What is the rating scale for Guillain-Barré Syndrome (GBS) recovery?

From the Guidelines

The Guillain-Barré Syndrome (GBS) recovery is typically measured using the GBS Disability Scale, which ranges from 0 to 6, as it is a widely used tool for documenting GBS disease course 1. The GBS Disability Scale is used to assess the level of disability in patients with GBS, with a score of 0 indicating normal functioning, 1 meaning minor symptoms with ability to run, 2 representing ability to walk independently but not run, 3 indicating ability to walk with assistance, 4 means bed or chair bound, 5 represents requiring mechanical ventilation, and 6 is death. Some key points to consider when using this scale include:

• Recovery from GBS varies significantly between individuals, with approximately 80% of patients regaining independent walking within 6 months 1.
• The recovery process generally occurs in reverse order of symptom onset, with the last affected muscles being the first to recover.
• Complete recovery takes anywhere from a few weeks to several years, with about 60-80% of patients achieving full recovery within 12 months.
• However, 20-30% of patients may experience residual weakness, and 3-5% may suffer relapses.
• Treatment during recovery typically includes physical therapy, occupational therapy, and sometimes speech therapy, focusing on muscle strengthening, coordination, and functional activities. Regular assessments using the GBS Disability Scale help healthcare providers track progress and adjust rehabilitation strategies accordingly, which is crucial for improving patient outcomes and reducing morbidity and mortality 1.

From the Research

Rating Scales for Guillain-Barré Syndrome Recovery

• The GBS disability scale (GDS) is a commonly used ability outcome measure in Guillain-Barré syndrome (GBS) 2.
• The inflammatory Rasch-built overall disability (I-RODS) scale has been suggested as an alternative to the GDS, particularly for use in inflammatory polyneuropathies 2.
• A study comparing the responsiveness of the GDS and I-RODS scales found that the GDS was more responsive in the acute phase of GBS, while the I-RODS scale was more useful for longer follow-up periods 2.

Development of a Rating Scale for GBS Severity

• A rating scale for the severity of Guillain-Barré syndrome was developed using the Delphi method and tested on 258 patients 3.
• The scale consists of 10 items and assesses motor function, cranial nerve function, and autonomic function 3.
• The scale has been shown to have good reliability and validity, with a Cronbach's α coefficient of 0.852 3.

Outcome Measures for GBS Recovery

• The Hughes Functional Grading score is a commonly used outcome measure for GBS recovery, with scores ranging from 0 (full recovery) to 6 (death) 4.
• A study of patients with GBS who required intensive care unit (ICU) admission found that the median Hughes score was higher in patients who received mechanical ventilation (MV) compared to those who did not 4.
• The study also found that patients who received MV had longer ICU and hospital stays, and were more likely to experience complications such as venous thromboembolism and gastrointestinal bleeding 4.

Treatment Outcomes for GBS

• Intravenous immunoglobulin (IVIg) and plasma exchange (PE) are the primary treatments for GBS, with IVIg shown to hasten recovery as much as PE in severe disease 5.
• A study comparing the efficacy of IVIg and PE found that there were no statistically significant differences in outcome measures between the two treatments 5.
• The use of IVIg after PE did not confer significant extra benefit, although more research is needed to determine the optimal treatment strategy for GBS 5, 6.