|
 
 |
| CASE REPORT |
|
| Year : 2022 | Volume
: 16
| Issue : 4 | Page : 334-338 |
|
Management of guillain-barre syndrome in a child through ayurveda intervention – A case study
Bhimrao Meshram, Rajagopala Shrikrishna, Arun Kumar Mahapatra
Department of Kaumarabhritya, All India Institute of Ayurveda, New Delhi, India
| Date of Submission | 20-Jul-2022 |
| Date of Decision | 20-Sep-2022 |
| Date of Acceptance | 20-Sep-2022 |
| Date of Web Publication | 17-Dec-2022 |
Correspondence Address:
Bhimrao Meshram
Department of Kaumarabhritya, All India Institute of Ayurveda, New Delhi - 110 076
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/joa.joa_185_22
Introduction: Guillain-Barré syndrome (GBS) is an acute, postinfection, autoimmune polyneuropathy disease. GBS reveals a greater rapid and severe course, with common involvement of respiratory muscles and cranial nerves and a slightly autonomic nervous system. Main Clinical Findings: The female patient, an 8-year-old child, had been complaining of swaying while standing, inability to grasp, reduced strength in both upper and lower limbs, and inability to walk, stand or run quickly for 1 month. Diagnosis: She was diagnosed and treated for acute inflammatory demyelinating polyneuropathy (GBS). According to Ayurvedic classics, GBS can be correlated with Sarvanga Gata Vatavyadhi. Intervention: The principles of Vatavyadhi Chikitsa were used, i.e., Panchakarma procedures and internal medicines. Outcome: The patient showed remarkable recovery in the complaints, i.e., improvement in muscle power, strength, general condition, and daily activities. Conclusion: The Ayurveda intervention showed good clinical improvement. This further confirms the correlation between disease, the treatment principle adopted, and the procedures and drugs chosen for managing the GBS symptoms.
Keywords: Guillain-Barre syndrome, Sarvanga Gata Vatavyadhi, Shashtikashali Pinda Sweda, Shirotalam
How to cite this article:
Meshram B, Shrikrishna R, Mahapatra AK. Management of guillain-barre syndrome in a child through ayurveda intervention – A case study. J Ayurveda 2022;16:334-8 |
How to cite this URL:
Meshram B, Shrikrishna R, Mahapatra AK. Management of guillain-barre syndrome in a child through ayurveda intervention – A case study. J Ayurveda [serial online] 2022 [cited 2023 Feb 6];16:334-8. Available from: http://www.journayu.in/text.asp?2022/16/4/334/364041 |
| Introduction | |  |
Guillain-Barré syndrome (GBS) is an acute, postinfection, autoimmune polyneuropathy disease. GBS reveals a greater rapid and severe course, with the common involvement of respiratory muscles and cranial nerves and a slightly autonomic nervous system. This syndrome affects human beings of all ages.[1] The illness is mainly monophasic but about 7%–16% of sufferers may be afflicted by the recurrent episodes of worsening after an initial improvement.[2] The incidence of GBS is 1–2/100,000 population, it increases with age and males are 1.5 instances greater affected than females.[3] The prevalence is 2.7/100,000 in a year.[1] The prognosis of GBS is determined mainly by age (over 40 years of age may have a poorer outcome), preceding diarrhea and the severity of symptoms after 2 weeks shows poor prognosis.[4] As consistent with Ayurvedic classics, this condition can be correlated with Sarvangagata Vatavyadhi (Vata affecting all the parts of the body).[5] In Vatavyadhi, the predominance of Vata Dosha is the reason, and hence, the standards of Vatavyadhi Chikitsa are often utilized.[6]
| Case Report | | |
The female patient, an 8-year-old child, had been complaining of swaying during standing, unable to grasp things, decreased strength in bilateral upper limb and lower limbs, and inability to walk, stand or run fast for 1 month, she was treated for acute inflammatory demyelinating polyneuropathy (i.e., GBS) at V.M.M.C., Safdarjung Hospital, New Delhi, India, earlier and when no relief was found with the condition deteriorating parents of the child brought her to the outpatient department (OPD) Kaumarabhritya at All India Institute of Ayurveda, New Delhi on February 24, 2020. The patient was admitted to the indoor patient department (IPD - IPD No. 3960- February 24, 2020) for further evaluation and management. The patient did not have any history of diabetes, tuberculosis, or asthma, and there was no history of surgical procedures. There was no family history of allergy or drug abuse. The patient was apparently healthy before, on January 11, 2020, she developed a fever with pain and weakness in both lower limbs for which they consulted a local practitioner, took medication for 4 days, the fever subsided but weakness persisted further. After about 4 days, she gradually developed an imbalance in standing and walking, and running, the weakness spread to both the upper limbs and difficulty in grasping. On January 17, she was referred to the higher center and was admitted to V.M.M.C., Safdarjung Hospital, New Delhi, India, where she was diagnosed with a case of acute inflammatory demyelinating polyneuropathy (GBS). She was shifted to the pediatric intensive care unit and she was on intravenous immunoglobulin for 5 days keeping a possibility of GBS. She was shifted to the ward later and investigations such as lumber puncture were done on 18/01/2020 to look for albumin cytological association, the report which was within the normal limit. Electro-myelogram and nerve conduction velocity tests too were done on January 22, 2020. In the motor nerve conduction study (NCS), velocity decreased in the right median, ulnar, and tibial nerves; latency was normal in median, ulnar, and tibial nerves; and amplitude was decreased in the median and tibial nerves. In sensory NCS, is not recordable in the right ulnar nerve. Velocity and SNAP were decreased in the right median nerve, and latency was normal. Hence, the impression was demyelinating motor and sensory polyradiculoneuropathy consistent with GBS.
The patient was hemodynamically stable after 7 days of hospital stay; she was discharged from the hospital and advised to follow-up after 1 week. During the first follow-up aged 1 week, she was referred to the physical medicine department where medicines were given for 15 days with the advice of follow-up after 1 month. However, the condition of the patient was not improved. The medication received at OPD level for over a month period includes tablet gabapentine 100 (1 OD), syrup calcimax P (1 tsf BD), and syrup B complex (1 tsf BD).
| Examination on Admission | | |
Birth and developmental history
She was born as a full-term baby through normal vaginal delivery, cried soon after birth, and had a birth weight of 2.25 kg. There were no H/O seizures, jaundice, or other illness and all milestones of development were achieved normally according to age.
General examination
The patient had no fever and a pulse rate of 80/min. She was pale, malnourished, and underweight (18 kg).
Physical examination
Weakness was present in all extremities, more distal than proximal, and affecting the lower extremities more than the upper extremities with decreased muscle tone.
Systemic examination
Respiratory and cardiovascular systems were within the normal limits. The abdomen was soft, nontender, and without bloating.
Central nervous system examination
- Higher mental function: Normal
- Cranial nerves – Cranial nerve examination revealed normal functioning.
- Motor system
- Sensory nerves: Intact
- Cerebellar signs - nil
- Signs of meningeal irritation - nil.
 | Table 2: Improvement in deep-tendon reflex before, after, and follow-up treatment
Click here to view |
Diagnosis
The patient was diagnosed case of acute inflammatory demyelinating polyneuropathy (GBS) (at V.M.M.C., Safdarjung Hospital, New Delhi). Symptomatically, GBS can be related to a clinical condition Sarvangagata Vatavyadhi mentioned in the Ayurveda. Sarvangagata Vata presents a motor disorder that can affect individual limbs down to the whole body. Hence, the diagnosis was made as Sarvangagata Vatavyadhi due to the clinical presentation of symptoms.
Criteria for assessment
Assessment of patient improvement has been done using The Barthel Index Scale,[7] Modified Rankin Scale,[8] and GBS Disability Scale (Hughes scale).[9] The scales were assessed before treatment (0th day), after treatment (27th day), and follow-up period (189th day).
Interventions
GBS was treated in line with the pathological condition of Sarvangagata Vata. The following procedures were administered along with the Shamana Aushadhi [Table 3], [[Table 4], [Table 5].
Outcome
Symptoms improved before and after treatment. The patient was evaluated after each procedure and improvement noted [Table 2], [Table 6] and [Table 7]. | Table 7: Improvement in Barthel Index Scale, Modified Rankin Scale, Guillain-Barre Syndrome Disability Scale (Hughes scale)
Click here to view |
| Discussion | | |
In Ayurveda classics, one-to-one correlation of GBS is not possible, but symptomatically GBS can be relates to a clinical condition Sarvangagata Vatavyadhi mentioned in the Ayurveda. Sarvangagata Vata presents a motor disorder that can affect individual limbs down to the whole body. Hence, the diagnosis was made as Sarvangagata Vatavyadhi due to the clinical presentation of symptoms. The Ayurveda intervention showed effective in managing this case. Extensive follow-up showed that improvement was well sustained and patient continued follow-up even after complete remission of GBS symptoms.
Ayurveda interventions include Sarvanga Abhyanga (full body massage with medicated oil), Nadi Sweda (fomentation), Matra Basti (Medicated enema), Shastikashali Pinda Sweda (rubbing medicated rice poultice on the body), Shirotalam (applying medicines on the scalp), and internal medicines.
Udwartana procedure helps to improve blood as well as lymphatic circulation by opening the minute channels. Udwartana is KaphaVatahara and removes Aavarana.[10]
Sarvanga Abhyanga was done with Balaashwagandhadi Taila. Pressure applied during the procedure stimulates superficial mechanoreceptors or deep-tendon receptors which reduce the hyperexcitability of neurons.[11] Considering the vitiated Vata Dosha and Dhatukshaya (degeneration of body tissues), Vatahara and Balya Taila were selected for the Abhyanga. Due to Sweda (local fomentation), the vitiated Dosha gets liquefied and comes to the Koshtha (passage from where it can be easily removed).[12]
Matra Basti promotes strength, it performs the function of Brimhana and cures Vatavyadhi.[13] Matra Basti was given with Mahanarayana Taila which nourishes all the Dhatu in the body and acts as Balya, Brimhana, Rasayana, and empowers the nerves.[14]
Shastikashali Pinda Sweda helped opening the nerve conduction channels and promoted remyelination and helped transmit nerve impulses.[15]
Shirotalam procedure helped in improving the functions of the Uttamanga (brain) of the child.[16] Rasna Churna is the choice of drug in the treatment of Vatavikara.[17] Ksheerbala 101 Taila pacifies the vitiated Vata Dosha acting as a Snehana-Brimhnana.[18]
The Tab. Azaraqi, a proprietary medicine contains Shodhita Kupilu (purified Strychnos nux vomicose) 40 mg, Nirgundi Ghana (extract of Vitex negundo) 40 mg, Erandamoola (Ricinus communis) 40 mg, Shallaki (Boswellia serrata) 40 mg, Ashwagandha (Withania somnifera) 120 mg, Ekangaveera Rasa 40mg, Sameer Pannaga Rasa 40 mg, Mahavatavidhvamsa Rasa 40 mg, and Yograj Guggul 120 mg.
Ashwagandharishta - Ashwagandha has Rasayana (rejuvenate tonic), and Balya properties that helped strengthen and promote muscle tissue mass.[19]
Tab. Chitrakadi Vati was used as Deepana and Pachana. Agni is very essential for the process of metabolic transformation so all the Dhatu get nourished well.[20]
Triphala Churna is Rasayana with a balance and rejuvenation effect. Triphala Churna is high in Vitamin C and contains linoleic oil and other important nutrients, so it has a tonic effect.[21]
In conditions such as GBS which includes the sensory motor system, Ayurveda management showed very effective on the line of Vatavyadhi Chikitsa. Acharya Charaka has mentioned the management of Sarvangagata Vatavyadhi with Abhyanga, Anuvasana Basti is beneficial as it pacifies the vitiated Vata Dosha.[22] Hence, the treatment includes various Panchakarma procedures and internal medication showed complete recovery.
| Conclusion | | |
In the present study, the disease entity GBS is correlated with Sarvangagata Vatavyadhi and the line of treatment followed was Vata Vyadhi. The Ayurveda intervention showed good clinical improvement and also during the extended follow-up period. This further confirms the correlation between disease, the treatment principle adopted, and the procedures and drugs chosen for managing the GBS symptoms. The cost-effectiveness of Ayurvedic treatment seems promising, as immunoglobulin treatment is an expensive alternative. Ayurveda management has potency to treat such a disability condition such as GBS and improves the quality of life.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given her consent for images and other clinical information to be reported in the journal. The guardian understands that her names and initials will not be published and due efforts will be made to conceal the patient's identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet 2016;388:717-27.  |
| 2. | Ghai OP, Paul VK, Bagga A. Paediatrics. 9 th ed. New Delhi: CBS Publishers & Distributors Pvt Ltd.; 2019. p. 585. |
| 3. | Shrivastava M, Nehal S, Seema N. Guillain-Barre syndrome: Demographics, clinical profile & seasonal variation in a tertiary care centre of central India. Indian J Med Res 2017;145:203-8. [ PUBMED] [Full text] |
| 4. | van Doorn PA. Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS). Presse Med 2013;42:e193-201. |
| 5. | |
| 6. | |
| 7. | Collin C, Wade DT, Davies S, Horne V. The Barthel ADL index: A reliability study. Int Disabil Stud 1988;10:61-3. |
| 8. | van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-7. |
| 9. | Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet 1978;2:750-3. |
| 10. | Verma J, Srivastava P, Gopesh M, Garg G. Udvartana (Ayurveda powder massage): A review article. Int J Innov Sci Res Technol 2019;4:449-52. |
| 11. | Devendra K, Ojha N. Ayurvedic management of spastic cerebral palsy: A case study. Int J Res Ayurveda Pharm 2018;9:50-2. |
| 12. | |
| 13. | |
| 14. | Bhishagaratna Shri Bramha Shankar Mishra Shastri, Bhavaprakasha, Madhyakhanda, Vatavyadhiadhikara. Ch. 24., Ver 317-24. Varanasi: Chaukhamba Sanskrita Bhavan; 2018. p. 274-5. |
| 15. | Wajpeyi SM. Role of Ayurveda in the management of Guillain-Barré syndrome. Int J Ayurvedic Med 2019;9:288-92. |
| 16. | Shailaja U, Mangala Jyothsna GP. Ayurvedic management of spastic cerebral palsy: A case study. Int J Res Ayurveda Pharm 2020;11:1-4. |
| 17. | |
| 18. | |
| 19. | Singh N, Bhalla M, de Jager P, Gilca M. An overview on Ashwagandha: A Rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med 2011;8:208-13. |
| 20. | Mishra S. Bhaisajyaratnavali, Agnimandyadhirogadhikara. Ch. 10., Ver 22-4. Varanasi: Chaukhamba Surbharti Prakashan; 2019. p. 337-8. |
| 21. | Kumar NS, Nair AS, Nair AM, Murali M. Pharmacological and therapeutic effects of Triphala †A literature review. J Pharmacogn Phytochem 2016;5:23-7. |
| 22. | |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
|
Search Pubmed for