Treatment Outcomes for GBS Patients at 2 Weeks After Onset
At 2 weeks after symptom onset, most GBS patients are at or approaching their maximum disability (nadir), as patients typically reach peak weakness within 2 weeks, making this the critical window for immunotherapy initiation rather than a time when treatment outcomes can be fully assessed. 1
Disease Trajectory at 2 Weeks
The 2-week mark represents the typical nadir phase, not the recovery phase. Most GBS patients reach maximum disability within 2 weeks of onset, meaning they are at their worst or still progressing at this timepoint. 1, 2
Approximately 20% of patients will have developed respiratory failure requiring mechanical ventilation by this stage, regardless of treatment. 3, 2
The plateau phase (period of maximum disability) lasts from days to weeks or months before recovery begins, so patients at 2 weeks are typically still in or just entering this plateau. 2
Expected Treatment Response at 2 Weeks
Clinical improvement typically begins within days to weeks after treatment completion, but 40% of patients show no improvement in the first 4 weeks following standard IVIg or plasma exchange. 1, 3
This lack of early improvement does not indicate treatment failure—progression might have been worse without therapy. 1
The treatment effect is not permanent; it provides acute immunomodulatory benefit during the active inflammatory phase, but the underlying immune response can continue. 2
Critical Pitfall to Avoid
Do not expect dramatic recovery at 2 weeks post-onset. The 2-week timepoint is when most patients are at their worst, not when they show significant improvement. Treatment initiated within this window modifies disease severity and accelerates eventual recovery, but the visible benefits typically manifest later in the disease course. 1, 2
Treatment-Related Fluctuations
6-10% of patients will experience treatment-related fluctuations (TRFs) within 2 months following initial treatment-induced improvement, indicating the treatment effect has worn off while inflammation continues. 1, 3, 2
TRFs must be distinguished from insufficient initial response (the 40% who don't improve in first 4 weeks). 1, 3
Long-Term Outcome Expectations
About 80% of GBS patients regain the ability to walk independently at 6 months after disease onset, which is the more meaningful outcome timepoint than 2 weeks. 1, 3, 4
Recovery is most extensive in the first year but can continue for more than 5 years after disease onset. 1, 2
Mortality occurs in 3-10% of cases, most commonly from cardiovascular and respiratory complications that can occur in both acute and recovery phases. 1, 3, 4
Prognostic Assessment at 2 Weeks
Use the modified Erasmus GBS Outcome Score (mEGOS) at admission to calculate the probability of regaining walking ability in individual patients. 1, 5
Use the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess risk of requiring artificial ventilation. 5
Risk factors for poor outcome include advanced age and severe disease at onset. 1
Monitoring Requirements at 2 Weeks
Continue respiratory function assessment using the "20/30/40 rule": patient is at risk of respiratory failure if vital capacity <20 ml/kg, maximum inspiratory pressure <30 cmH₂O, or maximum expiratory pressure <40 cmH₂O. 3, 4
Monitor for autonomic dysfunction via electrocardiography, heart rate, blood pressure, and bowel/bladder function. 3
Assess for pain (muscular, radicular, or neuropathic), which is frequently reported and requires early management. 1, 3