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  • Guillain-Barre Syndrome, Neuralgia, ALS

    PresentedByProf.Dr.R.R.Deshpande(M.DinAyurvdicMedicine&M.D.inAyurvedicPhysiology)

    www.ayurvedicfriend.com Mobile9226810630 [email protected]

    11/17/2016 1Prof.Dr.R.R.Deshpande

    http://www.ayurvedicfriend.com/mailto:[email protected]

  • Kayachikitsa -- Paper 2 Part A Point 5

    NidanaandChikitsaofUrusthambha

    GullianBarriesyndrome MuscularDystrophy MyastheniaGravis MotorNeuronDiseasesandNeuralgia Neuralgia

    11/17/2016 2Prof.Dr.R.R.Deshpande

  • Guillain Barre Syndrome Introduction

    Guillain-Barre(GB)syndrome---raredisorder ThesyndromeisnamedaftertheFrenchneurologistsGuillain&Barre,whodescribeditin1916

    Body'simmunesystemattacksonnerves Weaknessandtinglinginextremitiesareusuallythefirstsymptoms

    Thesesensationscanquicklyspread Eventuallyparalyzingwholebody MostsevereformGuillain-Barresyndromeisamedicalemergency&mustbehospitalized

    11/17/2016 3Prof.Dr.R.R.Deshpande

  • Guillain Barre Syndrome Introduction

    Thecauseisunknown.

    AutoImmunedisorder.Bodysownimmunesystemattackstheperipheralnerves&damagetheirmyelininsulation

    ImmunedysfunctioncanbetriggeredbyanInfection,Surgery,Vaccination

    11/17/2016 4Prof.Dr.R.R.Deshpande

  • Guillain Barre Syndrome Introduction

    Diagnosisismadebysigns&symptoms---withexclusionofothercauses

    SupportedbyTestslikeNerveConductionStudies,ExamofCSF

    Therearesubtypesbasedonareasofweakness,resultsofNerveconductionstudies,presenceofAntibodies

    CalledalsoasAcutePolyNeuropathy

    11/17/2016 5Prof.Dr.R.R.Deshpande

  • Guillain Barre Syndrome Causes

    Cause---Idiopathic(ExactcausenotKnown)

    Oftenprecededbyaninfectiousillnesssuchasarespiratoryinfection

    ThereisnoknowncureforGuillain-Barresyndrome, Treatmentscaneasesymptomsandreducethedurationoftheillness MostpeoplerecoverfromGuillain-Barresyndrome Somemayexperiencelingeringeffectsfromitlikeweakness,numbnessorfatigue.

    11/17/2016 6Prof.Dr.R.R.Deshpande

  • Guillain Barre Syndrome Causes

    Thedisorderusuallyappearsdaysorweeksafterarespiratoryordigestivetractinfection

    Rarely,recentsurgeryorimmunizationcantriggerGuillain-Barresyndrome

    11/17/2016 7Prof.Dr.R.R.Deshpande

  • Clinical Features of GB syndrome

    Beginswithtinglingandweaknessstartinginfeetandlegsandspreadingtoupperbodyandarms

    Inabout10percentofpeoplewiththedisorder,symptomsbegininthearmsorface

    AsGuillain-Barresyndromeprogresses,muscleweaknesscanevolveintoparalysis.

    11/17/2016 8Prof.Dr.R.R.Deshpande

  • G B Syndrome Clinical Features

    Prickling,"pinsandneedles"sensationsinfingers,toes,anklesorwrists

    Weaknessinlegsthatspreadstoupperbody Unsteadywalkingorinabilitytowalkorclimbstairs Difficultywitheyeorfacialmovements,includingspeaking,chewingorswallowing

    Severepainthatmayfeelachyorcramp-likeandmaybeworseatnight

    Difficultywithbladdercontrolorbowelfunction Rapidheartrate,Loworhighbloodpressure,Difficultybreathing11/17/2016 9Prof.Dr.R.R.Deshpande

  • G B Syndrome Clinical Features

    Patientexperiencesmostsignificantweaknesswithintwotofourweeksaftersymptomsbegin

    Recoveryusuallybeginstwotofourweeksafterweaknessplateaus

    11/17/2016 10Prof.Dr.R.R.Deshpande

  • Types of GB Syndrome

    AcuteInflammatoryDemyelinatingPolyradiculoneuropathy(AIDP)---mostcommonformintheU.S.

    ThemostcommonsignofAIDPismuscleweaknesswhichstartsinthelowerpartofthebodyandspreadsupward

    MillerFishersyndrome(MFS)--inwhichparalysisstartsintheeyes&isalsoassociatedwithunsteadygait

    11/17/2016 11Prof.Dr.R.R.Deshpande

  • Types of GB Syndrome

    MFSoccursinabout5percentofpeoplewithGuillain-BarresyndromeintheU.S.butismorecommoninAsia

    AcuteMotorAxonalNeuropathy(AMAN)andAcuteMotor-SensoryAxonalNeuropathy(AMSAN)----arelesscommonintheU.S.butmorefrequentinChina,JapanandMexico

    11/17/2016 12Prof.Dr.R.R.Deshpande

  • Warning signals must consult Doctor

    Tinglingthatstartedinthefeetortoesandisnowmovingupthebody

    Tinglingorweaknessthat'sspreadingrapidly

    Difficultycatchingyourbreathorshortnessofbreathwhenlyingflat

    Chokingonsaliva11/17/2016 13Prof.Dr.R.R.Deshpande

  • Why Hospitalization ?

    Guillain-Barresyndromeisaseriousconditionthatrequiresimmediatehospitalizationbecauseitcanworsenrapidly.

    Thesoonerappropriatetreatmentisstarted,thebetterthechanceofagoodoutcome.

    11/17/2016 14Prof.Dr.R.R.Deshpande

  • GB Syndrome Pathology & Effect

    InGuillain-Barresyndrome,ownimmunesystemwhichusuallyattacksonlyinvadingorganismsattacksonthenerves

    InAIDP,themostcommonformofGuillain-BarresyndromeintheU.S.,thenerves'protectivecovering(myelinsheath)isdamaged.

    Thisdamagepreventsnervesfromtransmittingsignalstoyourbrain,causingweakness,numbnessorparalysis

    11/17/2016 15Prof.Dr.R.R.Deshpande

  • GB Syndrome Pathology

    11/17/2016 16Prof.Dr.R.R.Deshpande

  • GB Syndrome Cause & Symptoms

    11/17/2016 17Prof.Dr.R.R.Deshpande

  • GB Syndrome Risk factors

    Guillain-Barresyndromecanaffectallagegroups. Butgreaterriskisseenin-- Olderadult Guillain-Barresyndromemaybetriggeredby-- Infectionwithcampylobacter,atypeofbacteriaoftenfoundinundercookedpoultry,Influenzavirus,Epstein-Barrvirus,HIV,Mycoplasmapneumonia,SurgeryHodgkin'slymphoma,Rarely,influenzavaccinationsorchildhoodvaccinations

    11/17/2016 18Prof.Dr.R.R.Deshpande

  • ARS Campylobacter jejuni Triger GB

    11/17/2016 19Prof.Dr.R.R.Deshpande

  • GB Syndrome Risk factors & symptoms

    11/17/2016 20Prof.Dr.R.R.Deshpande

  • GB Syndrome Complications

    Breathingdifficulties---Theweaknessorparalysiscanspreadtothemusclesthatcontrolyourbreathing,apotentiallyfatalcomplication.

    ThesepatientswillneedVentilator Bloodpressurefluctuationsandirregularheartrhythms(cardiacarrhythmias)arecommonsideeffects

    UptohalfofpeoplewithGuillain-Barresyndromeexperienceseverenervepain,whichmaybeeasedwithmedication.

    Bowelandbladderfunctionproblems--SluggishbowelfunctionandurineretentionmayresultfromGuillain-Barresyndrome.

    11/17/2016 21Prof.Dr.R.R.Deshpande

  • Hand Held Spirometry in GB

    11/17/2016 22Prof.Dr.R.R.Deshpande

  • GB Syndrome Complications

    PeoplewhoareimmobileduetoGuillain-Barresyndromeareatriskofdevelopingbloodclots.

    Untilpatientisabletowalkindependently,takingbloodthinnersandwearingsupportstockingsarerecommended.

    Duetoimmobilityputsariskofdevelopingbedsores(pressuresores).Frequentrepositioningmayhelpavoidthisproblem.

    Upto5percentofpeoplewithGuillain-Barresyndromeexperiencearelapse.

    11/17/2016 23Prof.Dr.R.R.Deshpande

  • GB Syndrome Complications

    Severe,earlysymptomsofGuillain-Barresyndromesignificantlyincreasetheriskofseriouslong-termcomplications.

    Rarely,deathmayoccurfromcomplicationssuchasrespiratorydistresssyndromeandheartattack.

    11/17/2016 24Prof.Dr.R.R.Deshpande

  • GB Syndrome Diagnosis

    Diagnosisismostlydonewithamedicalhistoryandthoroughphysicalexamination.

    LumbarpunctureCSFistestedforachange,thatcommonlyoccursinpeoplewhohaveGuillain-Barresyndrome.

    Electromyography--Theelectrodesmeasurenerveactivityinthemuscles.

    Nerveconductionstudies--tomeasurethespeedofnervesignals.

    11/17/2016 25Prof.Dr.R.R.Deshpande

  • GB Syndrome Treatment

    There'snocureforGuillain-Barresyndrome. Buttwotypesoftreatmentscanspeedrecoveryandreducetheseverityoftheillness:

    i)Plasmaexchange(plasmapheresis)-- Plasmaisremovedandseparatedfrombloodcells.Thebloodcellsarethenputbackintothebody,whichmanufacturesmoreplasmatomakeupforwhatwasremoved.Plasmapheresisworksbyriddingplasmaofcertainantibodieswhichcontributetotheimmunesystem'sattackontheperipheralnerves.

    11/17/2016 26Prof.Dr.R.R.Deshpande

  • GB Syndrome Treatment

    ii)Immunoglobulintherapy---

    Immunoglobulincontaininghealthyantibodiesfromblooddonorsisgivenintravenously.

    HighdosesofimmunoglobulincanblockthedamagingantibodieswhichcontributetoGuillain-Barresyndrome.

    11/17/2016 27Prof.Dr.R.R.Deshpande

  • GB Syndrome Treatment

    Bothtreatments,plasmapheresis&Immunoglobulintherapyareequallyeffective.

    Mixingthemoradministeringoneaftertheotherisnomoreeffectivethanusingeithermethodalone.

    Medicationisgiventorelievepain(whichcanbesevere), Medicinesaregiventopreventbloodclots,whichcandevelopwhilethepatientisimmobile

    11/17/2016 28Prof.Dr.R.R.Deshpande

  • GB Syndrome Physiotherapy

    PeoplewithGuillain-BarresyndromeneedPhysiotherapyduringrecovery

    Movementofyourarmsandlegs,beforerecoveryhelptokeepmusclesflexibleandstrong

    Physicaltherapyduringrecoveryhelptoregainstrengthandpropermovement

    Trainingwithadaptivedevices,suchasawheelchairorbracesgivemobilityandself-careskills

    Exercisetherapyhelptocopewithfatigue

    11/17/2016 29Prof.Dr.R.R.Deshpande

  • GB Syndrome Recovery

    Somepeoplecantakemonthsandevenyearstorecover Afterthefirstsignsandsymptoms,theconditiontendstoprogressivelyworsenforabouttwoweeks

    Symptomsreachaplateauwithinfourweeks

    Recoveryusuallylastsforsixto12months Butforsomepeopleitcouldtakeaslongasthreeyears

    11/17/2016 30Prof.Dr.R.R.Deshpande

  • GB Syndrome Recovery

    About80percentcanwalkindependentlysixmonthsafterdiagnosis

    About60percentfullyrecovermotorstrengthoneyearafterdiagnosis

    About5to10percenthaveverydelayedandincompleterecovery

    Children,whorarelydevelopGuillain-Barresyndrome,generallyrecovermorecompletelythanadults.

    11/17/2