CGTC FAQs: Academic Support

Guillain-Barre syndrome, GBS, is an autoimmune disorder that affects the peripheral nervous system and causes sudden onset of weakness and paralysis.  The pathophysiology behind this disorder is that patients typically have a viral infection such as influenza or pneumonia that triggers the autoimmune destruction of the myelin sheath and of the axons in the motor and sensory nerves.  Sounds like MS because destruction is in the central nervous system having destruction of the myelin sheath.  However, GBS has a peripheral nervous system distribution.  Signs and symptoms of GBA include tingling in feet and hands, as well as, symmetric weakness.  The patient may also have decreased deep tendon reflexes.  Symptoms typically occur at the feet and move up the body.  In terms of treatment, plasmapheresis can be done which will filter the blood and get rid of those bad antibodies that are attacking the nerves.  Treatment with IVIG, an intravenous immunoglobulin, with as good antibodies for the patient.  Because muscle paralysis is possible, we want to maintain a patent airway and monitor the patient for aspiration, pneumonia, as well as respiratory failure.  

Myasthenia gravis or MG is an autoimmune disorder that causes severe muscle weakness.  It is characterized by periods of exacerbation and periods of remission.  The pathophysiology behind this condition is that antibodies block and destroy acetylcholine receptors at the neuromuscular junction.  This causes symptoms such as muscle weakness which is worse with exercise and improves with rest.  MG can also cause diplopia, and double vision.  As well as, dysphagia, and difficulty swallowing.  It can cause shortness of breath and thymus hyperplasia.  The thymus is located in the mediastinum superior to the lungs, and it produces T cells.  If the gland is enlarged, then that may be indicative of MG.  MG patients may have drooping eyelids.  Diagnose MG using electromyography as well as a repetitive nerve stimulation test.  Also can do an edrophonium or Tensilon test to diagnose MG.  Purpose of this test is to differentiate Myasthenia Gravis from a cholinergic crisis.  Both Myasthenia gravis and cholinergic crisis can cause extreme muscle weakness.  The cholinergic agent is going to increase the levels of acetylcholine which would help a patient with MG because they have too little acetylcholine secondary to the destruction of acetylcholine receptors at the neuromuscular junction.  Edrophonium would increase the amount of acetylcholine, and make the patient feel better.  A patient in a cholinergic crisis, meaning there is too much acetylcholine would make matters worse.  These would require atropine, an anticholinergic agent.  Treatment for MG includes neostigmine and pyridostigmine which are cholinergic agents preventing the breakdown of acetylcholine.  Can also use immunosuppressants such as prednisone.  Patients may also get plasmapheresis, which will filter the patient's  blood to get rid of those bad antibodies.  A thymectomy may be helpful as well.  In terms of nursing, we want to ensure that the patient maintains a patent airway.  Assist the patient with ambulation.  Frequent small high-calorie meals then monitor for aspiration and choking because of the risk of dysphagia.  Patients with MG usually have problems with closing eyes at night.  This may be the cause of drying of the eye which could lead to damage to the cornea.  Administer eye drops, and then tape their eyes shut at night to prevent that drying and irritation.