From the Guidelines
Beta blockers are not a standard treatment for Guillain-Barré Syndrome (GBS) but may be used to manage autonomic dysfunction, specifically to control heart rate elevations or blood pressure fluctuations, under close monitoring in an intensive care setting. The primary focus in managing GBS is on addressing the autoimmune process with treatments like intravenous immunoglobulin (IVIG) and plasma exchange (plasmapheresis) [ 1 ]. However, the involvement of the autonomic nervous system in GBS can lead to cardiac arrhythmias and blood pressure instability, contributing to mortality [ 1 ]. In such cases, the use of beta blockers, such as esmolol or metoprolol, can be considered to manage these complications.
Key points to consider in the use of beta blockers in GBS include:
- They are used to manage specific symptoms related to autonomic dysfunction, not as a standard treatment for GBS.
- The choice of beta blocker and dosing must be individualized based on the patient's condition and cardiovascular parameters.
- Close monitoring is essential due to the potential for beta blockers to worsen hypotension and bradycardia, which can also occur as part of GBS autonomic dysfunction.
- The management of GBS and its complications, including the use of beta blockers, should ideally occur in an intensive care setting due to the potential for rapid disease progression and the need for mechanical ventilation in about 20% of patients [ 1 ].
Given the complexity and variability of GBS presentations, and the potential for significant morbidity and mortality, the approach to managing autonomic dysfunction with beta blockers must be cautious and tailored to the individual patient's needs, always prioritizing their morbidity, mortality, and quality of life outcomes [ 1 ].
From the Research
Beta Blockers in Guillain-Barré Syndrome (GBS)
- Beta blockers are given in GBS to manage cardiovascular complications, particularly hypertension and tachycardia, which are common in patients with GBS 2, 3, 4, 5.
- The use of beta blockers in GBS is supported by studies that have shown their effectiveness in controlling hypertension and reducing the risk of cardiovascular complications 3, 4.
- In one study, propranolol therapy was successfully used to control hypertension in a child with GBS 3.
- Another study found that the majority of blood pressure treatments in children with GBS involved calcium channel and beta blockers 4.
- The management of cardiovascular complications, including the use of beta blockers, is important in GBS as these complications can affect functional outcomes 5.
Indications for Beta Blockers in GBS
- Hypertension: Beta blockers are used to control hypertension in GBS patients, which can be caused by sympathetic nervous system hyperactivity 2, 3, 4.
- Tachycardia: Beta blockers are also used to manage tachycardia, which is a common cardiovascular complication in GBS patients 2, 5.
- Autonomic dysfunction: Beta blockers may be used to manage autonomic dysfunction, which can manifest as labile hypertension, tachycardia, or bradycardia in GBS patients 2, 6, 5.