From the Guidelines
Intravenous immunoglobulin (IVIG) at 0.4 g/kg daily for 5 consecutive days is the recommended treatment for Guillain-Barré Syndrome (GBS), as it is equally effective as plasma exchange and easier to administer 1.
Treatment Options
The primary treatments for GBS include IVIG and plasma exchange (plasmapheresis).
- IVIG is typically administered at 0.4 g/kg daily for 5 consecutive days
- Plasma exchange involves 5 exchanges over 1-2 weeks, with 200–250 ml plasma/kg body weight in five sessions 1. These treatments are most effective when started within the first two weeks of symptom onset.
Supportive Care
Supportive care is equally important, including:
- Respiratory monitoring (as 25% of patients require mechanical ventilation)
- Physical therapy to prevent complications of immobility
- Pain management with medications like gabapentin (300-1200 mg three times daily) or carbamazepine (200-400 mg twice daily)
- Prevention of deep vein thrombosis with compression stockings and anticoagulants.
Corticosteroids
Corticosteroids are not recommended as they have not shown benefit in the treatment of GBS, with eight randomized controlled trials showing no significant benefit, and treatment with oral corticosteroids even showing a negative effect on outcome 1.
Recent Developments
Recent studies have explored the use of small-volume plasma exchange (SVPE) as a low-cost and effective treatment strategy for GBS in low-income and middle-income countries (LMIC) 1. However, the efficacy of SVPE has only been shown in a small number of patients, and large-scale studies are required before this technique can be implemented in routine clinical practice. Complement inhibitors, such as eculizumab, are also being studied as a potential treatment for GBS in high-income countries (HIC) 1.
Outcome
Most patients recover from GBS, though recovery can take months to years, with about 80% walking independently by 6 months. Close monitoring in a hospital setting is essential during the acute phase to manage potential respiratory failure and autonomic dysfunction. IVIG remains the first choice of treatment due to its ease of administration, wide availability, and reduced frequency of adverse effects compared with plasma exchange 1.
From the Research
Treatment Options for Guillain-Barré Syndrome
- Intravenous immunoglobulin (IVIg) is beneficial in treating Guillain-Barré syndrome (GBS), as shown in studies 2, 3, 4, 5.
- Plasma exchange (PE) is also an effective treatment for GBS, and its efficacy is comparable to IVIg 2, 3, 4.
- The combination of PE and IVIg may not provide significant extra benefit compared to PE alone 2, 3, 4.
- IVIg is more likely to be completed than PE, and it has a trend towards more improvement with high-dose compared to low-dose IVIg in children 2, 3, 4.
- Corticosteroids alone are ineffective in treating GBS 4.
Efficacy of IVIg in Different Patient Groups
- In severe disease, IVIg started within two weeks from onset hastens recovery as much as PE 2, 3, 4.
- In children, IVIg probably hastens recovery compared to supportive care alone, according to low-quality evidence 2, 3, 4.
- More research is needed in mild disease and in patients whose treatment starts more than two weeks after onset 2, 3, 4.