From the Guidelines
The treatment of Guillain-Barré Syndrome (GBS) should primarily involve intravenous immunoglobulin (IVIg) at 0.4 g/kg body weight daily for 5 days, as it is the most effective and widely available treatment option. This recommendation is based on the most recent and highest quality study available, which found that IVIg and plasma exchange are equally effective treatments for GBS, but IVIg is generally easier to administer and has comparable risks of adverse events 1. The study also noted that plasma exchange can be considered as an alternative, but it is not more effective than IVIg alone and may have higher risks of discontinuation.
Some key points to consider in the treatment of GBS include:
- IVIg is the first-line treatment, with a recommended dose of 0.4 g/kg body weight daily for 5 days 1
- Plasma exchange can be considered as an alternative, but it is not more effective than IVIg alone and may have higher risks of discontinuation 1
- Corticosteroids are not recommended as they have not shown benefit in the treatment of GBS, and may even have a negative effect on outcome 1
- Supportive care is crucial and includes respiratory monitoring, prevention of complications, pain management, and physical therapy to maintain muscle strength and prevent contractures
It is also important to note that antimicrobial or antiviral treatment can be considered in patients with GBS who have an ongoing infection, but preceding infections have usually resolved before the onset of weakness 1. Additionally, early treatment significantly improves outcomes and reduces long-term complications, as these interventions work by removing or neutralizing the autoantibodies that attack peripheral nerves in GBS. Close monitoring in a hospital setting is essential, particularly during the progressive phase, as approximately 25% of patients may require mechanical ventilation due to respiratory muscle weakness.
From the Research
Treatment Options for Guillain-Barré Syndrome (GBS)
- Intravenous immunoglobulin (IVIg) and plasma exchange are the cornerstones of treatment for GBS, as they have been shown to hasten recovery and improve outcomes 2, 3, 4, 5.
- IVIg is beneficial in treating GBS, with moderate quality evidence suggesting that it started within two weeks from onset hastens recovery as much as plasma exchange 2.
- Plasma exchange has been shown to significantly hasten recovery compared with supportive treatment alone, and is often used in combination with IVIg 2, 5.
- The combination of plasma exchange followed by IVIg may provide extra benefit, but the evidence is not conclusive 2.
- Immunoabsorption followed by IVIg has not been shown to provide significant extra benefit compared with immunoabsorption alone 2.
- High-dose IVIg may be more effective than low-dose IVIg in children, but more research is needed to confirm this 2.
- Novel immunomodulatory therapies are being developed, including those that target IgG autoantibody catabolism and complement activation, which may provide more potent options for GBS patients who do not respond to IVIg or plasma exchange 6.
Administration and Monitoring of Treatment
- IVIg can be administered over two days or five days, with no significant difference in outcomes 2.
- Treatment response is currently monitored through interval neurological examination and outcome measures, with the potential role of fluid biomarkers being explored 5.
- Patients with GBS require qualified neurologic and supportive care, particularly those who require mechanical ventilation 4.
Future Directions
- More research is needed to develop novel and more potent treatments for GBS, particularly for patients who do not respond to IVIg or plasma exchange 3, 6.
- Incorporating neuroprotective interventions based on evolving understanding of mechanisms underlying nerve injury and axonal degeneration may be a future direction for treatment 6.