Guillain-Barré syndrome(GBS) is characterized by an initial polyneuropathy that progresses quickly is a rare autoimmune disease. It’s also known as Acute Inflammatory Demyelinating Polyneuropathy(AIDP).

It is frequently brought on by infections that cause the immune system to target peripheral nerves. Peripheral nerves’ myelin sheath is damaged by an abnormal immune response that causes demyelination, which is the cause of GBS. Although most GBS patients recover, the process can take weeks or years, and others may have long-term nerve damage. 

According to Ayurveda, Guillain-Barre syndrome is a nervous system disorder mostly caused by an imbalance in VATA DOSHA(which regulates the nerve system and the body’s movements) along with dhatu kshaya and ojo kshaya. 

While classical Ayurvedic scriptures do not specifically mention GBS, symptoms such as paralysis, loss of sensation, and muscle weakness can be associated with illnesses such as Vata Vyadhi. Similarly symptoms like emaciation, discomforts associated with sense organs, weak immune system etc can be correlated to oja kshaya. Muscle weakness and fatigue ,is been in agreement with dhathu kshaya lakshanas.

CLINICAL SYMPTOMS OF GUILLAIN BARRE SYNDROME:

1.Weakness:

• Symmetrical muscle weakness: The most typical symptom, which begins in the legs and spreads to the arms, face, and upper body.
• Difficulty in walking: Patients find it difficult while standing or walking due to muscle weakness.
• Ascending paralysis: Usually the weakness begins from the lower limb and progressively traverses to the upper body.

2.Reflex Changes:

• Areflexia or hyporeflexia: One typical and distinguishing sign is the loss or decrease of deep tendon reflexes, such as the knee jerk reflex.

3.Pain:

• Nerve pain: Sharp, shooting pain that may get worse at night, especially in the legs.
• Muscle pain: Typically in the shoulders, thighs, or lower back, aching or cramping pain will be seen.

4.Sensory Disturbances:

• Loss of sensation: Diminished sense of touch, pain, or temperature; usually begins in the extremities.
• Tingling or numbness(paresthesia): Tingling, prickling  sensations that frequently begin in the hands and feet.

5.Autonomic Dysfunction:

• Difficulty in regulating body temperature.
• Abnormalities in heart rate(Arrhythmia or Tachycardia).
• Fluctuations in blood pressure(Low or high BP).
• Difficulty with bowel movements and urination.

6.Respiratory issues:

• Breath shortness and failure in respiration: Severe paralysis can impair breathing muscles, including the diaphragm, necessitating mechanical ventilation.

7.Weakness of cranial nerve and facial nerve:

• Sometimes Bell’s palsy-like symptoms include difficulty in blinking, smiling, or closing one’s eyes.
• Weakness in the muscles of the mouth, throat, or tongue that makes it difficult to swallow, chew, or talk.

8.Coordination Difficulty:

• Ataxia: Impaired balance and coordination brought on by weakness or sensory deficiencies, which causes unsteady gait.

Quick onset of respiratory distress, dysphagia, or muscle weakness are medical emergencies that need to be attended to right away. Usually, the symptoms reach their climax in two to four weeks, then plateau and followed by  recovery. Under certain circumstances, paralysis can occur quickly and completely in a matter of days.

DIAGNOSIS OF GBS

In addition to laboratory testing and diagnostic examinations, the diagnosis of GBS is mostly reliant on clinical symptoms.

1.Analyzing Clinical Symptoms:

• The symptoms generally begin with weakness and tingling in the lower limb  and traverse to the upper limb.
• Usually symmetrical muscle weakness will be noticed.
• Rapid progression of symptoms.
• Areflexia are cardinal symptoms to be noted.

2.Neurological Examination:

• Muscle strength, sensory functions and reflexes should be studied to estimate the nerve involvement.

3.Nerve Conduction Studies(NCS):

• Nerve damage in GBS is confirmed by frequently delayed or stopped nerve conduction.

4.Lumbar Puncture(Spinal Tap):

• Cerebrospinal fluid is examined via lumbar puncture. In GBS, albuminocytologic dissociation occurs—ie, an increased protein level with a normal white blood cell count—is frequently observed.

5.Autonomic Functions’ Assessment:

• The autonomic nerve system may be impacted by GBS, leading to symptoms such as erratic heartbeats, variations in blood pressure and dyspnea.

6.Electromyography:

• Muscle response to nerve stimulation is measured by EMG, which helps to identify  the distinctive alterations in GBS.

To rule out alternative causes of symptoms, such as infections or problems with the spinal cord, standard imaging studies like MRI,CT etc and blood tests can also be performed.

TREATMENT OF GBS IN MAURYA AYURVEDA

At our Maurya Ayurvedic Hospital, we offer comprehensive and holistic treatments for Guillain barre syndrome(GBS) .Our treatment protocols are designed to address not only the physical symptoms of GBS but also to restore body’s vital energies and stability, promoting overall health and wellbeing. With a focus on patient centered care, we also offer individualized treatment plans  that support faster recovery  and enhance the quality of life for our patients.

EXTERNAL  AYURVEDA TREATMENT

1.PODIKIZHI:

Podi  kizhi is where massaging the body is done with heated herbal poultices. Normally KOLAKULATHADI CHOORNAM is used for the same

Benefits:

• It aids in nerve stimulation and also manages mild inflammation associated with GBS.
• It helps in reduction of muscle stiffness(with the help of medicinal herbs and warmth of kizhi .
• It improves the flexibility of muscles and joints.
• Improved circulation leads to better tissue healing.
• The rhythmic way of massage provides relaxation and leads to reduction of stress.

2.UDWARTHANAM:

Udwarthanam is a dry massage with vigorous strokes, using medicinal herbs. Normally KOLAKULATHADI CHOORNAM alone or mixed with TRIPHALA CHOORNAM is used for the same.

Benefits:

• It aids in stimulating the lymphatic and circulatory system ,leading to alleviation of numbness and discomfort associated with weakened muscles due to GBS.
• It also provides relief from stiffness and inflammation.
• Helps the patient gain improved muscle tone.
• Udwarthanam also has the calming effect, which  promotes relaxation, helps in reduction of stress indirectly leading to better recovery process.

3.NADI SWEDAM:

Nadi swedam is done with a tube or pipe, involves applying steam to specific body parts and produces sweat. It’s considered as a supportive therapy.

Benefits:

• Heat in Nadi sweda, relieves muscle tension, alleviates stiffness and pain.
• Also sweating helps to eliminate toxins from the body.
• It helps in reducing inflammation and swelling.
• Since it helps in lubricating the joints, it improves the flexibility and mobility of the patient.
• It enhances blood circulation to affected areas, which brings up better oxygenation and supply of nutrients and better recovery.

4.ELAKIZHI:

In Ela kizhi, the medicinal herbs wrapped in a cloth bundle(kizhi) that is dipped in warm medicated oil and massage is done.

Castor leaves(Eranda,Ricinus communis),Tamarind leaves(Tamarindus indica),Arka leaves(Calotropis gigantea) etc are generally used to make the elakizhi.

Benefits:

• Here, the warmth of kizhi soothes the muscles and reduces stiffness and pain.
• Since the leaves used in kizhi have anti-inflammatory properties they help to reduce inflammation.
• This kizhi also helps for nerve stimulation enhancing neuromuscular coordination over the time.
• Since GBS is mainly associated with imbalance of VATA, elakizhi is best with pacifying VATA dosha and ensures better muscle coordination and nerve function.

5.NJAVARA KIZHI:

In njavara kizhi, (shashtika shali pinda sweda) pottali is made using njavara rice(medicinal rice).The rice is cooked with milk and herbal decoction ,till it’s consistency become like porridge. The warm kizhi is used to massage the body or the affected area.

Benefits:

• It helps to improve muscle tone and strength.
• It improves joint flexibility.
• Helps in reduction of stiffness.
• Though it’s warm and soothing nature, it provides relief from pain, tingling sensations and numbness.
• It’s extremely nourishing to skin and promotes tissue healing.

5.MAMSA KIZHI:

In Mamsa kizhi ,meat and other medicinal herbs  are cooked and made into the form of a bolus, then a kizhi or pottali is prepared. Using this a therapeutic massage is done.

Benefits:

• This is extremely useful for muscle nourishment and strengthening(meat is highly rich in nutrients and proteins),for the patients who experience atrophy and weakness related to GBS.
• Aids in regeneration of damaged nerves and nourishes nerves.
• Improved range of motion with reduction in stiffness.
• Extremely good in pacifying vata  dosha, and bettering nerve health.
• It’s good for regaining  muscle function, strength and mobility.
• It aids in overall recovery and supports rehabilitation.

6.KADI VASTHI:

Kadi vasthi is holding warm medicated oil in the low back ,held in place by a ring made of dough. 

Benefits:

• The warm medicated oil in helps in reducing muscle stiffness and relaxes the muscle.
• Kadi vasthi is extremely beneficial for pain reduction.
• It nourishes the nervous system, speed up the nerve recovery.
• Improves the circulation and promotes muscle recovery.
• It’s also good at managing stress and improving overall mental health.

7.MATRAVASTHI:

Matra Vasthi(medicated enema) includes administering medicated oil or ghee into the rectum in small amounts, after certain period(30-60 minutes) and bowel is evacuated. In GBS Matra Vasthi is considered as a supportive treatment.

Benefits:

• It’s extremely good for Nervous system rejuvenation.
• GBS is often associated with  muscle weakness, pain and immobility and matra vasthi benefits with improving strength and flexibility of muscles and reduction of pain.
• Helps in relieving  muscle spasm.
• It also pacifies VATA dosha, which is one of  the prime reasons for the GBS.

8.NASYAM:

Nasyam involves application of herbal oil/powders through the nostrils. Patient is made to lie down and followed with head and face massage. Then after applying steam to face, medicinal oil is administered, usually 2 drops(Prathimarsha nasya) or 2-10 drops(Marsha nasya)is  done. After that gentle face massage is done.

It’s benefits in Guillain Barre Syndrome are:

• It improves the functioning of the nervous system.
• Supports reduction of muscle spasm related to neck ,shoulders and upper back region.
• Enhanced circulation.
• Helps in diminution of pain and inflammation.

9.THALAM:

Applying the  medicinal paste to the center of the head is known as thalam. The medicinal paste helps to lessen and treat illness by stimulating and acting upon nerve endings. Rasnadi Choornam is normally used for keeping the thalam.

Its benefits include: 

• Reducing the prevalence of headaches, including migraines and other ENT-related conditions.
• Helps with sleep issues.
• Stimulates senses and sensory channels.

ROLE OF PHYSIOTHERAPY IN GBS

Physiotherapy plays a major role in rehabilitation of GBS ,especially after the acute phase of the disease. The chief complaints associated with this are; muscle weakness, paralysis, respiratory difficulties, hence physiotherapy restores strength, mobility and function. The modalities used in GBS are:

1.Positioning:

Here the techniques used are making the patient lie in 

• Supine position .
• Prone position.
• Side lying position.
• Semi fowler’s position(Head of bed raised at 30-45  degree).

The benefits are:

• Prevention of bed sores.
• Supporting respiratory function.
• Improves blood circulation and prevents blood clotting.
• Improves joint integrity and prevents contracture of muscles.
• Proper positioning leads to decrease in neuropathic pain.
• Positioning with splints helps prevent deformities such as foot drop and helps in attaining correct alignment and posture.

2.Passive Range of Motion(PROM):

Here the physiotherapist  gives gentle movements like flexion, extension ,adduction, abduction and rotation of joints like wrist, elbow, hips, knees, ankle etc .It can be repeated a few times based on the condition of the patient. Splints, cushion, wedges can also be used for a support.

Benefits of PROM:

• PROM increases the blood circulation to the upper and lower limbs, thus preventing oedema in paralyzed patients.
• Better circulation, better oxygenation, better recovery.
• It aids in better sensory stimulation to nerves and muscles.
• Improves muscle memory, helpful when the patient begins Active Range of Motion.
• Helps in preventing muscular atrophy.
• Helps in reduction of pain and discomfort by reduction of stiffness and improved circulation.

3.Active Range of Motion Exercises(AROM):

It involves moving muscles and joints in their full range of motion without any assistance. Given below are few AROM exercises that is practiced:

A)SHOULDER AND ARM EXERCISES:

• Shoulder flexion, abduction and circles.
• Elbow flexion and extension.
• Wrist flexion and extension.

B)HAND AND FINGER EXERCISES:

• Thumb opposition.
• Spreading the fingers.
• Finger flexion/extension.

C)HIP AND LEG EXERCISES:

• Hip flexion and abduction.
• Knee flexion and extension.
• Ankle pumps and circles.

D)NECK AND TRUNK EXERCISES:

• Neck flexion, extension and rotation.
• Trunk rotations.
• Side bends.

E)CORE AND LOWER BACK EXERCISE:

• Seated trunk flexion.
• Bridging.
• Pelvic tilts.

F)ANKLE AND FOOT EXERCISES:

• Toe taps.
• Heel lifts.
• Ankle dorsiflexion and plantar flexion.

G)SPINAL MOBILITY EXERCISES:

• Seated Spine twist.
• Cat-cow stretch.

H)FULL BODY MOVEMENT(GENERAL):

• Seated arm raises.
• Heel slides for legs.
• Wall slides for shoulders.

Benefits:

• This helps improve muscle strength, flexibility and joint mobility.

4.Active Assisted Range of Motion Exercise(AAROM):

It’s usually given in the recovery period. Few ways to perform AAROM exercises in GBS patients:

A)Upper Extremities(Arms):

• Assisted shoulder flexion/Extension.
• Assisted elbow flexion/extension.
• Assisted wrist and finger movements.

B)Lower Extremities(Legs):

• Assisted hip flexion/extension.
• Assisted Knee flexion/extension.
• Assisted Ankle and toe movements.

C)Spine and Trunk

• Assisted Trunk Rotation.

Benefits of AAROM exercises:

• It re-educates muscles and helps in neural recovery.
• Even in weakened muscles it helps retain some muscle activity.
• It promotes circulation.
• It reduces chances of stiffness and contractures in the joints.

5.Soft Tissue Massage :

It includes gentle manipulation of connective tissues and muscles.

Benefits:

• It can reduce pain and muscle soreness associated with GBS.
• Improves blood flow.
• Reduces muscle stiffness.
• Massage can have a calming effect and reduces stress and anxiety.

6.Electrotherapy:

It involves the use of electrical stimulation ,which helps in reactivation of muscle and pain control. Major types of electrotherapy:

A)TENS(Transcutaneous Electrical Nerve Stimulation):

• Helps in the reduction of neuropathic pain.

B)ULTRASOUND:

• Mainly aimed at tissue healing and reduction of pain.
• Also helps in reduction of inflammation and swelling.
•  Improves circulation and promotes healing.

7.Balance and Coordination Exercises:

Here are some balance and coordination exercises:

A)BALANCE EXERCISES:

• Seated balance exercises: Seated Marching ,Weight shifts.
• Standing balance exercises: Tandem standing, Single-leg stance.
• Walking exercises: Heal-to-toe walking, Lateral walking.

B)COORDINATION EXERCISES:

• Ball Tossing.
• Clapping patterns.
• Finger Tapping.

C)CORE STRENGTHENING EXERCISES:

• Bridges.
• Pelvic Tilts.

D)USE OF STABILITY TOOLS:

• Practicing Swiss ball exercises.
• Use of Balance board/Wobble board.

E)GAIT TRAINING:

• Parallel bar walking.
• Use of assisted walking devices.

Benefits:

Practicing these exercises regularly,

• Helps improve motor function.
• Enhances coordination.
• Acquiring strength.

8.Endurance Training:

Exercises performed in endurance training are:

A)WALKING BASED EXERCISES:

• Slow, short walks.
• Interval walking: between slow and faster walking.
• Treadmill walking.

B)CYCLING.

• Stationary biking(5-10 minutes).

C)UPPER BODY EXERCISES:

• Usage of resistance bands to perform repetitive upper body movements.

D)AEROBICS(LOW IMPACT):

• Seated aerobics.
• Step ups.

E)RESPIRATORY ENDURANCE EXERCISES:

• Usage of spirometer.
• Deep breathing exercises.

G)STRETCHING AND FLEXIBILITY EXERCISES.

•  Stretching should be done after endurance exercise to prevent injury.

Benefits:

• It helps in gaining stamina.
• Improve all functional abilities.
• It helps patients regain mobility.
• Increased muscle strength and control.
• Increased sensory awareness.
• Helps in attaining functional independence.
• Also helps in fatigue management and energy conservation.

9.Functional Re-education:

The major components included in Functional re-education are:

A)TRANSFER TRAINING:

• Mobility from bed.
• Sit-to-stand training.
• Transfer in chairs.

B)FUNCTIONAL TASK TRAINING:

• Activities for upper body.
• ADL(Activities of Daily Living)-like eating, dressing ,undressing, household tasks etc.

C)RE-EDUCATION OF UPPER LIMB:

• Training of fine motor tasks.
• Weight bearing exercises.
• Coordination tasks for hand and eye.

D)SENSORY RE-EDUCATION:

• Proprioception training.
• Tactile stimulation.

E)PSYCHOLOGICAL AND EMOTIONAL SUPPORT.

ROLE OF ACUPUNCTURE IN GBS

In GBS ,acupuncture is given, which depends on the patient’s symptoms, stage of disease and recovery process. Few acupuncture techniques given in our hospital:

A)Systemic Acupuncture: Here the fine needles are inserted in acupoints present on arms, legs and back  which are related with nerves and muscles of GBS.

Usual acupoints of GBS are:

• GV20(Baihui) and GV14(Dazhui):It supports neurological function.
• ST36(Zusanil):It enhances the immune system of the body.
• BL23(Shenshu) and BL40(Weizhong):It improves muscle strength and enhances nerve healing.
• L14(Hegu) and L11(Quchi):it helps to reduce pain and inflammation.
• S13(Zhongzhu):It helps for muscle tone regulation and improves nerve function.
• BL60(Kunlun):It’s beneficial  for muscle strength and lower limb motor function.
• DU20(Baihui):It’s given for cognitive function, memory and sensory integration.
• GB21(Jianzhongshu) andBL10(Tianzhu):It’s good for balance, coordination and sensory integration.
• Yintang: It calms the mind, promotes relaxation and helps in reduction of pain.

B)Electro Acupuncture:

Here, needles are used to apply electrical currents.

• It’s extremely beneficial to stimulate nerves and muscles intensely.
• It’s also used to treat numbness, weakness, peripheral nerves healing etc.
• Helps in reduction of neuropathic pain.
• It enhances nerve regeneration.
• Also helps in reducing inflammation in GBS.
• Improves blood circulation.

DIETARY RECOMMENDATIONS IN GBS

General Dietary Guidelines advised  from our hospital are:

• Drink enough water  about(2.5-3 L)
• Avoid arduous activities.
• Intake of vegetables in the boiled form.
• Food items like hot Kanji, steamed idiyappam, puttu, appam(not fermented)(Kerala cuisine),chapati etc can be taken during the course of treatment.

Patients are suggested to avoid :

• Dry fruits, nuts, cold food ,pickles.
• Fermented dosa ,idli, appam.
• Tubers like tapioca, potato, sweet potato.
• Non vegetarian items like fish, meat, egg .If mandatory, mutton can be taken in  curry form.
• Milk and milk products.
• Avoid bakery items, fast food, oily and fried food.

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.