From the Guidelines
Guillain-Barré syndrome (GBS) should be treated with intravenous immunoglobulin (0.4 g/kg for 5 days) or plasma exchange (usually five sessions at 200–250 ml/kg) as soon as possible, as these are proven and equally effective treatments for GBS 1.
Treatment Overview
The management of GBS requires a multidisciplinary approach, including supportive medical care and immunotherapy.
- Intravenous immunoglobulin is considered the first choice of treatment as it is easy to administer, widely available, and associated with a reduced frequency of adverse effects compared with plasma exchange 1.
- Plasma exchange is less costly than intravenous immunoglobulin and could theoretically be a preferred treatment option for GBS in low-income and middle-income countries (LMIC) 1.
Outcome and Prognosis
The mortality rate for GBS is 2–10% worldwide, although disparities are evident between regions, with higher mortality rates reported in LMIC 1.
- Admission to the ICU is recommended for patients with GBS who have imminent respiratory insufficiency, severe autonomic dysfunction, or rapidly progressive weakness 1.
- The Erasmus GBS Respiratory Insufficiency Score (EGRIS) and the Erasmus GBS Outcome Score (EGOS) can be used to predict the risk of requiring mechanical ventilation and outcomes in patients with GBS, although these tools may need to be validated or adapted for use in LMIC 1.
Supportive Care
Supportive care is crucial, including:
- Respiratory monitoring
- Prevention of complications like blood clots and pressure ulcers
- Pain management with gabapentin or carbamazepine
- Physical therapy to prevent contractures and maintain muscle strength 1.
Special Considerations
In LMIC, the lack of access to ICU services, immunotherapy, and integrative rehabilitation services can adversely affect recovery and long-term quality of life of patients with GBS 1.
- Small volume plasma exchange (SVPE) is a novel, relatively low-cost technique that has been shown to be a safe and feasible treatment for GBS in resource-limited settings, although large-scale studies are required to confirm its efficacy 1.
From the Research
Definition and Symptoms of Guillain-Barré Syndrome
- Guillain-Barré syndrome (GBS) is a neuropathic condition that leads to the rapid development of impairments and is characterized by weakness and numbness or tingling sensation in the legs and arms and sometimes loss of movement and feeling in the legs, arms, upper body, and face 2.
- It is a potentially devastating yet treatable disorder, and is the leading global cause of acquired neuromuscular paralysis 3.
- The most common symptoms include ascending limb weakness and paralysis, which may progress to respiratory failure 4.
Treatment Options for Guillain-Barré Syndrome
- Currently, the cure for the disease is yet to be developed, however, treatment options such as intravenous immunoglobulin (IVIG) and plasma exchange (PE) have been used to minimize the symptoms and duration of the disease 2.
- Plasma exchange removes antibodies and other potentially injurious factors from the blood stream, and has been proven to be superior to supportive treatment alone in GBS 5.
- IVIG is beneficial in hastening recovery and reducing the long-term morbidity from GBS, and has been shown to be as effective as PE in severe disease 6.
- The choice between IVIG and PE may depend on the individual patient's needs and circumstances, as IVIG seems easier to use and may be preferred for treating GBS 2.
Efficacy of Treatment Options
- A systematic review and meta-analysis found no significant difference in the curative effect between IVIG and PE in treating GBS patients with severe symptoms 2.
- Another study found that plasma exchange was beneficial in patients with mild, moderate and severe GBS, and that it was more beneficial when started within seven days after disease onset 5.
- A Cochrane review found that IVIG started within two weeks from onset hastens recovery as much as PE, and that adverse events were not significantly more frequent with either treatment 6.