in this video we'll talk about Gillian B syndrome recently in India Gillian B syndrome was a big news and in last 2 weeks several regions of India has reported cases of gilan B syndrome Pune one of the major cities in India has several Gillian bar syndrome cases and who rates it among one of the largest outbreak in the world out of 140 patients who who are affected by Gillian B syndrome 18 of them are on ventilators so question comes what is gilean bar syndrome I mean how does it affect the human body what caused the disease and is there a treatment and most importantly why patients are on ventilator how does it affect our breathing all these aspects would be answered in this video so stay tuned till the end so Gillian bar syndrome is also known as um acute inflammatory demyelinating poly neuropathy quite a mouthful is a disease where the peripheral nervous system is affected due to an autoimmune attack that means the body's own immune system attack the peripheral nervous system that lead to muscle weakness tingling and many other symptoms in the Gan bar syndrome so here is a nerve and the nerve is covered with a sheet known as mine sheet milein sheet ensures that there is a rapid conduction of the nerve impulse now in gilean bar syndrome what happens is the body's own immune system which was supposed to protect the body mistakenly attacks these kind of milein sheets as a result the milein Sheed is damaged that lead to poor conduction of nerve impulse in the peripheral nervous system and that's the key of the pathology of this disease now the peripheral nervous system is really important for controlling several bod's function for example it controls breathing Rhythm sometimes it regulates the way we move our hands and legs Etc so obviously in this in this syndrome there is a numbness in the extremities there could be also muscle weakness and tingling Sensations so visible symptoms involve numbness in the hands and the legs most prominent in the extremities that means in the fingertips or the toe tips then there is swallowing difficulty there could be shortness of breath so the clinical presentation includes a progressive onset of pain which is starting from the extreme and eventually ascending upwards people also call this stalking pattern of pain that means as if the pain is worn like a stalking basically the second thing is paresthesia that means numbness and tingling in the extremities that we have discussed all already third is loss of reflexes or a reflexia that means fine-tuned reflexes which are not controlled by our brain those are hampered and that is crucial for survival of any species there could be autonomic dysfunction leading to irregular heartbeat blood pressure instability Etc also there could be respiratory involvement in sever cases ventilation is required so at this point we should ask how there is a respiratory involvement is this caused by a respiratory virus well the respiratory involvement is due to a different reason so basically there are important nerves such as frenic nerves which supplies uh to the diaphragm now diap is a particular muscular structure that helps to contract the lungs and basically change the volume of the entire thoracic cavity so in the chest cavity it make it regulates the breathing patterns so if the frenic nerves are affected that would lead to a problem in the breathing Rhythm also there could be weakness in the intercoastal muscles these are also uh muscles associated with breathing that would lead to high hypoventilation or a breathing difficulty also there could be uh bulbar dysfunction that means a brain stem involvement brain stem has specific regions which regulate the swallowing and uh regul and protects our Airway system from swallowing any kind of like food or anything so if this particular Rhythm and this particular function is disrupted then there would be swallowing of uh saliva following swallowing of food Etc which might lead to an aspiration pneumonia and these are the leading cause why a patient might need a ventilator in this particular disease so just to summarize the clinical presentation there could be motor symptoms that means Progressive and this Progressive means it happens over days there are progressive ascending paralysis like a problem mostly these are symmetric that means happens in both the legs or both the hands and the pattern is distal to proximal which is actually a stocking or glove like pattern then there could be involvement of the uh lungs and and respiratory system basically sensory functions can also get compromised autonomic functions such as regulation of heartbeat heart rhythm Etc can be getting disregulated and reflexes can be compromised leading to a reflexia so the risk factors include one of the major risk factor is ciloa Juni bacteria viral infection and sometimes influenza vaccine that is rare So basically ipin bar virus cytomegalo virus and in some cases neuro viruses are reported to do this kind of um this kind of syndrome these are associated with it but it's hard to really put them in a causal stage now the question is how does these infection can actually lead to gulan syndrome so imagine there is a bacterial attack in the body so obviously body would like to clear that bacteria and as a result body would secrete uh I mean the immune system of the body the B cells would secrete specific neutralizing antibodies against these bacterial antigen but some of these antigen mimics the antigens that that are normally found in the nervous system so obviously due to this molecular mimicry mistak ly the antibodies secreted by the B cells affect the milein sheet and that leads to the damage of the peripheral nervous system this is a boon for the bacteria but a huge loss for the body and this leads to the uh overall dysfunction in the peripheral nervous system in the gilean bar syndrome now there are several subtypes of the gilan syndrome for example the most common one is aidp or acute inflammatory demyelinating poly neuropathy that means this neuropathy is due to demyelination most common in us and uh Europe there is also acute motor axonal neuropathy this is most oftenly associated with ciloa Juni infection there is acute motor sensory axonal neuropathy so both sensory and the motor system are compromised here and this is very severe actually and there is another variant known as Miller fure syndrome which is characterized by Axia and arifia so these are the overall subtypes but anyway in this particular case the aidp is the most common one how is the diagnosis done so one of one can check the nerve conduction velocity using electromyography test so overall a decreased uh decreased parameter would basically tell uh that there is a diffuse demin happened in the Gillian B syndrome that might have reduced the conduction velocity also CSF examination is really important cerebral spinal fluid can be collected by Lumar puncture and in the CSF there is an abnormal increase increase in the protein concentration protein concentration more than 55 mg per Dil with little or no pleomorphic cells would indicate a GBS syndrome so the white blood cells are generally not there so basically it's not a CSF infection or a meningitis so that can be ruled out so overall um these are some differentials that a clinician need to know but overall the treatment option requires plasma feris and IVIG are the first line of treatment basically corticosteroids are generally not indicated so frequent monitoring of the situation respiratory function and other kind of um rhythms has to be monitored properly so that is why ICU admission might be required and aggressive physical rehabilitation is is needed it's often fatal for less than 10% of the cases but sometimes there could be unknown cause that is causing this disease and could be could be very detrimental for the human being so recovery might take even up to 1 year so here is a quick summary that would help to remember you about the ganb syndrome and the pathologies associated with it so it's called adip so acute inflammatory demyelinating polyneuropathy and the paralysis or the overall progression of the nerve weakness happens in ascending fashion there is it's also autonomic neuropathy and and there is a presentation of albuminocytological uh Association that means basically there is more protein in the cerebral spinal fluid so I hope this video was useful if you like this video give it a quick thumbs up don't forget to like share and subscribe you can follow our notes in Instagram and Facebook page so see you in next video you can support us using super thanks and see [Music] you for