Resident Physician, Department of Physical Medicine and Rehabilitation Buddhist Tzu Chi Medical Foundation Hualien Tzu Chi Hospital Hualien City, Hualien, Taiwan (Republic of China)
Case Diagnosis: Acute motor and sensory axonal neuropathy (AMSAN), status post plasmapheresis and IVIG, with tetraparesis, dysphagia and autonomic dysfunction
Case Description: A 68-year-old woman with type 2 diabetes mellitus, dyslipidemia, and a prior left internal capsule infarction was admitted for diarrhea and fever and treated with antibiotics. On day 10, she developed sudden generalized weakness and dysphagia. Cerebrospinal fluid analysis revealed albuminocytologic dissociation, and nerve conduction studies confirmed axonal sensorimotor polyneuropathy. Plasmapheresis was initiated but discontinued after cardiac arrest; due to hemodynamic instability and worsening weakness, IVIG was arranged and completed. The Modified Erasmus GBS Outcome Score (EGOS) at admission was 9. Following multidisciplinary rehabilitation—including physical, occupational, and speech therapy, as well as respiratory training—Foley catheter and supplemental oxygen were discontinued at one month. The nasogastric tube was removed at two months after traditional swallowing therapy combined with neuromuscular electrical stimulation (NMES). At three months, nerve conduction studies demonstrated substantial motor recovery but incomplete or absent sensory recovery. By five months, the patient was able to ambulate with a walker.
Discussions: Comprehensive rehabilitation significantly enhanced muscle strength, balance, and independence in activities of daily living for this AMSAN patient. Traditional swallowing therapy combined with NMES appeared beneficial for dysphagia recovery, supporting its potential role in multidisciplinary care. These findings align with current evidence emphasizing early, structured physiotherapy and adjunctive interventions to optimize functional outcomes. However, further research, including randomized controlled trials, is needed to validate these approaches and establish standardized protocols for AMSAN rehabilitation.
Conclusions: Employing multidisciplinary rehabilitation improved the patient’s overall functional capacity among AMSAN patients.
