E-ISSN:2456-3110

Case Report

Guillain Barre Syndrome

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 4 May
Publisherwww.maharshicharaka.in

Understanding of Guillain Barre Syndrome and its management through Ayurveda - A Case Study

Hiremath M.1*, Dharmannavar G.2
DOI:

1* Mahantesh Hiremath, Second Year Post Graduate Scholar, Department of Kayachikitsa, Shri Shivayogeeshwar Rural Ayurvedic Medical College & Hospital, Inchal, Belagavi, Karnataka, India.

2 Girishkumar S. Dharmannavar, Assistant Professor, Department of Kayachikitsa, Shri Shivayogeeshwar Rural Ayurvedic Medical College & Hospital, Inchal, Belagavi, Karnataka, India.

Guillain-Barre’ Syndrome is an acute inflammatory demyelinating polyneuropathy caused generally by autoimmune response after certain post infections. GBS damages part of nerves. This nerve damage causes tingling, muscle weakness and paralysis. According to Ayurveda, it can be correlated with Vatavyadhi - Sarvangaghata. A 62 Year old male patient, presenting with sudden onset of, complete paralysis of all four limbs (quadriplegia), unable to walk, stand, sit, difficulty in deglutition (dysphagia) and dysarthia. Previously patient admitted and treated in SNMC Medical College, Bagalkot, but did not show any sign of improvement. So, patient was admitted and treated with Ayurvedic treatment for 60 days. As per Ayurvedic classics which is Apatarpan a nature (diseases with deprived nourishment of body tissue) preceded by Jvara (H/O fever before onset of GBS). Hence the principle of treatment is Santarpan Chikitsa (nourishing treatment) includes Bahyopakramas (nourishing external treatment modalities), such as Abhyanga (oleation therapy) and Shastika Shali Pinda Sveda (sudation using hot and processed), Kalabasti (medicated enema), Sirodhara (gentle pouring of medicated liquid over forehead) and using various Ayurvedic herbomineral compounds. Remarkable results were observed in the form of improvement in the muscle power from zero to five of all four limbs with improvement in speech. There was no difficulty post treatment in deglutition, sitting, standing and walking; and now patient is near to normal movements.

Keywords: GBS, Santarpan Chikitsa, Sastikasalipindasveda, Kalabasti, Sirodhara, Abhyanga

Corresponding Author How to Cite this Article To Browse
Mahantesh Hiremath, Second Year Post Graduate Scholar, Department of Kayachikitsa, Shri Shivayogeeshwar Rural Ayurvedic Medical College & Hospital, Inchal, Belagavi, Karnataka, India.
Email: 		Mahantesh Hiremath, Girishkumar S. Dharmannavar, Understanding of Guillain Barre Syndrome and its management through Ayurveda - A Case Study. J Ayu Int Med Sci. 2022;7(4):146-150.
Available From
https://jaims.in/jaims/article/view/1849

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-04-02 2022-04-04 2022-04-11 2022-04-18 2022-04-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Mahantesh Hiremath, Girishkumar S. Dharmannavarand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(4)146
Hiremath M et al: Understanding of Guillain Barre Syndrome and its management

Introduction

Guillain barre syndrome is an acute, frequently severe and fulminant polyradiculopathy that is autoimmune in nature. Guillan barre syndrome is a rare disorder that causes the immune system to attack the peripheral nervous system (PNS).[1] The paralysis is of LMN type with loss of reflexes. Mostly no sensory abnormalities are seen. Bladder and bowel are rarely involved. Sometimes respiratory system may involve causing serious complications including death. The CSF protein is raised. Diagnosis is done by EMG-NCV. Supportive treatment is given with IV immunoglobulin.[2]

As per Ayurvedic classics, this condition can be correlated with Sarvangagata Vatavyadhi (Vata disorder affecting all parts of the body),[3] GBS is Apatarpanjanya Vatvyadhi, hence the choice of treatment is Santarpana (nourishing treatment). Santarpana did in the form of Balya and Brimhanan Chikitsa as well as Bahya and Abhyantar Snehana done in the form of Alepa Chikitsa, Sarvanga Dhanyaamladhara, Taladhara, Veshtana Karma, Swastika Sali Pinda Sveda, Kalabasti, Sirodhara, Abhyanga.

Case Study

A 62 years old male patient (OPD no.- 8864-03/03/2022) came to our institute with the complaints of complete paralysis of all the four limbs, inability to walk, stand, do regular activities and severe muscle wasting with a weight of 48 kg. Patient was conscious and vital functions were normal. Patient was admitted in Shri Shivayogeeshwar Rural Ayurvedic Medical College and Hospital, Inchal (IPD no. - 1331-03/03/2022).

Past History

H/O - DM.

No H/O - HTN, Asthma or Tuberculosis.

No H/O - Alcohol consumption or any other drug abuse.

History of presenting symptoms

Patient was healthy eight days before presentation of quadriplegia, but had high grade fever for which he took medication from SNMC Bagalkot. But fever didn’t subside. He developed gradual weakness in all the four limbs in approximately

three days. For these complaints he got admitted in Shri Shivayogeeshwar Rural Ayurvedic Medical College and Hospital, Inchal. There MRI brain, EMG-NCV and other investigations done. Patient was diagnosed with GBS. Treatment given to patient in SNMC Bagalkot, over a period of eight days included dosage of Tab. Pregabalin and Methylcobalamin (BD), Inj Tramadol, Inj Human actrapid, Tab Ecosprin gold (10mg OD), IV Fluids, Syp Zincovit (2tsf TID), Tab DOLO (500mg BD), Ceftriaxone (1gm BD), Pantoprazole (BD), Physiotherapy and Trans Electrical Nerve Stimulation and As well as IV Immunoglobulin treatment was given, but no improvement noted. Then patient remained bedridden for almost 10 months.

General Examination

The patient was afebrile and his pulse was 80/min, Blood pressure 110/70mmhg. He appeared pale and he had moderate weight (47kg).

Physical examination

The distal greater than proximal and involving the lower limbs more than the upper limbs. Muscle tone was decreased and vibratory sensation was diminished in the distal lower extremities. Muscle stretch reflex were absent.

Systemic examination

Abdomen was mildly distended, non-tender, and bowel sounds were present. Patient was conscious and well oriented and pupillary reaction to light was normal. In the systemic examination, findings of respiratory and cardiovascular system were within the normal limits.

Reflexes

All upper and lower limbs reflexes are absent along with no response in the plantar aspect (Both right & left limb).

Muscle power grade

Both upper limb and lower limb of right and left side of the body have Grade 2 muscle power that is, movement which is possible if gravity is eliminated.

Investigations

  • EMG-NCV - Suggestive of predominantly motor demyelinating type polyradiculoneuropathy involving the all the four limbs.
  • Routine blood and urine investigations - WNL

Journal of Ayurveda and Integrated Medical Sciences 2022;7(4)147
Hiremath M et al: Understanding of Guillain Barre Syndrome and its management
  • MRI Brain - No significant Abnormality seen

jaims_1849_01.JPG

jaims_1849_02.JPG

Ayurvedic management - Shodhana Chikitsa

Treatment Plan
Alepa Chikitsa (1st round)
Sarvanga Dhanyaamla Dhara (1st round)
Taladhara - (Vacha Churna) (1st round)
Veshtana Karma - (Moorchita Taila) (1st round)
Sastika Sali Pinda Sveda (1st and 2nd round)
Kala Basti - (Rajayapana Basti) (1st and 2nd round)
Abhyanga - (Narayana Taila) (2nd round)
Shirodhara (2nd round)

Shamana Chikitsa

Medicine Frequency
Tab Rasarajeshwarirasa OD
Cap Palsineuron BD
Tab Ekangaveera Rasa BD
Tab Vishatinduka Vati BD
Dhanadanayadhi Kashaya TID
Cap Nuro-XT TID
Mashabaladi Kashaya TID

Gait Change’s

SN Week Gait
1. 1st week Unable to get up
2. 3rd week Stand with support
3. 5th week Walk with support
4. 6th week Stand without support
5. 7th week Walk without support

Weight Change’s

SN Week Weight
1. 1st week 48kg
2. 3rd week 53kg
3. 5th week 55kg
4. 6th week 58kg
5. 7th week 60kg

Showing Improvement of patient after treatment

SN Signs and symptoms Before treatment After treatment
1. Torso balance With support Yes
2. Grasp of object No Yes
3. Holding object No Yes
4. Without initiation Holding objects No Yes
5. Release of object No Yes
6. Able to rise the shoulder No Yes
7. Stability No Yes
8. Knot Tying No Yes
9. Propelling of object No Yes
10. Eating No Yes
11. Holding glass of water No Yes
12. Clothing No Yes
13. Squatting No Yes
14. Standing No Yes
15. Combing No Yes
16. Writing No Yes
17. Bathing No Yes
18. Walking No With support
19. Weight 48kg 60kg
20. Climbing the stairs No With support



Journal of Ayurveda and Integrated Medical Sciences 2022;7(4)148
Hiremath M et al: Understanding of Guillain Barre Syndrome and its management

Result and Observations

Improvement seen in patient after treatment compare to before treatment. Patient admitted on 03/03/2022. Above treatment was started and continued for 60 days.

Before treatment After treatment
Both upper limb and lower limb of right and left side of the body have Grade 2 muscle power that is, movement which is possible if gravity is eliminated. Both upper limb and lower limb of right and left side of the body have Grade 5 (normal).

Discussion

The G B Syndrome is an acute / subacute relatively symmetric lower motor neuron paralysis from which greater than 85% of patients obtain a full/functional recovery.

Here in this case of LMN type of GBS which can be correlated to Apatarpanajanya Vatavyadhi of ayurveda the Viparith Chikitsa is given in form of Santarpanadhi Chikitsa and Pathya.

Patient was treated systematically with both Shodhana and Shamana Chikitsa which is sequentially explained before. Shodhana Chikitsa like Alepa Chikitsa,[4] Sarvanga Dhanyaamladhara,[5] Taladhara, Veshtanakarma, Shashtikashali Pinda Sweda,[6] Kalabasti,[7] Abyanga,[8] Shirodhara[9] were given and also the Shamana Chikitsa were included like Rasarajeshwari Rasa,[10] Ekangaveera Rasa, Vishatinduka Vati, Dhanadanayadhi Kashaya,[11] Mashabaladi Kashaya.

There was a gross improvement in both gait and weight along with different signs and symptoms of patient following treatment from 1st week to 7th week with complete difficulty to get up till walk without support, weight increased from 48kg to 60kg and also patient was able to perform his work by himself.

LMN type of GBS is one type in which there is Gross reduction in muscle power, here both upper and lower limb of right and left side of body attained with grade 5 muscle power after completion of treatment.

Conclusion

GBS is a severe acute paralytic neuropathy with rapid progression usually occurring post infections which can be correlated to Vatavyadhi

of Ayurveda. As in this case study it’s a LMN type of GBS its correlated to Apatarpana Janya Vatavyadhi hence, Vatahara Chikitsa and Santarpana Chikitsa were being followed for period of 7 weeks. Here there is Vata Prakopa associated with Dhatu Kshaya with association of other Doshas. Preceded with Jwara and Stamba of extremities suggestive of involvement of other Doshas along with Vata.

Hence, in this case study it is seen how GBS is being treated with Ayurvedic mode of Shodana and Shamana treatment along with other Santarpana Chikitsa and after the treatment follow up showed sustenance of all positive outcomes.

Ayurveda management of GBS showed improvement in motor and sensory deficits following ayurveda treatment have been beneficial to the patient. Outcome showed significant role of ayurveda in severe debilitating disorder like GBS.

Reference

1. Longo DL, Fauci AS, Kasper DL, Jameson JL, Hauser SL, Loscalzo J. Harrison’s Principle of Internal Medicine Vol 2. New York, NY; McGraw Hill; 2010, Page No- 3473

2. Brian R. Walker, Nicki R. Colledge, Stuart H. Raltson, Ian D. Penman Davidson’s Principle of Medicine, Churchill livingstone Elsevier 22nd edition, GBS, Page No- 1225

3. Mahadevan L, Srividya S, Jeyalakshmi B. Dr. L. Mahadevan’s Guide to Ayurvedic Clinical Practice Neurology Vol 2. Kanyakumari, Tamilnadu, India: Sarada Mahadevalyer Ayurvedic Educational and Charitable Trust Derisanamscope;2011. p.300-1.

4. A clinical study on the effect of Agni Chikitsa in Pakshaghata -Dr.Patanjali, SDMCA&H, Udupi, 2006

5. Agnivesha, Charaka, Drudabala, Chakrapanidatta. Sutra sthana, In: Acharya YT (Edi.), Charaka Samhita with Ayurveda Deepika Commentary. Reprint Edition: 2014. Varanasi: Chaukhambha Surabharathi Prakashana: 2014.

6. Acharya Vidyadhar Shukla and Prof. Ravidutta Tripathi, Charak samhita of Agnivesha part I, Chaukhamba Surbharati Prakashan ,Sutrasthana,Adhyaya 14, Verse 26, page no 220

7. Ibidem. Charaka Samhita, Siddhi Sthana, Trimarmeeyam Siddhim Adhyaya, 9/7. 6:330.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(4)149
Hiremath M et al: Understanding of Guillain Barre Syndrome and its management

8. Acharya Vidyadhar Shukla and Prof. Ravidutta Tripathi, Charaksamhita of Agnivesha part I (Purvardha), Chaukhamba Surbharati Prakashan, Sutrasthana, Adhyaya 05, Verse 85, page no 100

9. Uebaba K,Xu FH, Tagawa M, et al. Using a healing robot for the scientific study of shirodhara.Altered states of consciousness and decreased anxiety through Indian dripping oilb treatments. IEEE Eng Med Biol Mag.2005;24(2):69-78.

10. Bhaishajya Ratnavali, Vatavyadhi chikitsa 26/198-202

11. Rao GP. Sahasra Yogam, chapter 3, verse 192. Varanasi: Choukhamba Sanskrit Series; 2016.P.91.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(4)150