Factors to consider in the treatment of a young patient with Acute Motor Axonal Neuropathy type Guillain Barre Syndrome: A case report

Case Diagnosis: 28 year old male with Acute Motor Axonal Neuropathy (AMAN) received holistic care on inpatient rehabilitation to optimize his recovery and functionality.

Case Description or Program Description: 28 year old male with Acute Motor Axonal Neuropathy (AMAN), a rare, pure motor subtype of Guillain Barre Syndrome (GBS). The patient initially presented with acute onset distal to proximal progressing weakness. His GBS rapidly progressed to respiratory failure requiring mechanical ventilation. He underwent multiple courses of IVIG and plasma exchange. He was weaned off the ventilator to independent respiration and sent to acute rehabilitation for severe bilateral upper and lower extremity weakness, orthostasis, and enteric dysmotility. Patient had notable motor weakness in all extremities but overall preserved sensory function with voluntary anal sensation and contraction: a C4 ASIA C. Rehab goals focused on core strengthening and upper extremity functional tasks with assistive devices. After 2 months of inpatient rehabilitation, patient had improvements in strength return, supervised sitting duration, and ambulation with assistance.

Setting: Inpatient rehabilitation

Assessment/Results: AMAN makes up less than 5% of GBS cases and severe cases must be treated in a holistic manner for optimal functional recovery.

Discussion (relevance): Like other more common forms of GBS, the AMAN subtype usually involves all 4 limbs and can affect cranial nerves and respiration in more severe cases. Since this patient was previously young and healthy, interdisciplinary care was crucial to improve this patient's quality of life. Therapies provided strength and functional task training. Neuropsychology helped the patient adjust and set new goals. Recreation therapy introduced the patient back into the community in a controlled setting to analyze barriers that the patient must learn to maneuver. The work of several teams together on the rehab unit allowed this patient confidence and capability post discharge.

Conclusions: Holistic care of patients with rare subtypes of GBS is vital for optimum recovery.