From the Guidelines
The management of Guillain-Barré Syndrome (GBS) should primarily involve immunotherapy with intravenous immunoglobulin (IVIG) at a dose of 0.4 g/kg body weight daily for 5 consecutive days, as it is the most effective and widely available treatment option. This approach is supported by the most recent and highest quality study, which found that IVIG and plasma exchange are equally effective in treating GBS, but IVIG is generally easier to administer and more widely available 1.
Key Considerations in GBS Management
- Immunotherapy: IVIG is the preferred treatment option, but plasma exchange can be used as an alternative, typically 5 sessions over 1-2 weeks.
- Supportive care: close monitoring of respiratory function, pain management, and prevention of complications such as deep vein thrombosis and pressure ulcers are crucial.
- Rehabilitation: early initiation of physical and occupational therapy is important for maintaining muscle strength and preventing contractures, and should continue after discharge.
The rationale behind immunotherapy is to modulate the immune response, either by providing antibodies (IVIG) that interfere with the pathogenic process or by removing harmful antibodies (plasma exchange) 1. Supportive care addresses the consequences of nerve damage and prevents secondary complications, allowing the body time to recover and regenerate damaged nerve fibers. It is also important to note that corticosteroids have not been shown to be effective in treating GBS, and may even have a negative effect on outcome 1.
Additional Considerations
- Respiratory function should be monitored closely, as respiratory failure can occur without symptoms of dyspnea 1.
- Clinical improvement is usually most extensive in the first year after disease onset and can continue for more than 5 years 1.
- The incidence of GBS can increase during outbreaks of infectious illnesses that trigger the disease, highlighting the need for globally applicable guidelines for diagnosis and management 1.
From the Research
Management of Guillain-Barré Syndrome (GBS)
The management of GBS involves a combination of supportive care, immunotherapies, and complication management. The main treatment options include:
- Intravenous immunoglobulin (IVIg) 2, 3, 4, 5
- Plasma exchange (PE) 2, 3, 5
- Mechanical ventilation and intensive care for severe cases 2
- Supportive care, including multidisciplinary care and management of complications 2, 6
Immunotherapies
IVIg and PE are considered the most effective treatments for GBS. Studies have shown that IVIg is at least as effective as PE in hastening recovery and reducing long-term morbidity 3, 5. The efficacy of IVIg has been demonstrated mainly in adults with a typical and severe form of GBS, but it is also effective and safe in pediatric patients 3, 5.
Treatment Dilemmas
Treatment dilemmas may occur in patients with a relatively mild presentation, variant forms of GBS, or when the onset of weakness was more than 2 weeks ago 6. Other therapeutic dilemmas may arise in patients who do not improve or even progress after initial treatment. In these situations, the use of additional IVIg or other intensified treatments may be considered 4, 6.
Emerging Therapies
New developments in the management of GBS include the use of complement inhibition combined with IVIg, which may improve outcomes in GBS patients 4. Additionally, nerve ultrasound and MRI are potentially useful techniques to diagnose inflammatory neuropathies, and prognostic models may guide the selection of patients with a relatively poor prognosis who may benefit from additional treatment 4.