What is the level and grading of Guillain-Barré Syndrome (GBS)?

From the Guidelines

Guillain-Barré Syndrome (GBS) is typically graded using a system that categorizes the severity of the disease, with the most recent and highest quality evidence suggesting a grading system based on the level of interference with daily activities and symptoms concerning to the patient, as outlined in the 2021 ASCO guideline update 1. The grading system for GBS is as follows:

• G2: Moderate, with some interference with activities of daily living (ADLs) and symptoms concerning to the patient
• G3-4: Severe, with limiting self-care and aids warranted, weakness limiting walking, or respiratory problems This grading system is crucial in determining the management and treatment of GBS, with more severe grades requiring more aggressive interventions, such as intravenous immunoglobulin (IVIG) or plasmapheresis, and supportive care, including respiratory monitoring and pain management 1. The treatment of GBS should be guided by the severity of the disease, with IVIG at 2g/kg divided over 5 days or plasma exchange (PLEX) with 5 exchanges over 2 weeks being equally effective first-line therapies for moderate to severe GBS 1. It is essential to note that the outcome of GBS can be predicted using the modified Erasmus GBS outcome score (mEGOS) prognostic tool, with most patients showing extensive recovery, especially in the first year after disease onset, and about 80% of patients regaining the ability to walk independently at 6 months after disease onset 1. However, death can occur in 3-10% of cases, most commonly due to cardiovascular and respiratory complications, and long-term residual complaints, such as neuropathic pain, weakness, and fatigue, are common 1. In terms of management, the 2021 ASCO guideline update recommends discontinuing immune checkpoint inhibitor therapy in patients with GBS, with severe cases requiring admission to an inpatient unit with capability of rapid transfer to ICU-level monitoring, and initiation of IVIG or plasmapheresis 1.

From the Research

Level and Grading of Guillain-Barré Syndrome (GBS)

The level and grading of Guillain-Barré Syndrome (GBS) can be assessed using various scales, including:

• Hughes Functional Grading Scale (HFGS) 2, 3
• Modified Erasmus GBS outcome score (mEGOS) 4
• Modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) 4, 3
• Expanded Grading Scale (EGS) for GBS 5
• Medical Research Council (MRC) scale for muscle strength 3
• Modified Barthel Index (MBI) 5

Key Factors in Grading GBS

Some key factors to consider when grading GBS include:

• Severity of weakness and sensory disturbances
• Presence of cranial nerve involvement, respiratory insufficiency, autonomic dysfunction, and pain
• Need for mechanical ventilation
• Presence of autonomic dysfunction, bulbar palsy, and sensory impairment
• High neutrophil-lymphocyte ratios (NLR) and high systemic immune-inflammation index (SII) values 3

Prognostic Indicators

Prognostic indicators for GBS include:

• Lowest total MRC scale for muscle strength score at admission 3
• High mEGRIS score 3
• High EGS score at nadir 5
• Tetraparesis, respiratory involvement, urinary retention, and the need for nasogastric enteral feeding 5