Bettie
(dis nou my Mosbolletjie) is gediagnoseer met Guillain-Barré
syndroom.
Sy
het Saterdag 25 Julie skielik verlam geraak in haar onderlyf, en sy
is opgeneem in die hospitaal. Daar is 'n MRI skandering op haar
gedoen, wat gewys het dat daar inflammasie in die senuwees van haar
rug is. Daarna is 'n lumbaal punktuur (lumber puncture) op haar
gedoen wat getoon het dat daar proteïne in die werwelkolom vloeistof
aanwesig is. Dit het bevestig dat dit inderdaad Guillain-Barré
syndroom is.
Sy
word nou behandel in die hoësorg eenheid in Alberlito Hospitaal. Die
behandeling behels tans dialise om bloedplasmavervanging te doen.
Later sal verdere behandeling ook gedoen word. Sy kry ook
fisioterapie om die verlamde bene te oefen.
Hier
onder is inligting wat ek van die Internet gekry het oor
Guillain-Barré syndroom.
Bid
asseblief vir Bettie.
Louis
Nel
What
is Guillain-Barré syndrome?
Guillain-Barré syndrome
(GBS) is a disorder in which the body's immune system attacks part of
the peripheral nervous system. The first symptoms of this disorder
include varying degrees of weakness or tingling sensations in the
legs. In many instances the symmetrical weakness and abnormal
sensations spread to the arms and upper body. These symptoms can
increase in intensity until certain muscles cannot be used at all
and, when severe, the person is almost totally paralyzed. In these
cases the disorder is life threatening - potentially interfering with
breathing and, at times, with blood pressure or heart rate - and is
considered a medical emergency. Such an individual is often put on a
ventilator to assist with breathing and is watched closely for
problems such as an abnormal heart beat, infections, blood clots, and
high or low blood pressure. Most individuals, however, have good
recovery from even the most severe cases of Guillain-Barré syndrome,
although some continue to have a certain degree of weakness.
Guillain-Barré
syndrome can affect anybody. It can strike at any age and both sexes
are equally prone to the disorder. The syndrome is rare, however,
afflicting only about one person in 100,000. Usually Guillain-Barré
occurs a few days or weeks after the patient has had symptoms of a
respiratory or gastrointestinal viral infection. Occasionally surgery
will trigger the syndrome. In rare instances vaccinations may
increase the risk of GBS.
After
the first clinical manifestations of the disease, the symptoms can
progress over the course of hours, days, or weeks. Most people reach
the stage of greatest weakness within the first 2 weeks after
symptoms appear, and by the third week of the illness 90 percent of
all patients are at their weakest.
What
causes Guillain-Barré syndrome?
No
one yet knows why Guillain-Barré — which is not contagious —
strikes some people and not others. Nor does anyone know exactly what
sets the disease in motion.
What
scientists do know is that the body's immune system begins to attack
the body itself, causing what is known as an autoimmune disease.
Usually the cells of the immune system attack only foreign material
and invading organisms. In Guillain-Barré syndrome, however, the
immune system starts to destroy the myelin sheath that surrounds the
axons of many peripheral nerves, or even the axons themselves (axons
are long, thin extensions of the nerve cells; they carry nerve
signals). The myelin sheath surrounding the axon speeds up the
transmission of nerve signals and allows the transmission of signals
over long distances.
In
diseases in which the peripheral nerves' myelin sheaths are injured
or degraded, the nerves cannot transmit signals efficiently. That is
why the muscles begin to lose their ability to respond to the brain's
commands, commands that must be carried through the nerve network.
The brain also receives fewer sensory signals from the rest of the
body, resulting in an inability to feel textures, heat, pain, and
other sensations. Alternately, the brain may receive inappropriate
signals that result in tingling, "crawling-skin," or
painful sensations. Because the signals to and from the arms and legs
must travel the longest distances they are most vulnerable to
interruption. Therefore, muscle weakness and tingling sensations
usually first appear in the hands and feet and progress upwards.
When
Guillain-Barré is preceded by a viral or bacterial infection, it is
possible that the virus has changed the nature of cells in the
nervous system so that the immune system treats them as foreign
cells. It is also possible that the virus makes the immune system
itself less discriminating about what cells it recognizes as its own,
allowing some of the immune cells, such as certain kinds of
lymphocytes and macrophages, to attack the myelin. Sensitized T
lymphocytes cooperate with B lymphocytes to produce antibodies
against components of the myelin sheath and may contribute to
destruction of the myelin. In two forms of GBS, axons are attacked by
antibodies against the bacteria Campylobacter jejuni, which react
with proteins of the peripheral nerves. Acute motor axonal
neuropathy is particularly common in Chinese children. Scientists
are investigating these and other possibilities to find why the
immune system goes awry in Guillain-Barré syndrome and other
autoimmune diseases. The cause and course of Guillain-Barré syndrome
is an active area of neurological investigation, incorporating the
cooperative efforts of neurological scientists, immunologists, and
virologists.
How
is Guillain-Barré syndrome diagnosed?
Guillain-Barré
is called a syndrome rather than a disease because it is not clear
that a specific disease-causing agent is involved. A syndrome is a
medical condition characterized by a collection of symptoms (what the
patient feels) and signs (what a doctor can observe or measure). The
signs and symptoms of the syndrome can be quite varied, so doctors
may, on rare occasions, find it difficult to diagnose Guillain-Barré
in its earliest stages.
Several
disorders have symptoms similar to those found in Guillain-Barré, so
doctors examine and question patients carefully before making a
diagnosis. Collectively, the signs and symptoms form a certain
pattern that helps doctors differentiate Guillain-Barré from other
disorders. For example, physicians will note whether the symptoms
appear on both sides of the body (most common in Guillain-Barré) and
the quickness with which the symptoms appear (in other disorders,
muscle weakness may progress over months rather than days or weeks).
In Guillain-Barré, reflexes such as knee jerks are usually lost.
Because the signals traveling along the nerve are slower, a nerve
conduction velocity (NCV) test can give a doctor clues to aid the
diagnosis. In Guillain-Barré patients, the cerebrospinal fluid that
bathes the spinal cord and brain contains more protein than usual.
Therefore a physician may decide to perform a spinal tap, a procedure
in which a needle is inserted into the patient's lower back and a
small amount of cerebrospinal fluid from the spinal column is
withdrawn for study.
How
is Guillain-Barré treated?
There
is no known cure for Guillain-Barré syndrome. However, there are
therapies that lessen the severity of the illness and accelerate the
recovery in most patients. There are also a number of ways to treat
the complications of the disease.
Currently,
plasma exchange (also called plasmapheresis) and high-dose
immunoglobulin therapy are used. Both of them are equally effective,
but immunoglobulin is easier to administer. Plasma exchange is a
method by which whole blood is removed from the body and processed so
that the red and white blood cells are separated from the plasma, or
liquid portion of the blood. The blood cells are then returned to the
patient without the plasma, which the body quickly replaces.
Scientists still don't know exactly why plasma exchange works, but
the technique seems to reduce the severity and duration of the
Guillain-Barré episode. This may be because plasmapheresis can
remove antibodies and other immune cell-derived factors that could
contribute to nerve damage.
In
high-dose immunoglobulin therapy, doctors give intravenous injections
of the proteins that, in small quantities, the immune system uses
naturally to attack invading organisms. Investigators have found that
giving high doses of these immunoglobulins, derived from a pool of
thousands of normal donors, to Guillain-Barré patients can lessen
the immune attack on the nervous system. Investigators don't know why
or how this works, although several hypotheses have been proposed.
The
use of steroid hormones has also been tried as a way to reduce the
severity of Guillain-Barré, but controlled clinical trials have
demonstrated that this treatment not only is not effective but may
even have a deleterious effect on the disease.
The
most critical part of the treatment for this syndrome consists of
keeping the patient's body functioning during recovery of the nervous
system. This can sometimes require placing the patient on mechanical
ventilatory assistance, a heart monitor, or other machines that
assist body function. The need for this sophisticated machinery is
one reason why Guillain-Barré syndrome patients are usually treated
in hospitals, often in an intensive care ward. In the hospital,
doctors can also look for and treat the many problems that can
afflict any paralyzed patient - complications such as pneumonia or
bed sores.
Often,
even before recovery begins, caregivers may be instructed to manually
move the patient's limbs to help keep the muscles flexible and strong
and to prevent venous sludging (the buildup of red blood cells in
veins, which could lead to reduced blood flow) in the limbs which
could result in deep vein thrombosis. Later, as the patient
begins to recover limb control, physical therapy begins. Carefully
planned clinical trials of new and experimental therapies are the key
to improving the treatment of patients with Guillain-Barré syndrome.
Such clinical trials begin with the research of basic and clinical
scientists who, working with clinicians, identify new approaches to
treating patients with the disease.
What
is the long-term outlook for those with Guillain-Barré syndrome?
Guillain-Barré
syndrome can be a devastating disorder because of its sudden and
unexpected onset. In addition, recovery is not necessarily quick. As
noted above, patients usually reach the point of greatest weakness or
paralysis days or weeks after the first symptoms occur. Symptoms then
stabilize at this level for a period of days, weeks, or, sometimes,
months. The recovery period may be as little as a few weeks or as
long as a few years. About 30 percent of those with Guillain-Barré
still have a residual weakness after 3 years. About 3 percent may
suffer a relapse of muscle weakness and tingling sensations many
years after the initial attack.
Guillain-Barré
syndrome patients face not only physical difficulties, but
emotionally painful periods as well. It is often extremely difficult
for patients to adjust to sudden paralysis and dependence on others
for help with routine daily activities. Patients sometimes need
psychological counseling to help them adapt.
What
research is being done?
Scientists
are concentrating on finding new treatments and refining existing
ones. Scientists are also looking at the workings of the immune
system to find which cells are responsible for beginning and carrying
out the attack on the nervous system. The fact that so many cases of
Guillain-Barré begin after a viral or bacterial infection suggests
that certain characteristics of some viruses and bacteria may
activate the immune system inappropriately. Investigators are
searching for those characteristics. Certain proteins or peptides in
viruses and bacteria may be the same as those found in myelin, and
the generation of antibodies to neutralize the invading viruses or
bacteria could trigger the attack on the myelin sheath. As noted
previously, neurological scientists, immunologists, virologists, and
pharmacologists are all working collaboratively to learn how to
prevent this disorder and to make better therapies available when it
strikes.
