00:01
What's going on with Guillain-Barre?
What's the pathophysiology of AIDP?
Well, this is an
inflammatory disorder
and involves both cellular
and humoral immune features.
00:12
Some of those humoral
immune features,
or B cell antibody features
include production of
antiganglioside antibodies.
00:19
Some of those include
GM1, GD1a, and GQ1b,
which are associated with
certain variants of Guillain-Barre.
00:27
But at the end of the day,
what's going on
is the immune markers that are
within the systemic circulation
are able to break through
and gain access to the nerve.
00:36
This results in breakdown of
the myelin and demyelination,
as well as sensitization of T-cells
to myelin basic protein
propagating this immune response.
00:46
We see immune attack
on the distal nerve,
we see immune attack
on the proximal nerve,
and that results in both
with prominent weakness
and early areflexia
as well as some component
of sensory abnormalities.
00:57
commonly in these patients.
01:03
Let's think a little bit more
about our diagnosis
and how we use lumbar puncture
which is the most important test
to evaluate for an
inflammatory nerve disorder.
01:12
We're looking for
signs of inflammation
and classically an inflammatory LP
is elevated protein
with normal cells.
01:18
We call this
albuminocytologic dissociation
which is something to know
that term is often associated
with Guillain-Barre,
but that pattern can be seen
with any inflammatory disorder
of the nerve or
central nervous system.
01:33
Albuminocytologic dissociation
means
elevated albumin,
elevated protein with normal cells,
no pleocytosis or
minimal pleocytosis.
01:43
And again, we can see mildly
elevated cells or pleocytosis,
but typically
not more than 10 or 20.
01:51
EMG nerve conduction
is also important.
01:53
And again in classic
AIDP or Guillain-Barre,
we see demyelinating findings.
01:58
Prolong distal latency,
asymmetric reduced
conduction velocity,
we may see conduction block
or prolonged F-waves,
and all of those things
are indicating
an inflammatory disorder
of the myelin
and are supportive of
a diagnosis of the AIDP.
02:16
We may also see axonal patterns and
that would point us to a variant
of typical classic Guillain-Barre
and may influence prognosis.
02:26
So how do we treat a
AIDP or Guillain-Barre?
Well, this is an
immune mediated disorder.
02:32
And so we use
immunomodulating therapy.
02:34
We typically don't use
steroids for this condition,
and a treatment is reserved
for intravenous immune globulin
or plasmapheresis.
02:43
We don't treat the underlying
pathophysiology the nerve damage.
02:46
The goal is to
reduce ongoing damage
and allow the nerve to reinnervate
and to reinnervate over time.
02:53
The goal of treatment is to
reduce the severity of the nadir
to prevent patients
from requiring
mechanical ventilation
or respiration.
03:02
We want to limit the
need for that intubation
and reduce the duration
of intubation if necessary.
03:07
And importantly,
we do need to monitor
respiratory status
to evaluate respiratory
and pulmonary function
in these patients.
03:16
There are some complications
that we can see with Guillain-Barre,
and some key findings
and associated symptoms
that we watch for in hospitalized
patients with this condition.
03:26
The first is patients can develop
an autonomic neuropathy
that can result in
cardiac instability.
03:31
arrhythmias, heart block.
03:32
We can see SIADH.
03:34
We do monitor patients on telemetry,
we monitor
respiratory status frequently
and do consider laboratory studies
to evaluate for these
associated complications.