lay in a vegetative position.  This also helps with circulation and the onset of bedsores.  Bedsore prevention mattresses provide comfort to the patient if the family is unable to maintain 24 hour care.  This is important because hospital recovery from Guillain-Barre can last from weeks to months.


==References==
==References==

Revision as of 15:24, 20 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, MBBS [2]

Overview

With prompt treatment of plasmapheresis followed by immunoglobulins and supportive care, the majority of patients will regain full functional capacity. However, death may occur if severe pulmonary complications and dysautonomia are present.

Medical Therapy

  • Treatment for Guillan Barre syndrome can be divided into two groups:
    • Supportive therapy:
      • Respiratory assistance: WE measure maximal expiratory vital capacity and if vital capacity falls under 15 ml/kg we start mechanical ventilation and endotracheal intubation.
      • Heart rate and blood pressure monitoring.
      • Prevention of thromboembolic complications by heparin.
      • Reduce respiratory infections by minimal sedation in intensive care units.
      • Pain control by analgesics.
      • Prevention of contracture by early passive movement.
    • Immunomodulating therapy
      • Plasma exchange: It is proved in so many studies that plasma exchange is an effective treatment option and can reduce recovery time.[1]
      • High dose immunoglobulin
      • Corticosteroids

References

  1. ↑ "Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids. French Cooperative Group on Plasma Exchange in Guillain-Barré syndrome". Ann. Neurol. 22 (6): 753–61. December 1987. doi:10.1002/ana.410220612. PMID 2893583.

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