From the Guidelines
Intravenous immunoglobulin (IVIG) at 0.4 g/kg/day for 5 days is the recommended treatment for Guillain-Barré syndrome (GBS) due to its ease of administration, wide availability, and reduced frequency of adverse effects compared to plasma exchange. Management of GBS requires prompt initiation of immunotherapy and supportive care, with the goal of reducing morbidity, mortality, and improving quality of life. According to the most recent and highest quality study 1, IVIG and plasma exchange are equally effective treatments for GBS, but IVIG is often preferred due to its convenience and fewer complications.
Key Considerations
- Patients require close monitoring for respiratory compromise with regular vital capacity measurements; intubation should be considered if vital capacity falls below 15-20 mL/kg or if there are signs of respiratory distress.
- Autonomic dysfunction may require blood pressure management and cardiac monitoring.
- Deep vein thrombosis prophylaxis, pain control with gabapentin (300-1200 mg three times daily) or carbamazepine (200-400 mg twice daily), and early rehabilitation are essential components of care.
- Corticosteroids are not recommended as they show no benefit and may worsen outcomes, as evident from eight randomized controlled trials 1.
- Approximately 80% of patients recover well, though recovery can take months to years, with about 20% experiencing significant residual disability.
Treatment Challenges in Low-Income and Middle-Income Countries
In low-income and middle-income countries, the high cost of IVIG and plasma exchange poses a significant challenge, with only a small percentage of patients able to afford these treatments 1. Small volume plasma exchange (SVPE) is a novel, relatively low-cost technique that has been shown to be safe and feasible in resource-limited settings, but large-scale studies are required to establish its efficacy. Complement inhibitors, such as eculizumab, are being studied in high-income countries, but their availability and affordability in low-income and middle-income countries are uncertain.
From the Research
Management of Guillain-Barré Syndrome
- The management of Guillain-Barré syndrome (GBS) involves intensive care and treatment, including immunotherapies, mechanical ventilation, supportive care, and complication management 2.
- Current immunotherapies include intravenous immunoglobulin (IVIg) and plasma exchange (PE), which have been shown to benefit patients by alleviating hyperreactive immune responses 2, 3.
- The choice between IVIg and PE is still a topic of debate, with some studies suggesting that IVIg may be more effective in certain cases 4, while others have found no significant difference between the two treatments 5.
Treatment Options
- IVIg and PE are the cornerstones of treatment for GBS, with both treatments producing significant improvement in clinical rating scales 4.
- The long-term outcomes of IVIg and PE have been shown to be equivalent, although the effect size may indicate a slight superiority of IVIg 4.
- Novel potential therapies for GBS are being explored, including complement inhibition combined with IVIg, but none have yet modified clinical practice 3, 6.
Intensive Care and Supportive Care
- Up to 30% of patients with GBS develop respiratory failure and require mechanical ventilation and intensive care 2.
- Supportive care, including multidisciplinary care and complication management, is crucial for patients with severe GBS 2.
- The importance of intensive care and treatment, other than mechanical ventilation, in patients with severe GBS cannot be overstated 2.
Diagnosis and Prognosis
- The diagnosis of GBS relies on clinical features, supported by laboratory findings and electrophysiology 6.
- Prognostic models could guide the selection of patients with a relatively poor prognosis who may benefit from additional IVIg or intensified treatment 3.
- New diagnostic tools, such as nerve ultrasound and MRI, may help with early and accurate diagnosis in difficult GBS cases 3.