From the Guidelines
The immediate treatment for Guillain-Barré Syndrome (GBS) should be intravenous immunoglobulin (IVIG) at 0.4 g/kg daily for 5 consecutive days, as it is the most effective and widely available treatment option, according to the most recent and highest quality study 1.
Treatment Overview
The treatment of GBS involves immunomodulatory therapies, with IVIG and plasma exchange being equally effective options. However, IVIG is generally preferred due to its ease of administration and wider availability.
- IVIG is typically administered at 0.4 g/kg daily for 5 consecutive days.
- Plasma exchange involves 5 exchanges over 1-2 weeks, but it is less commonly used due to its higher cost and complexity.
Supportive Care
In addition to immunomodulatory therapy, supportive care is crucial in managing GBS patients. This includes:
- Close monitoring for respiratory compromise, with frequent vital capacity measurements and preparation for mechanical ventilation if breathing deteriorates.
- Cardiac monitoring due to potential autonomic dysfunction.
- Deep vein thrombosis prophylaxis.
- Pain management with gabapentin or carbamazepine for neuropathic pain.
- Physical therapy to prevent complications of immobility.
Corticosteroids and Other Treatments
Corticosteroids are not recommended for GBS treatment, as they have not shown benefit and may worsen outcomes, as noted in a study published in 2019 1. Other treatments, such as complement inhibitors, are being studied but are not yet widely available or recommended for routine use.
Treatment Setting
Treatment should be initiated in a hospital setting where respiratory and cardiac support are readily available, as approximately 25% of GBS patients will require mechanical ventilation during the course of their illness.
From the Research
Immediate Treatment for Guillain-Barré Syndrome (GBS)
The immediate treatment for a patient diagnosed with Guillain-Barré Syndrome (GBS) includes:
- Intravenous immunoglobulin (IVIg) therapy, which is equally effective as plasma exchange (PE) in improving recovery time in GBS patients 2, 3, 4, 5
- Plasma exchange (PE), which was the first treatment proven to be superior to supportive treatment alone and is still used today, especially in cases with axonal involvement or refractory cases 2, 6, 5
- Both IVIg and PE are effective in GBS, but steroids alone are ineffective 2
Treatment Considerations
- IVIg is usually the preferred treatment due to practical reasons, but PE should be considered early in GBS cases with axonal involvement or in recurrent or familial GBS forms 2, 6
- Patients with severe GBS may benefit from PE after IVIg treatment in refractory cases 6
- The choice between IVIg and PE may depend on the individual patient's condition and the availability of treatment options 5
Treatment Outcomes
- Studies have shown that IVIg and PE have similar curative effects in treating GBS patients with severe symptoms 5
- The length of hospitalization and duration of mechanical ventilation were found to be insignificant between the IVIg and PE groups 5
- The risk of GBS relapse and complications related to treatment regimens were also found to be similar between the two groups 5