From the Guidelines
Autonomic dysfunction is a common and potentially life-threatening complication in Guillain-Barré Syndrome (GBS), affecting a significant proportion of patients, and close monitoring is essential.
Monitoring and Management
It is recommended to closely monitor patients with GBS for signs of autonomic dysfunction, such as fluctuations in blood pressure, heart rate variability, and bowel or bladder dysfunction 1.
- Monitoring should include electrocardiography and assessment of heart rate, blood pressure, and bowel and bladder function 1.
- Patients with GBS may require fluid management and vasoactive medications to maintain stable blood pressure.
- Additionally, medications such as midodrine and propranolol may be used to manage orthostatic hypotension and hypertension, respectively.
Complications and Supportive Care
It is also essential to monitor patients for other complications of autonomic dysfunction, such as cardiac arrhythmias, and to provide supportive care, including pain management and bowel and bladder care 1.
- The duration of autonomic dysfunction in GBS can vary, but it typically resolves within 2-6 weeks after the onset of symptoms.
- However, some patients may experience persistent autonomic dysfunction, requiring ongoing management and monitoring 1.
From the Research
Autonomic Dysfunction in Guillain-Barré Syndrome (GBS)
- Autonomic dysfunction occurs in approximately two-thirds of GBS patients in the acute phase of the disease 2
- Subclinical autonomic involvement may be present for 3-8 years after the GBS episode 2
- The frequency of autonomic dysfunction among patients with GBS was significant, with 41.53% of patients experiencing dysautonomia 3
- The most frequent autonomic manifestations were constipation and diarrhea, with 22% and 21.2% of patients experiencing these symptoms, respectively 3
Clinical Spectrum of Dysautonomia in GBS
- Dysautonomia in GBS can manifest as a range of symptoms, including ileus, hypertension, hypotension, fever, tachycardia or bradycardia, and urinary retention 4
- Quadriparesis, bulbar and neck flexor weakness, and mechanical ventilation were associated with autonomic dysfunction 4
- Patients with dysautonomia more commonly had cardiogenic complications, syndrome of inappropriate antidiuretic hormone, posterior reversible encephalopathy syndrome, and higher GBS disability score and Erasmus GBS Outcome Score (EGOS) 4
Relationship between Autonomic Dysfunction and Motor Recovery in GBS
- Severe dysautonomia is typically seen during the acute phase of GBS, but improves gradually with motor and disability recovery 5
- Autonomic parameters, such as heart rate variability and baroreflex sensitivity, were significantly poorer among GBS patients compared to healthy controls at admission, but normalized by 6 weeks 5
- The improvement in autonomic function was associated with significant improvements in motor and disability recovery over a period of 24 weeks 5