Chronic demyelinating polyneuropathy Guillain-Barré
Chronic demyelinating polyneuropathy Guillain-Barré, in contrast to simple Guillain-Barré syndrome, is characterized by delayed development, the phase of disease progression usually lasts at least 2 months. Chronic demyelinating polyneuropathy Guillain-Barré today means Guillain-Barré polyneuropathy, which has an acute onset and lasts more than 2 months, sometimes accompanied by exacerbations and remissions.
The prevalence of this disease, according to research data, is from 1 to 2 patients per 100,000 population, while the disease is slightly more often found in men, most often occurring at the age of 40-60 years. Improvement in this form of polyneuropathy can occur without any treatment. The methods of treatment almost completely coincide with the methods of treating the acute form of this syndrome.
Chronic demyelinating Guillain-Barré polyneuropathy, like other autoimmune diseases, often occurs when several factors do not coincide. Such factors can be prolonged stimulation and / or depletion of the immune system. This factor means sleep deficit, stress, trauma, surgery, vaccinations, infections, serious illness. Also, these factors include genetic predisposition.
The type of disease course (progressive, recurrent, or monophasic) in any particular patient remains unchanged throughout the course of the disease, and the severity of the condition and the severity of symptoms may differ in different phases of the disease. The leading symptom of Guillain-Barré demyelinating polyneuropathy is muscle weakness. Chronic demyelinating polyneuropathy can be accompanied by remissions and exacerbations, as well as progress steadily.
The initial symptoms of the disease are often weakness in the lower parts of the legs, most often symmetrical, but sometimes it is asymmetric, as well as numbness and paresthesia of the hands and feet. Further, paresthesia from the distal parts spreads higher, capturing not only the legs, but also the arms, sometimes leading to the fact that patients are bedridden.
Pain syndrome in chronic demyelinating polyneuropathy is noted much less often than in the usual Guillain-Barré syndrome, here if it occurs, then it most often happens during exacerbations. Due to the fact that the signals sent by the nerves poorly reach the brain, one of the symptoms may be loss of balance with closed eyes. In some cases, a tremor appears in the hands, which does not subsequently spread to other parts of the patient's body.
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Symptoms also include fatigue, general malaise, a slight prolonged rise in temperature, apathy, depression. Loss of 10 to 20 kg of weight during the year at normal body temperature and the absence of gastrointestinal disease can also be one of the symptoms of this serious disease. As a result of illness and nerve damage, nerve impulses do not reach their target, therefore, the disease is accompanied by characteristic symptoms.
The main symptom is muscle weakness, with muscle weakness extending not only to the upper and lower extremities, but also to the bladder, intestines, and other muscles. Also characteristic symptoms is a decrease in sensitivity - numbness and perversion of sensitivity.
Diagnosis of chronic demyelinating polyneuropathy Guillain-Barré has three main components: electrophysiological, laboratory and clinical. The clinical component requires the patient to have sensorimotor neuropathy, which develops within at least 2 months and is accompanied by either areflexia or hyporeflexia, as well as a significantly increasing limitation in the functions of the arms and legs.
The laboratory component is an increase in protein in the cerebrospinal fluid, while not accompanied by an increase in the number of cells. This criterion is confirming the diagnosis, but is not required. The electrophysiological component implies that the examination will reveal a slowdown in the conduction of nerve impulses along the motor nerves.
Usually, the establishment of a diagnosis does not cause problems, however, recently, an atypical course and development of the disease has been increasingly noted. With the help of effective immunotherapy, it is possible to achieve an improvement in 70 - 90% of cases of chronic demyelinating polyneuropathy Guillain-Barré, but the main difficulty of treatment is maintaining the achieved positive result.
The main components of such treatment are corticosteroids, immunoglobulin and plasmapheresis, while in each individual patient one or another method will be more effective, based on the personal indicators of each patient.
The choice of a treatment method will be determined depending on the presence of concomitant diseases, which, due to their specifics, may limit the use of certain drugs. So, for example, long-term use of corticosteroids is undesirable in the case of diabetes mellitus and in women in menopause. Individual metrics such as the sensitivity and availability of a given method will also influence the choice of treatment. Methods can be used individually or combined.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
