From the Guidelines
Guillain-Barré syndrome (GBS) should be treated with either intravenous immunoglobulin (IVIG) or plasma exchange (PLEX) as soon as possible, as these treatments are equally effective in improving outcomes when started within the first two weeks of symptom onset 1.
Diagnosis and Treatment
GBS is a rare autoimmune disorder where the body's immune system attacks the peripheral nerves, causing rapid-onset muscle weakness that can progress to paralysis. The diagnosis of GBS is based on the patient's history, neurological examination, electrophysiological studies, and cerebrospinal fluid (CSF) analysis 1.
- Key features of GBS include:
- Rapid-onset muscle weakness
- Ascending sensorimotor neuropathy
- Abnormal electrophysiological studies
- Increased protein level and normal cell count in CSF
Management
Treatment typically involves either IVIG at 0.4g/kg daily for 5 days or PLEX with 5 exchanges over 2 weeks, both of which are equally effective when started within the first two weeks of symptom onset 1.
- Supportive care is crucial, including:
- Respiratory monitoring as 25% of patients require mechanical ventilation
- Deep vein thrombosis prophylaxis
- Pain management with gabapentin or carbamazepine for neuropathic pain
- Physical therapy to prevent complications and aid recovery Most patients should be hospitalized for monitoring, especially during the progressive phase. GBS occurs when antibodies mistakenly target peripheral nerve components following an infection (commonly Campylobacter jejuni) or other immune trigger.
Prognosis
About 80% of patients recover fully, though recovery can take months to years, with approximately 20% experiencing long-term disability 1. Early recognition and treatment significantly improve outcomes.
- The prognosis of GBS can be predicted based on the severity of the disease, the presence of respiratory failure, and the response to treatment 1.
Long-term Management
Long-term management of GBS includes physical therapy, pain management, and monitoring for residual disability and complications. The goal of long-term management is to improve functional outcomes and quality of life for patients with GBS.
- The management of GBS should be individualized based on the patient's specific needs and circumstances, and should involve a multidisciplinary team of healthcare professionals 1.
From the Research
Treatment Options for Guillain-Barré Syndrome
- Intravenous immunoglobulin (IVIg) and plasma exchange (PE) are two common treatment options for Guillain-Barré syndrome (GBS) 2, 3, 4, 5, 6
- IVIg has been shown to be beneficial in hastening recovery and reducing long-term morbidity from GBS, especially when started within two weeks from onset 2
- PE has also been proven to be effective in treating GBS, with benefits seen in patients with mild, moderate, and severe disease 3, 4
Comparison of IVIg and PE
- A systematic review found that IVIg is equally efficacious as PE in improving primary and secondary outcomes in GBS patients 5
- IVIg may have a slight advantage over PE in reducing the need for mechanical ventilation and hospital stay duration 5
- However, PE may be more effective in improving secondary outcomes in children 5
Adverse Events and Cost-Effectiveness
- PE is associated with a slightly higher risk of adverse events and post-treatment worsening symptoms compared to IVIg 5
- IVIg is considered more user-friendly with a significantly lower patient discontinuation rate than PE 5
- IVIg treatment is found to be significantly more expensive than PE 5, 6
- A study found that adding PE to IVIg did not improve short-term outcomes, but increased cost and duration of hospitalization 6