A Study on Guillain Barre’s Syndrome Clinical Profile and Treatment Outcome.

Saravanan, P (2008) A Study on Guillain Barre’s Syndrome Clinical Profile and Treatment Outcome. Masters thesis, Madras Medical College, Chennai.

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Abstract

Guillain Barre Syndrome (GBS) is an acute, self limited, inflammatory, autoimmune disorder of the peripheral nervous system triggered usually by a bacterial or viral infection or other antecedent events. It affects 0.9 to 2/100,000 persons in a year, with a worldwide distribution and a slight male preponderance. Generally at the end of one year of illness, 5% of the patients had expired and 15% might be unable to walk. Hence it causes large loss of productivity and burdens the health care due to its prolonged morbidity. It is a heterogeneous disorder in its type, severity, pathogenesis and prognosis. GBS is characterised by a rapidly Progressive weakness of all 4 limbs with or without sensory loss, evolving within 4 weeks, followed later by slow clinical and electrophysiological recovery. The subtypes of GBS are several. Among those which produce weakness, the common one are Acute Inflammatory Demyelinating polyradiculopathy (AIDP), Acute Motor Sensory Axonal Neuropathy (AMSAN) and Acute Motor Axonal Neuropathy (AMAN) and the rare one are pharyngo-cervico Brachial variant, Bilateral foot drop, and bifacial weakness. Among those which do not produce weakness the common one is Miller. Fischer syndrome (MFS) and the rare ones are Pure sensory variant, and acral parasthesia with areflxia. A significant proportion of patients present with peak disability within 8 days of onset of illness to whom definite treatment options are to be made available to enhance a good and early recovery, because this is the group associated with poor outcome. The mean improvement in GBS disability scale from admission to the end of 8th week is more for IvIg treated patients when compared to methyl prednisolone treated group, which is statistically significant. It is also applied well to the AIDP subtype of GBS. Though statistically not significant in this study, injection methyl predisolone is associated with high percentage of poor outcome when compared to IvIg and plasma exchange. The prolonged morbidity of the illness evidenced by the need for tracheostomy is more for those treated with methyl prednisolone when compared to other definite treatment options. Peak expiratory flow rate can also be used as an objective measure to assess the respiratory function, which is handy, and it correlates with the standard assessment like single breath count. Autonomic dysfunction, bulbar weakness, rapidity of onset of illness, severe grade disability and diarrhea are significantly correlating with poor outcome. Postural hypotension was noted in all patients who had expired and it needs further analysis, as a specific prognosticating parameter in patients having autonomic dysfunction. A high index of suspicion is needed to diagnose GBS types like those who present with pain as the predominant feature. A small but significant group of patients present with a fulminant form of disease for whom the prognosis is the worst in spite of good supportive measures and IMCU care.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Guillain Barre’s Syndrome ; Clinical Profile ; Treatment ; Outcome.
Subjects: MEDICAL > Neurology
Depositing User: Kambaraman B
Date Deposited: 28 Jun 2017 11:01
Last Modified: 28 Jun 2017 11:01
URI: http://repository-tnmgrmu.ac.in/id/eprint/562

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