Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal-paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2-4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12-15 L in four to five exchanges over 1-2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.

European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome.

‘Just the ticket’: case studies, reflections and clinical supervision (part III)

Graves' disease (GD) and Guillain-Barre syndrome (GBS) are both autoimmune disorders and are triggered by interactions between genetic and environmental factors. GBS in patients who suffer from other autoimmune diseases is rarely reported, and the development of atypical GBS with cranial nerve involvement in a patient with GD has never been previously reported. Herein, we report a patient with GD and a rare form of pharyngo-cervico-brachial variety of GBS.

/pdf/guillain-barre-syndrome-developing-in-a-patient-with-graves-3e1fs8ewc9.pdf

Guillain-Barré Syndrome developing in a patient with Graves' Disease

ResumenEl proposito de esta revision es presentar al equipo de salud latinoamericano y de la region del caribe un panorama de la situacion actual con el virus Zika (ZIKAV), y al mismo tiempo, proveer conocimiento clinica y molecular relevante para enfrentar este problema emergente. Esperamos que esta revision tenga un impacto positivo en el diagnostico, vigilancia, y tratamiento de esta enfermedad viral, especialmente en comunidades endemicas, como parte de un esfuerzo colectivo para enfrentar este virus. Este manuscrito sera distribuido electronicamente y fisicamente como una iniciativa de salud publica y epidemiologica.AbstractThe purpose of this review is to provide Latin America's and the region's healthcare professionals with an overview of the current situation related to Zika virus (ZIKAV), and at the same time, to provide relevant clinical and molecular knowledge against this emerging problem. We expect to have a positive impact in diagnostic, surveillance and treatment of this viral disease, specially in those endemic communities, as part of a collective effort against the virus. This review will be distributed as hard-copy and online as a public health and epidemiological initiative. Palabras claves:ZIKAV, control de vector, brote, vigilancia epidemiologica, microcefaliaKeywords: Zika virus, vector control, outbreak, survillance, microcephaly

/pdf/zika-en-panama-y-latinoamerica-aspectos-clinicos-y-hz2tbnde6m.pdf

Zika en Panamá y Latinoamérica: Aspectos clínicos y moleculares de una problemática emergente

Guillain-Barré syndrome (GBS), a rare neurological disorder which attack self-immune system especially peripheral nervous system (PNS)and its network of nerves located outside of the brain and spinal cord. GBS has a number of recognized subtypes that have differing clinical and pathophysiological features. Most of the incidence rates of GBS reported was between 1.1/100,000/year and 1.8/100,000/year with lower rates reported in children (less than 16 years) of 0.4/100,000/year to 1.4/100,000/year. The reason for GBS though unknown but according to the Centre for Disease Control and Prevention (CDC), about two-thirds of people developed GBS post to gastrointestinal or a respiratory infection. Infectives include Campylobacter jejuni, Zika virus and herpes virus besides pesticides accumulation. Nerves innervating various muscles are affecting showing difficulty in response to the brain signals is one major symptom. Electrodiagnostic study and cerebrospinal liquid (CSF) estimations are the current diagnostics. Intravenous immunoglobulin G and plasmapheresis have been demonstrated to be successful in the treatment.

http://ijapbjournal.com/2019/20190504003.pdf

Guillain-Barré Syndrome (GBS)- A Review

Clinical diagnosis of Guillain Barre Syndrome begins with complaints of symmetric weakness, and absence of deep tendon reflexes on examination. The clinical diagnosis is confirmed by cerebrospinal fluid analysis and nerve conduction studies. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

/pdf/diagnosis-and-treatment-of-guillain-barre-syndrome-wo3x3dgzee.pdf

Diagnosis and treatment of guillain-barre syndrome.

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Diagnosis and treatment of guillain-barre syndrome.