Guillian Barre syndrome (GBS) is the commonest acute polyneuropathy. GBS is an acute, frequently severe, and fulminant polyradiculoneuropathy that is autoimmune in nature. It occurs year-round at a rate of about one case per million per month .It develops 1- 4 weeks after viral infection in 70% patients and more rarely follows surgery or immunisation. Pathologically there is demyelination of spinal roots or peripheral nerves which is certainly immunologically mediated.
GBS manifests as rapidly evolving areflexic motor paralysis with or without sensory disturbance. The usual pattern is an ascending paralysis that may be first noticed as rubbery legs. Weakness typically evolves over hours to a few days and is frequently accompanied by tingling dysesthesias in the extremities. The legs are usually more affected than the arms, and facial diparesis is present in 50% of affected individuals. The characteristic clinical feature is muscle weakness ,which is more marked proximally than distally and progresses ,often rapidly. Distal paraesthesia ascending proximally is common, and bilateral facial weakness develops in 50% of patients. Deep tendon reflexes usually disappear within the first few days of onset. Cutaneous sensory deficits, e.g., loss of pain and temperature sensation, are usually relatively mild; but functions subserved by large sensory fibers, such as deep tendon reflexes and proprioception, are more severely affected. The most striking findings on examination are diffuse weakness and wide spread loss of reflexes. In majority of patients, muscle weakness progress for 1-3 weeks, but occasionally rapid deterioration with respiratory failure develop within hours.
The protein content of C.S.F. is raised at some stage of illness but may be normal in first 10 days. There is usually no rise in cells and a lymphocytosis of greater than 50/cu.mm. should raise the possibility of an alternative diagnosis. Electrophysiological studies are usually normal in early stages of GBS. In the demyelinating forms of GBS, the basis for flaccid paralysis and sensory disturbance is conduction block. This finding, demonstrable ectrophysiologically, implies that the axonal connections remain intact. Hence, recovery can take place rapidly as remyelination occurs. In severe cases of demyelinating GBS, secondary axonal degeneration usually occurs; its extent can be estimated electrophysiologically
During the phase of deterioration regular monitoring of respiratory function is essential. Respiratory failure may develop with little prior clinical warning and the development of dyspnoea or a drop in the vital capacity below 1 litre may indicate the urgent necessity for intubation and positive pressure ventilation.
Physiotherapy – Early active and passive movements. Splints to prevent foot and wrist drop.
I was called to see a 15 yrs old male patient, Mr Varun Kapoor on 1st september 04 as the patient was completely bedridden and was not in a position to come to my clinic. He was unable to move his lower limbs since 1 month. On taking history, I was told that on 31st july 04,he had a fall in morning with sudden weakness in legs. After that he is completely unable to move his legs. There is sensation as if legs are joined and fixed. There is tingling in legs with sudden jerks and twitching of feet. There is heaviness in left leg. He also experiences severe headache off and on which is aggravated by pressure. He has pain in nape of neck, upper dorsal region and left shoulder and feeling of pressure on chest. Since the onset of problem, patient is having sweating on Right side of body only. He has ineffectual desire for urination and also urinary incontinence more at night. Patient also complains of anxiety and restlessness.
There is positive H/O anuria with U.T.I. prior to this problem.
F/H-Grand father was Diabetic. Grand mother had some joint problem.
PHYSICAL GENERALS-Desire for Salty food (++), Thermal Reaction-Hot,
Apetite, Thirst, Stool-Normal.
MENTALS – Patient is social, obedient and intelligent. He has childish behaviour, easily gets excited and loses his temper.
Patient was fully conscious with normal pulse, B.P. and temperature. There was complete loss of power in both lower limbs and normal power in both upper limbs.
INVESTIGATIONS (Done on 31st july)
Urine culture showed moderate growth of E coli.
Motor nerve conduction studies – Electrophysiology is suggestive of acute axonal polyradiculoneuropathy consistent with G.B.Syndrome.
MRI dorsal spine-Normal
Patient was taking Tab Vexx 20 O.D., Tab Uroton 25 mg B.D., Tab Methycopal 500 micro g O.D.
Even after hospital stay and 1 month of regular medication, the condition of the patient had not improved much.
Considering the symptoms of paralysis and urinary incontinence as chief presenting complaints, CAUSTICUM 1M,4 doses were prescribed to be taken on alternate days on 1st September and patient started improving thereafter.
On 5th October Patient complained of jerking (+++) of feet. He also gets fatigued easily. Urinary incontinence was better. So RHUS TOX 1M,4 doses on alternate days and ZINCUM MET 30 t.d.s. were prescribed.
Patient responded very well and on 3rd nov.he was able to come to my clinic for the first time. He was much better and was able to take few steps without walker even.
C/o jerking of feet : better, more in left leg. Now he was also able to control the urge for urine. Bed Wetting: frequency reduced to almost once in a week., Pain in legs :absent. C/O Headache after exertion. He has now started sweating on left side of body also. No more pain in nape of neck. No more tingling . Muscle tone building up. Same prescription was repeated for quite some time as patients condition was improving.
In between medicine like EQUISETUM H and GELSEMIUM were also given for associated complaints.
Motor nerve conduction studies repeated on 12th November showed- FUC of GBS showing Good Reinnervation on right side and early Reinnervation changes in left quadriceps and no reinnervation in left tibialis anterior.
Now after 7 months of regular treatment , patient is absolutely fine .It is such a pleasure to see Mr. Varun walking on his own to my clinic without any help. His parents are so elated with joy as prior to this treatment they were very apprehensive whether their son would ever be able to go to school or not. Not only did he go to school but also appeared in his 10th Board exams and did well.
RHUS TOX- Paralysis of lower limbs, great weariness and heaviness of lower extremities, restlessness of lower limbs at night . Stiffness of legs. Tearing pain in tendons ligaments and fasciae. Rheumatic pain spread over a large surface at nape of neck, loins and extremities, better motion. Numbness and formication. Trembling after exertion. Loss of power and tingling in feet. Rhus Tox also covered the symptom-Perspiration – One sided.
ZINCUM MET- Limbs paralysed, paresis and finally paralysis of both sides. Jerking ,trembling and prostration. Shocks and jerking during sleep. Lameness, weakness and twitching of various muscles.
CAUSTICUM- Paralysis of lower limbs. Indescribable fatigueand heaviness of body. There is tremulousness, quivering, jerking and twitching of muscles. Numbness and paralysis of single parts. unsteady walking and easy falling. Involuntary Urination at night .Urinary incontinence. Urine expelled very slowly and sometimes retained.
Sr. HOMOEOPATHIC CONSULTANT
Director-OVIHAMS ( Sh.Om Vidya Institute Of Homoeopathy and Allied Medical Sciences)
Recipient- International Hahnemann Award of the Millennium;
Member- Homoeopathic Advisory Committee Govt. of NCT Delhi.
Author- The Problem Child and Homoeopathy
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